A Case of Navigating Autism and Atypical Rashes in Dermatology Practice

A 4-year-old nonverbal autistic female presented to the clinic with a 3-month history of a persistent, inflamed papular rash, which was violaceous to skin-toned, verrucous, and dome-shaped with crateriform ulcerations on an erythematous base localized in the perianal region. A dermatologic condition with these characteristics, location, and demographic warrants a thorough workup, physical exam, and broad differential diagnosis. The clinical appearance of these lesions can mimic many cutaneous conditions in this age group and requires careful attention for potential signs of abuse. As demonstrated in our case, with a comprehensive patient history, a biopsy, and a culture of the lesions, one can properly direct management of what looked like a broad complex differential to something more benign and underappreciated. When seeing and performing skin check screenings on particular vulnerable patient populations, such as those with autism, educating these patients and their parents is a very important aspect of management. Narrowing the condition down, we reached a diagnosis of pseudoverrucous papules and nodules, a skin rash rarely discovered in children but detected in elderly patients who are debilitated and bedridden with urinary and/or fecal incontinence. This complex case illustrates the importance of proper patient care in patients with autism and considering the entire clinical context before making a diagnosis or conclusion, specifically in vulnerable youth.