Kirk Barber, MD, FRCPC

The photos presented this month reveal disease entities I have seen that did not respond to conventional therapy and that became resistant "diaper rashes." You may have seen some of these "bottoms" in previous issues of Consultant For Pediatricians. Next to each photograph, I have given several clues to the diagnosis. See if you can match these clues with the diagnostic choices listed below. You can check to see whether your diagnostic choices are correct on page 61.

The mother of this school-aged girl is concerned that her child has a fungal infection in her fingernails and that the nails are destroyed forever. Your examination reveals that all 20 of her nail plates are affected similarly.

A 13-year-old girl comes to your office in tears. Her mother wants to cut off her hair.

This skin condition is present at birth and usually has significant systemic manifestations. Would you be able to identify it in the nursery?

The diagnostic test is a Wood light examination. An example of another child with these lesions as they appear under Wood light is shown in Figure B. The Wood light is ultraviolet; it exploits the fact that melanin will preferentially absorb the light and appear darker. Those areas that contain less melanin thus will be highlighted.

This 6-year-old child was brought to the emergency department by her parents after these blisters suddenly appeared on her skin. She otherwise appeared to be well and was not febrile.

This infant was brought to the emergency department after a week-long exacerbation of her atopic eczema. She had not received any therapy for her eczema or for these erosions.

This young girl is brought to your office with a rash that her mother thinks is triggered by sunlight. The mother is concerned because her own aunt has lupus erythematosus. The mother also reports that several children at her daughter's school have a similar eruption.

A 9-year-old girl presented with these lesions on her face and extremities. The lesions, which had developed within the past 24 hours, were warm to the touch and only mildly pruritic. The child feels unwell with nonspecific complaints of malaise and lack of energy. Before this eruption, she had been healthy and had not been taking any medications.

This adolescent girl presents with painful purple papules that have developed on her toes. These papules are making it impossible for her to wear her "fashion" shoes to school in the late fall and early winter. She reports that her feet have been cold for as long as she can remember and that she is not bothered by it. She is otherwise healthy, takes no medications, and does not smoke.

Each of the 21 photographs on the following 4 pages was featured in Dermclinic during the past year. How many of these disorders do you recall?

This 12-month-old infant comes to your office with an asymptomatic eruption of sudden onset that involves the arms and legs. The child has a mild fever.

This 3-year-old girl presented with red tender skin, irritability, and fever. Her mother says that the rash began in her axilla and rapidly spread to involve all of her skin.