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Unilateral rash on a baby girl
Amor Khachemoune1, Ben N Lockshin, Hazem El-Gamal
1Wellman Center for Photomedicine (BAR 314), Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 40 Blossom Street, Boston, MA 02114, USA. amorkh@pol.net
Insights
A pruritic rash in an infant, starting in the popliteal fossa and spreading unilaterally, suggests a specific diagnosis. Prompt evaluation and management are key for pediatric skin conditions.
Area of Science:
- Pediatric Dermatology
- Clinical Case Study
Background:
- An 11-month-old female infant presented with a pruritic rash.
- The rash began in the popliteal fossa and spread unilaterally over two weeks.
- A preceding upper respiratory infection was noted.
Observation:
- Physical examination revealed excoriated erythematous papules coalescing into plaques.
- The rash was predominantly on the right side, affecting the arm, flank, and leg.
- No lymphadenopathy was present, and the infant appeared otherwise healthy.
Findings:
- The unilateral and asymmetric distribution of the rash is a key diagnostic feature.
- The morphology of papules and plaques suggests inflammatory dermatosis.
- The history of preceding URI may be relevant to the etiology.
Implications:
- Accurate diagnosis is crucial for appropriate management of pediatric pruritic rashes.
- Understanding the pattern of spread can aid in differential diagnosis.
- This case highlights the importance of detailed clinical observation in infant dermatology.
Abstract:
An 11-month-old baby girl came to the clinic with a pruritic rash. The rash initially appeared in her popliteal fossa 2 weeks before the visit. The eruption extended to the right leg, arm, and flank the week before the visit, subsequently spreading to the contralateral flank. Three weeks before to the eruption's appearance, the patient had an upper respiratory infection with a dry nonproductive cough, which resolved spontaneously without antibiotics. The physical examination revealed a healthy-appearing infant girl with excoriated erythematous papules coalescing into plaques on her right flexural arm that continued to the axilla and down the right flank to the flexural aspect of her leg (Figure 1). Her left side was essentially free of any rash (Figure 2). No cervical or axillary lymphadenopathy was noted, and the remainder of her exam was normal. What is your diagnosis? How would you manage this condition?
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