Dermatology

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The father of a healthy 3-year-old girl begs you to help with a bleeding bump on her left cheek. It has been present for a few weeks but in the last 2 days has bled profusely on 3 occasions for more than 30 minutes each time.

A 5-year-old boy was brought to the emergency department by his parents because of a rash that covered his entire body. The rash had started 2 days earlier, initially on the boy’s face, abdomen, and legs and had spread to his back, buttocks, and hands. There was a 1-day history of tactile fever when the child was sent home from school. He had no sick contacts and his immunizations were up-to-date. He had no significant medical history.

This distribution of an inflammatory disorder in a very young child almost always indicates atopic dermatitis. The family history of asthma suggests the atopic diathesis.

The history and lesional morphology are virtually pathognomonic for a dental sinus. Radiographic examination revealed an apical dental abscess that communicated with the skin via a sinus tract.