Two-month-old with diffuse erythema: A case report

We present a case of a 2-month-old female with an acute onset and rapidly progressing diffuse erythroderma involving the scalp, face, neck folds, torso, and groin. She had a history of seborrheic and diaper dermatitis and developed a worsening rash that initially appeared as a "blister-like" lesion on the cheek. Examination revealed greasy yellow scaling and intertriginous erythema. Workup ruled out herpes simplex virus/varicella-zoster virus, and blood cultures grew presumed contaminant Staphylococcus epidermidis. She was treated empirically with antibiotics, antivirals, anti-fungals, and topical steroids. Dermatology suspected inverse psoriasis. The patient improved within 48 h of treatment. Diagnoses included inverse psoriasis, fungal diaper dermatitis with secondary bacterial infection, and possible early staphylococcal scalded skin syndrome. This case emphasizes the diagnostic complexity of infantile erythroderma and the importance of a broad differential and multidisciplinary approach. Recognition of inverse psoriasis in this age group is crucial, especially in the setting of superimposed fungal and bacterial infections.