Dermatology

We know you love a diagnostic challenge. Can you crack these 6 puzzling cases?

The parents of a healthy 5-month-old boy bring him to the office for evaluation of an enlarging yellowish nodule on the back of his right thigh. It started as a pink macule several months ago and became yellow and lumpy over the last month. The infant was born at term and has grown and developed normally. His parents deny any trauma, but report occasional bleeding from the surface of the nodule. They deny any new medications or outdoor exposures. There is no history of new topical skin products.

Eczema affects around 11% of children overall, but only about half of minority children with severe eczema are treated for the condition. A new study looks at why these children are overlooked.

For Contemporary Pediatrics, Dr Bobby Lazzara discusses a large retrospective cohort study published in the Journal of the American Academy of Dermatology that examined whether children with pediatric psoriasis are at increased risk of cancer and discusses 2 caveats to the findings.

A 16-year-old girl presents for evaluation of an asymptomatic brown rash over her central chest and back that developed over the preceding 6 months. She is embarrassed by the appearance.

The mother of a healthy 11-year-old boy brings him to the office for help to clear a rash that has persisted around his mouth for 3 months. Although the boy rarely licks his lips, he does not use lip products and has not changed his dental products.

The mother of a healthy 5-year-old girl brings her to the office for evaluation of 2 itchy plaques on her right ankle that have worsened over the last 10 days despite treatment for possible tinea corporis with topical clotrimazole 1% ointment and hydrocortisone 2.5% ointment. A fungal culture is pending.

A healthy 9-year-old female presents with a 1-day history of fever, progressive rash, conjunctivitis, and superficial oral ulcers.

A father brings his 8-year-old son to the office for evaluation of new, asymptomatic blue bumps that have appeared on the boy’s chest over the last several months (Figure). The dad notes that he has had similar lesions as well.

You are asked to evaluate a healthy 9-year-old girl with an itchy rash on her face, neck, and hands for a week. She had a similar eruption 1 month ago that resolved over several days. Although she has a history of poison ivy, her parents knew of no exposure. There was no history of new topical skin products. However, she had begun to eat more seasonal fruits recently, including strawberries, grapes, and mangos.

A healthy newborn girl returns for a follow-up visit at age 7 days, and she is exhibiting multiple disseminated red macules and papules of varying sizes. While in the nursery, several red blanching macules had been noted on her trunk at age 2 days.

A preoperative evaluation is requested for a 15-year-old boy who is a renal transplant patient maintained on oral mycophenolate mofetil and tacrolimus. His parents are worried that an itchy rash on his hands and feet, which has been progressing over the last 4 months, will result in postponement of his surgery.

A healthy 12-year-old boy with eczema shows up at the office with an incredibly itchy rash on his legs that has exploded over the last 48 hours. He has a history of dry skin to which his mother regularly applies various moisturizers, including calendula oil.

The mother of a 12-year-old girl brings her daughter to the office for evaluation of recurrent, itchy red bumps and blisters on her legs. The mother gets the same rash recurrently as well.

A mother brings her healthy 6-month-old girl to the outpatient clinic with disseminated, asymptomatic, golden-brown bumps that occasionally become red and swollen.

A frustrated mother carries her 2-month-old son into the office for evaluation of a diffuse bright red rash with dramatic hypopigmentation. Scalp, neck, axillary, and diaper areas are involved.

An 11-year-old girl asks her pediatrician about an asymptomatic birthmark on her right thigh that drains clear to slightly bloody-tinged fluid occasionally when scratched. It has increased in size proportionally as she has grown.

Physical appearance can have a significant impact on the psychosocial health of children and adolescents, especially with identity and self-esteem.

The mother of a healthy 10-year-old girl brings her child to the office for evaluation of new onset “eczema.” The rash is asymptomatic and began on the patient's upper eyelids, later spreading to her chest and extremities over several weeks. The child complains of difficulty riding her bicycle.

Although pediatric atopic dermatitis and acne have some similarities among children with skin of color and lighter-skinned children, there are important differences when these common skin conditions affect darker skin types.

A father brings his 12-year-old son to the clinic for evaluation of a skin eruption that has been on the back of the boy’s neck for a year, but which just began to extend behind his ear. The rash is asymptomatic, and the otherwise healthy patient is annoyed that he has to spend a beautiful morning in a physician’s office.

The mother of a 4-year-old boy, whose family recently emigrated from Haiti, brings him to the pediatric mobile clinic for evaluation of a rash that had begun 11 days earlier as an eruption of vesicular, pruritic papules on the bilateral lower extremities and had spread to the buttocks and medial thighs with sparing of the face. The skin eruption was followed by desquamation of the skin on his palms and soles.

The parents of a 4-year-old boy who lives in eastern Maryland near the Pennsylvania line are worried about an expanding rash on his back, which started as a small red bump a week ago following a summer picnic. The boy has had a low-grade fever and has not been acting like himself for a few days.

An adolescent girl is referred by her pediatrician to dermatology for evaluation of a birthmark on her face.

The parents of a healthy 6-month-old boy with eczema bring him to the office for evaluation of a rapidly progressive rash on his arms, legs, face, and back. He had a low-grade fever and loose stools for 2 days last week.