Marissa J. Perman, MD

An 8-year-old female presented to the ED with a painful eruption for 6 days’ duration. She had a history of moderate eczema that was flaring for the past few weeks and was being managed with topical steroids.

A 2-year-old girl with a history of maple syrup urine disease presented to the dermatology clinic with an ongoing diaper rash.

A 3-year old boy presented to the ED for evaluation of an itchy rash. One week before presentation, he had complained of ear pain and was prescribed amoxicillin by his pediatrician for otitis media. A week later, he developed rhinorrhea, cough and a pruritic rash. The rash started on his hands and feet, then spread to his trunk and extremities. Some lesions seemed to disappear within a few hours. His hands and feet became swollen, and he developed pain with ambulation, prompting the ED visit for evaluation.

A 1-year-old boy presents with a diffuse rash on the body for the past 3 days (Figures 1 and 2). The rash started on his hands, then progressed to include his face, trunk, buttocks, groin, legs and feet. He also developed low-grade fevers and increased fussiness. He has a history of atopic dermatitis that has been difficult to control with hydrocortisone 2.5% ointment. He attends a day care center three times a week.

A 6-year-old girl presents with a rash on the back of her left leg for the past month. The rash is very itchy.

A 4-year-old boy presents with a bumpy rash on the right side of his face for the past 5 months. The rash is neither pruritic nor painful. Before onset of the rash, he had a cavity treated. He is in day care with another child who was seen by a dermatologist for bumps on the skin that were treated with a cold liquid. Hydrocortisone 1% cream was tried for 2 weeks without clearance of the lesions.

A 15-year-old healthy male presented to the dermatology clinic for evaluation of a lesion on the right forearm. He first noticed it approximately 1 year ago. At that time, it was a hard, pink papule, which he thought was an insect bite. The lesion continued to enlarge over time. In the last month, it developed white papules within it. It has never drained. An attempt to perform an incision and drainage with his primary care provider 1 week before revealed blood rather than purulent drainage, with no improvement in the lesion. It is occasionally painful if bumped but otherwise asymptomatic.

An 11-year-old healthy female presented to the dermatology clinic for evaluation of a facial rash that had lasted for 3 weeks. Initially, it was a round, scaling papule treated by another provider with combination betamethasone dipropionate 0.05%/clotrimazole 1% cream, but the rash worsened. This was followed by mupirocin ointment, without improvement. She has since been using triamcinolone 0.025% ointment for the last 4 days and feels it is enlarging (Figure 1). It is not painful but is mildly itchy.

A 7-year-old healthy male presented to the dermatology clinic for evaluation of a facial rash. The rash had been happening off and on over the last few years. It is most notable during the winter. He reported mild burning and itching at the site of the rash (Figure 1). His parents had tried multiple lip balms, shea butter and Aquaphor with varying levels of improvement. Coconut oil made it worse.

A 12-year-old healthy female athlete presented to the dermatology clinic for a mole check. The patient was most concerned about a new black spot on her left heel. She noticed it 2 weeks earlier. It did not resolve with rubbing alcohol. It was asymptomatic and had not changed in size or color since she noticed it. There was no pain, and she continued to attend field hockey practice multiple times per week without any issues.