Seven year old male with full body eruption

Presenter: Trent Gay, DO
Dermatology Program: Lewis Gale Hospital Montgomery
Program Director: Daniel Hurd, DO
Submitted on: Dec 5, 2015

CHIEF COMPLAINT:  Full body eruption

CLINICAL HISTORY:

Signs and symptoms:  Patient is a 7 year old male who presented with a 4 month history of an asymptomatic, scaly, persistent fully body rash. He denies any preceding infections or recent travel and is otherwise in good health.

Past medical history- None
Medications- None
Family history- Unremarkable
Social History- Lives at home with parents, no ETOH, no tobacco, attends elementary school
Surgical History- None
Allergies- NKDA

Previous Treatment:  At time of presentation, two punch biopsies were performed and patient was given desonide ointment and sarna lotion. The biopsy specimens returned revealing non-specific spongiotic dermatitis. One month later patient returned and was given an oral steroid taper. Patient returned two months later and reported rash had resolved while on steroids; however, it returned once they were tapered and it remained unresponsive to the previous topical medications. Two additional punch biopsies were obtained (see dermatohistopathology below). When the results returned, patient was put on oral erythromycin.

 

PHYSICAL EXAM:

Well nourished, otherwise healthy appearing male with a full body distribution of scaly macules and patches with post inflammatory hyperpigmentation changes at sites of old lesions. Palms and soles are spared and there is no oral involvement noted.

 

 

 

LABORATORY TESTS:

None

DERMATOHISTOPATHOLOGY:

Vacuolar interface changes with parakeratosis and extravasated erythrocytes. There are scattered, rare eosinophils in the dermal infiltrate.

DIFFERENTIAL DIAGNOSIS:

1.   Guttate psoriasis
2.   Lymphomatoid papulosis
3.   Pityriasis lichenoides chronica
4.   Pityriasis rosea
5.   Secondary syphilis


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