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JAMA Pediatrics Clinical Challenge
February 2014

An Unusual Inflammatory Rash

Author Affiliations
  • 1University of Mississippi Medical Center, Jackson
  • 2Abide Dermatology Clinic, Greenville, Mississippi
  • 3Department of Dermatology, University of Mississippi Medical Center, Jackson
  • 4University of Rochester School of Medicine and Dentistry, Rochester, New York
JAMA Pediatr. 2014;168(2):185-186. doi:10.1001/jamapediatrics.2013.3694

A 4-year-old, 15-kg girl presented with a 3-month history of a pruritic rash bilaterally on the cheeks, initially thought to be related to mosquito bites. Treatment with desonide, 0.05%, ointment twice daily proved to be ineffective. The patient’s rash also failed to clear with a therapeutic trial with griseofulvin liquid (125 mg/5 mL), 5 mL daily, and econazole, 1%, cream twice daily for 2 weeks and later ciclopirox, 0.77%, cream twice daily for 2 weeks, although the patient reported some improvement. The presence of persistent acneiform papules on the cheeks with postinflammatory hyperpigmentation led to a therapeutic trial of erythromycin, 400 mg/5 mL, 1.3 mL orally twice a day, with food. Test results for antinuclear antibody and rheumatoid factor were negative. Three weeks later, the patient presented with 2 slowly expanding, hyperpigmented, ringlike lesions with a tendency toward central clearing and peripheral scaling and erythema on the right cheek (Figure 1).

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