Picture of the Month—Quiz Case | Allergy and Clinical Immunology | JAMA Pediatrics | JAMA Network
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Special Feature
June 2013

Picture of the Month—Quiz Case

Author Affiliations


Author Affiliations: Departments of Dermatology (Drs Lau and Smidt) and Pediatrics (Dr Smidt), University of New Mexico School of Medicine, Albuquerque. Ms Johnson is a medical student at the University of New Mexico School of Medicine.

JAMA Pediatr. 2013;167(6):581. doi:10.1001/jamapediatrics.2013.328a

A 5-year-old girl presented with a 2½-year history of persistently dry, itchy, tender skin around the mouth. The mother denied frequent lip licking. Treatment involved topical antibiotics, hydrocortisone cream, and lip balms, without improvement. She was afebrile and otherwise healthy. There was no family history of similar dermatologic conditions. Examination demonstrated marked erythema and prominent scale periorally with blurring of the vermilion border (Figure 1). There was no warmth or drainage. Complete mucocutaneous examination revealed inflammation and edema of the upper gingival margins without ulceration. Her upper front teeth were covered with metal caps (Figure 2). Erythematous, scaly plaques on the bilateral earlobes were also noted (Figure 3).