A 3½-month-old white boy presented with scaly, erythematous plaques on perioral and perianal skin and on the trunk and right thigh. The perioral eruption began 1 month before presentation and was treated with oral antibiotics and mupirocin ointment, without improvement. Two weeks later, a perianal eruption and diarrhea developed. Five days before presentation, an eruption developed on the thigh and trunk. The patient was born 5 weeks prematurely and weighed 2.5 kg at birth. He was totally breast-fed. At 3 months, he weighed 5.6 kg. He had been irritable and hard to console since birth, with no smiling and almost continuous crying while awake.
Sahn EE, Woodall TG. Periorificial Dermatitis and Irritability in an Infant—Quiz Case. Arch Dermatol. 1999;135(10):1267–1272. doi:10.1001/jamadermatol.58606