REPORT OF A CASE
A 6-year-old boy had a 2-year history of erythematous papules with some crusting in the perioral region and around the nasal alae (Fig 1). They were not tender or pruritic. There was no evidence of a rash elsewhere on his body. The patient had been treated with oral and topical corticosteroids, oral antibiotics, and topical acyclovir, all without any response. The rest of the systems inquiry and family history were noncontributory. He was receiving no medications. Results of a complete physical examination were otherwise unremarkable.Laboratory tests included a complete blood cell count; measurements of erythrocyte sedimentation rate, serum calcium, phosphate, liver function, anti-nuclear antibody, and rheumatoid factor; and chest roentgenogram. All the results of the above tests were either normal or negative. A skin biopsy specimen from the left corner of the mouth is shown in Fig 2. No polarizable foreign body material was seen.