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Pediatric Rashes
David E. Berry, Ph.D., D.O.
Lewis-Gale Physicians
Salem, Virginia
8 AM, June 3, 2009
Newborn Rashes
Milia
uniform pinpoint yellow-
white papules
This healthy newborn had
numerous pinpoint
white and yellow
papules on the nose,
cheeks, and forehead
Newborn Rashes
Milia
symmetric grouped 1-2 mm
white papules
Comments: This healthy
newborn had milia
clustered on his nose
and upper lip.
Erythema Toxicum Neonatorum
urticarial plaques many
with central yellow
papules or pustules
Rapidly changing
urticarial plaques with
central papules and
pustules appeared on
the trunk of this
otherwise healthy 2
day old. Lesions
changed from hour to
hour and disappeared
completely 36 hours
later.
Erythema Toxicum Neonatorum
widespread red papules on an
urticarial base
This healthy infant developed an
asymtomatic generalized eruption
which lasted for several days and
disappeared without treatment.
Although the lesions were
generalized, they were most dense
on the trunk.
Infant Acne
2 to 4mm pink atrophic papules
This healthy infant presented with
several atrophic pink papules in
various stages of healing on the
bilateral cheeks. Her older brother
had a history of similar infantile
acne.
Storkbite Hemangioma
midline blanching
discrete red 5 cm
patch
This healthy 4-
month-old boy
had an innocent
salmon patch on
the nape of his
neck, over the
mid forehead, and
on both upper eye
lids.
Storkbite Hemangioma
midline red
blanching v-
shaped patch
Comments: This
healthy 5-month-
old boy sports a
salmon patch on
the back of his
scalp, nape of the
neck and in the
lumbosacral area
just above the
gluteal cleft and
on the left lower
back.
Port Wine Stain
red blanching patch on the
lower lip and red
macules and papules
scattered on the tip of
the tongue
This healthy 6-year-old boy
complained of episodic
bleeding from the tip of
his tongue. The vascular
malformation on his
tongue and lower lip had
been present since birth
but the bleeding had
occurrred only for the
last year. The lesion on
the tip of the tongue was
treated with pulsed dye
laser.
Hemangioma
slightly elevated oval
blue-purple 1.5 X
2.2 cm plaque with
surrouding pallor
Comments: This
healthy newborn
developed a blue-
purple oval plaque
in the right side of
the abdomen at 2
weeks of age.
Mongolian Spot
scattered well
demarcated and
poorly demarcated
blue green macules
and patches
Large blue macules were
noted at birth
covering the buttocks
and sacrum and
scattered on the
extremities. Similar
lesions were found in
other family
members. The child
also had atopic
dermatitis.
Mongolian Spots
confluent blue gray
macules and
patchesThis healthy
infant was evaluated
for extensive
pigmentation present
since birth. The
prognosis for
extensive dermal
melanocytosis, also
known as Mongolian
spots, is generally
good, with regression
occurring in the
majority of cases
during childhood. The
infant is otherwise
healthy and well,
growing and
developing normally.
Ear Tags
Two accessory
preauricular
skin tags These
preauricular
skin tags that
were present at
birth were not
associated with
other congenital
anomalies in
this healthy 4
month old
infant.
Ear Pits
clustered symmetric semi-
circular ear depressions
This healthy 15-month-old
boy was evaluated for
peculiar congenital
symmetric circular ear
depressions. He had no
other skin findings, no
history of organomegaly,
omphalocele, intestinal
malrotation, somatic
gigantism,
hemihypertrophy, or
macroglossia. Family
history was unknown,
because he was
adopted.
Dermatitis
Contact Irritant Diaper Dermatitis
symmetric confluent red plaques with
lichenification purple papules
over skin prominences and
relative sparing of the creases
This healthy 8-month-old girl
developed a recurrent and
chronic diaper dermatitis over the
skin prominences of the thigh,
vulva, and suprapubic area. She
was growing well, had no recent
exposure to systemic antibiotics,
and had not diarrhea or
constipation or underlying
medical disorders. The rash was
treated with barrier paste and
tapering topical steroids. A skin
biopsy was planned if the
eruption did not clear.
Candidiasis
confluent red papules
involving creases
and skin
prominences
This 6-month-old girl
developed an itchy
painful contact
irritant dermatitis
with secondary
candida. The
eruption improved
with topical nystatin
cream applied with
diaper changes.
Perianal Streptococcal infection
well demarcated red
eroded crusted patch
with surrounding scale
This healthy 4-year-old boy
had a 3 month history of
itchy painful perianal
eruption that was
treated with oral
antibiotics with
temporary relief. A
streptococcal screen
was positive, and he
was retreated with a 3
week course of oral
cephalexin.
Lip Licker Dermatitis
This two year old boy
developed perioral
erythema, scaling and a
small area of
maceration on the left
aspect of the upper lip.
He is a frequent lip
licker and it is winter.
This 2-year-old boy had
persistent well
demarcated scaly red
patch on the lower lip.
He confessed to
frequent lip licking
during the winter.
Lip Licker Dermatitis
scaly perioral plaque
A healthy 7 year old
developed a
worsening lip
licker's contact
irritant dermatitis.
He improved with
aggressive
application of a
bland lubricant.
This boy aged 6 year-old
has the habit of licking
his lips. He does this
as compulsively as
others suck their
thumbs or bite their
nails. Notice how the
design of the lesions
conforms to the extent
to which the lips can
be licked by his
tongue. This
dermatitis improved
somewhat in the
summer and flared in
the winter.
Contact Dermatitis Shoe
symmetric well
demarcated plaques
comprised of red
scaly discrete and
confluent papules
with excoriations and
crusts
Comments: This healthy
adolescent with a
history of atopic
dermatitis developed
a recurrent dermatitis
on the tops of his feet.
He was scheduled for
patch testing to
exclude an allergic
component related to
his shoes.
Poison Ivy
irregularly shaped
asymmetric edematous
red discrete and confluent
papules and plaques
This healthy 7-year-old girl
developed an extremely
pruritic red eruption which
started on her face and
spread to her neck and
extremities. Clothing
protected areas were
spared. Note the sparing
where her bangs
protected the right side of
her forehead.
Poison Ivy
Poison Ivy
grouped linear red
edematous scaly
plaques
This 5-year-old boy
developed an
itchy linear
eruption oh his
back the day after
a camping trip in
the woods.
Pityriasis Rosea
generalized but primarily
truncal 0.5-3.0 cm
round and annular
hyperpigmented
papules and plaques
with dusky centers and
gray borders with scale
pointing centrally
This 12-year-old boy was
noted to have
widespread scaly round
and annular plaques at
a scoliosis screening
visit. A skin biopsy
showed dermatitic
changes consistent
with pityriasias rosea.
Pityriasis Rosea
Eczema
Eczema
poorly defined oval
hypopigmented
minimally scaly
patches with
follicular
accentuation
This 6-month-old boy
had a 3 week
history of light
patches on his
abdomen. He had a
history of dry scaly
skin since age 2
months consistent
withy mild atopic
dermatitis.
Eczema
Eczema
Eczema
Atopic Eczema
diffuse erythema, scale, and
crusting
This healthy infant
developed diffuse facial
erythema, scaling, and
crusting. He was noted to
rub his face on his
mother's shirt repeatedly
while in the office. The
eruption improved
dramatically with liberal
application of topical
lubricants and judicious
use of topical
hydrocortisone 2.5
percent ointment.
Eczema
widespread symmetric red
scaly patches and
plaques some with
crusting and purulent
discharge
This 9-year-old boy, with a
history of chronic
suppurative otitis media,
rhinitis, dental caries and
recurrent purulent
conjunctivitis since 2
years of age, had a 2 year
history of chronic
recurrent predominantly
flexural eczema with
secondary staphylococcal
infection.
Eczema
Eczema
symmetric thickened
hyperpigmented
follicular papules
This adolescent had
chronic atopic
dermatitis with
prominent follicular
papules on the dorsal
aspect of his hands and
wrists. He admitted to
episodic rubbing and
scratching of the hands
and forearms. He also
had scattered lesions
on his shins. He
improved with topical
steroids and non-
steroidal anti-
inflammatory
Eczema
uniform 2 mm hypopigmented and
hyperpigmented papules
This 4-year-old boy had chronic atopic
dermatitis marked by recurrent
episodes of pruritic follicular
papules on his chest, abdomen,
shoulders and the flexural surfaces
of his arms and legs. He responded
well to aggressive use of emollients
and judicious use of topical
corticosteroids and non steroidal
anti-inflammatory agents. Note the
small congenital pigmented nevus
on his right abdomen and the café
au lait macule on the left upper
chest.
Eczema
Scaly erythematous
plaque in a nine
month old with history
of wheezing. It
resolved with a low
potency topical
corticosteroid and a
topical lubricant.
This 9-month-old boy
with a history of
asthma, developed a
red scaly plaque on
the right neck and
cheek. It resolved
within 2 days on a
topical steroid and
lubricant.
Nummular Eczema
acute red
edematous
annular scaly
and crusted
plaques
A 4 year old boy
with severe
atopic
dermatitis
developed
acute nummular
plaques on his
trunk with flares
of his disease.
Nummular Eczema
excoriated eroded
lichenified
nummular plaques
A 6 year old boy with
atopic dermatitis
scratched at
selected areas on
his arms and legs
resulting in chronic
nummular plaques.
Contact Dermatitis
lichenified
hyperpigmented
plaque
This 4-year-old boy
with atopic
dermatitis
developed a
chronic dermatitis
on the lower
abdomen. He
cleared with
topical steroids
and avoidance of
metal snaps and
belt buckles.
Hair Loss
Hair Pulling
well demarcated patch of decreased
hair density with shiny lusterless
hair and hairs of varying lengths
Comments: This healthy 4-year-
old girl was observed twirling
her hair at nap time and bed time
resulting a well demarcated
patches of hair thinning. She also
had dry lusterless hairs of
varying lengths giving a moth
eaten appearance. The hair loss
disappeared a year later when she
entered kindergarten.
Hair Pulling
Traumatic Hair Loss
hair thinning around
parts, plaits, and the
periphery of the scalp
This toddler was brought
by her mother for
evaluation of hair
loss. She kept her hair
in tight plaits
resulting in hair loss
at the edges of the
parts and the
periphery of the scalp.
A culture for tinea
was negative.
Traumatic Hair Loss
well defined patch
of hair
breakage and
thinning
This girl's mother
kept her hair in
tight plaits
resulting in
hair breakage
and thinning at
the periphery
of the scalp.
Traumatic Hair Loss
tightly pulled braids with pustules and
hair thinning along the parts
This 2-year-old girl developed pustules
along the parts created by braids in
her scalp. Loosening of the braids
and gentle shampooing usually
relieves this superficial
Staphylococcal folliculitis also
known impetigo of Bockhart. Note
the traction alopecia as well. These
children may also be prone to tinea
capitis which should be excluded
when local measures fail to result
in clearing.
Alopecia Areata
round to oval patches
of alopecia with
normal underlying
skin
A healthy adolescent
began with patches
of alopecia at age 5.
Since then he
experienced periods
of regrowth and
recurrent alopecia
areata.
Alopecia Areata
complete scalp
hair loss
A healthy 6-year-
old boy had
several
episodes of
complete hair
loss followed
by full
regrowth over
the last 3 years.
His eye brows
have been
involved in the
past.
Alopecia Areata
2.5 cm X 4 cm patch
of hair loss
This 9-year-old boy
with scattered
patches of
alopecia areata
on his scalp for
over a year points
out an area of
hair loss on his
forearm.
Infections
Tinea Corporis
Tinea Corporis
Tinea Corporis
scaly hypopigmented 3 cm patch with
decreased hair density; subtle scaly
annular patch on the left temple
This healthy 9-year-old girl had an itchy
scaly patch on her mid frontal scalp a
year ago which was treated with topical
steroids. The patch improved but hair
loss slowly progressed. She
subsequently developed several scaly
patches on her forehead and left temple
which also improved but never cleared
with topical steroids. On evaluation a
potassium hydroxide preparation was
floridly positive from hair bearing
(endothrix)as well as non-hair bearing
(septate branching hyphae) areas. She
was started on oral ultramicrosized
griseofulvin. Note the annular patch on
the left temple.
Tinea Corporis
annular red scaly plaques on the
mother's arm and fingers and
diffuse scaling in the child's
frontal scalp
This healthy 8-year old girl
demonstrates diffuse frontal
scalp scaling and some hair
thinning. A potassium
hydroxide preparation from
the child showed endothrix
spores, while the mother had
septate branching hyphae.
The daughter was treated with
oral antifungal medication,
and the mother responded to
topical antifungal cream.
Tinea Corporis
Pustular lesions which
progress to fairly oval in
shape, demonstrate
centralized clearing with
a well-defined leading
edge
This healthy 4-year-old girl
developed an itchy red
scaly papulopustular
eruption extending from
the right armpit. A
potassium hydroxide
preparation showed
branching septate
hyphae.
Tinea Corporis
This 10-year-old girl developed a single pruritic
expanding annular plaque on her left forearm. She
had a history of animal exposure. A potassium
hydroxide preparation was positive, and a fungal
culture was pending. Classic tinea corporis
presents on the trunk and limbs as single or
multiple annular papulosquamous lesions with
raised, erythematous, scaling borders and central
clearing. . The two most common species cultured
worldwide are Trichophyton rubrum and
Trichophyton mentagrophytes. Inflammatory lesions
may include vesicles, pustules, crusting, and
occasionally perifollicular and deep dermal
involvement with nodules. In general tinea corporis
caused by zoophilic dermatophytes such as
Microsporum canis is more inflammatory and more
symptomatic than infections caused by
anthropophilic dermatophytes. Risk factors for
infection include exposure to infected animals,
persons, and soil. Those at risk include athletes,
veterinarians, animal handlers, and anyone who
works outdoors. In addition, certain systemic
diseases may predispose to infection, including
Cushing’s syndrome, DM, atopy, and most
immunodeficiency conditions.
Tinea Corporis
Tinea Capitis
scaly round 1- 5 cm
patches with broken
hairs
This 11-year-old boy
developed
minimally itchy
scaly patches with
hair loss in his scalp
2 months ago. A
potassium
hydroxide
preparation was
positive for hyphae.
Tinea Capitis Black Dot
Ringworm
diffuse alopecia with
pinpoint black dot
residua of broken
hair shafts
This healthy 4 week-
old infant
presented with a 2
week history of
progressive hair
loss and "black
dots" on the scalp.
His school aged
sibling was also
affected.
Tinea Versicolor
symmetric truncal discrete
and confluent
hypopigmented
minimally scaly papules
and patches
These healthy adolescent
brothers complained of
a minimally itchy light
spots on the trunk for 2-
3 years. Their father
had a similar eruption.
A potassium hydroxide
preparation showed the
typical spores and
pseudohyphae of
Pityrosporum.
pt child male about 11
years complain from
multiple patch
hypopigmented
posterior neck.
This 11-year-old boy was
noted to have some
Tinea Versicolor minimally scaly
hypopigmented 0.2-
1.0 cm patches on his
neck and back. Note
the small pustules on
the upper back
consistent with a
pityrosporum
folliculitis
Tinea Versicolor
widespread truncal round
minimally elevated annular
discrete and confluent
hypopigmented scaly 3 mm-
1.0 cm papules
This healthy adolescent boy
was evaluated for a chronic
minimally scaly eruption on
the trunk, proximal
extremities, and neck. A
potassium hydroxide
preparation of scale from
the trunk demonstrated
pseudohyphae and spores
typical of tinea versicolor.
Scarlatina Eruption Pastia Lines
diffuse scarlatiniform
eruption with
accentuation in
skin creases
(Pastia lines)
This toddler with
Kawasaki
syndrome
developed a
scarlatiniform
eruption with
Pastia lines,
accentuation of the
rash in the skin
flexures.
Streptococcal Pharyngitis
discrete and confluent
petechiae
This healthy
adolescent
developed a sore
throat, anterior
cervical
adenopathy, and
palatal petechiae. A
rapid strep test was
positive, and her
symptoms resolved
24 hours after
initiating oral
amoxicillin.
Streptococcal Scarlet Fever
diffuse red sandpaper-like
This 10-year-old boy
developed a fever to 103
degrees F, tachycardia,
cough, myalgias, numbness
in his legs, a diffuse red
eruption, and a strawberry
tongue. He had a history of
a strep throat 2 weeks
earlier. He was treated with
ceftriaxone and oral
antibiotics for 10 days. The
scarlatiniform eruption
started on his abdomen and
disseminated.
Scarlet Fever Strawberry Tongue
red tongue with prominent
papillae
This 10-year-old boy
developed a fever to 103
degrees F, tachycardia,
cough, myalgias, numbness
in his legs, a diffuse red
eruption, and a strawberry
tongue. He had a history of
a strep throat 2 weeks
earlier. He was treated with
ceftriaxone and oral
antibiotics for 10 days. The
scarlatiniform eruption
started on his abdomen and
disseminated.
Scarlet Fever
red strawberry
tongue and
diffuse fine red
papular eruption
This 4-year-old girl
was evaluated for
a strawberry
tongue and
diffuse red sand
paper-like
papular eruption.
A throat culture
yielded Group A
beta-hemolytic
streptococcus.
Scarlet Fever
generalized red fine
papular sandpaper-
like eruption
This 5-year-old boy
had a five day
history of sore
throat and fever.
He developed a
generalized fine
sandpaper-like rash
on day 4 of illness.
He also had red,
swollen tonsils, and
palatal petechiae.
Impetigo
Infestations
Scabies
generalized red papules and
pustules many of which
are elongated with
overlying linear scale
This 5-month-old was
covered with scaly
papules and pustules with
most prominent
involvement of the feet.
Her mother had similar
lesions with generalized
excoriations. Note that
many of the papules and
pustules are elongated
typical of burrows.
Scabies
generalized excoriated
papules some with
crusts, erosions, and
surrounding erythema
This 8-year-old boy had
intensely pruritic bumps
over his abdomen,
hands, feet, groin, and
axillae for the past few
weeks. His siblings
have similar bumps.
Scabies
an asymmetric truncal eczematous eruption
comprised of linear red edematous papules
and pustules, some with overlying crusts
and surrounding hyperpigmentation
This healthy 7-week-old girl developed a
minimally itchy papulovesicularpustular
eruption with crusting particularly in the
right axilla. Many of the lesion also
demonstrated hyperpigmentation. The
lesions began in the right axilla and spread
over the chest, abdomen, and back with
sparing of the face, neck, arms, legs, and
diaper area. A skin biopsy showed a
spongiotic dermatitis with an infiltrate of
neutrophils consistent with an infected
eczematous process. Her mother had a few
pruritic excoriated papules on her wrists and
forearms. The entire family was treated with
5 percent permethrin cream.
Wood Tick
recently embedded tick
This wood tick had
recently embedded
in this 9 year old
girl's leg. It was
easily removed by
grasping the body
of the tick with a
forceps and slowly
but firmly pulling
away from the skin.
Rocky Mountain Spotted Fever
subtle red macules
This 9 year old boy developed a
red partially blanching papular
eruption on his hands and feet
including his palms and soles
that progressed to the trunk
over 3 days. He had a severe
headache, high fever,
arthralgias and myalgias. His
mother, who remembered
removing a wood tick from her
son's scalp 10 days earlier also
developed a rash, fever, and
headache.
Rocky Mountain Spotted Fever
subtle red macules
This 9 year old boy developed a
red partially blanching papular
eruption on his hands and feet
including his palms and soles
that progressed to the trunk
over 3 days. He had a severe
headache, high fever,
arthralgias and myalgias. His
mother, who remembered
removing a wood tick from her
son's scalp 10 days earlier also
developed a rash, fever, and
headache.
Rocky Mountain Spotted Fever
diffuse petechiae and edema
An ill appearing toddler with high
fever and a diffuse red rash
and edema suddenly developed
diffuse petechiae and
ecchymoses. Laboratory
studies showed a prolonged
bleeding time,
thrombocytopenia, anemia,
and neutropenia. After a
prolonged course in the
pediatric intensive care unit, he
recovered uneventfully with
the exception of necrosis of the
tips of several toes.
Rocky Mountain Spotted Fever
red partially blanching papules
This 9 year old boy developed a
red partially blanching papular
eruption on his hands and feet
including his palms and soles
that progressed to the trunk
over 3 days. He had a severe
headache, high fever,
arthralgias and myalgias. His
mother, who remembered
removing a wood tick from her
son's scalp 10 days earlier also
developed a rash, fever, and
headache.
Scabies Nit
viable head louse egg
This nit was still viable when it
was cut from the scalp of a
10 year old girl shortly
before she was treated with
permethrin lotion. At the
time the image was taken,
the nit was already dead.
The left side of the nit is
oriented toward the scalp
while the operculum or
breathing apparatus at the
right end points away from
the scalp. Note the intact
embryo within the egg.
Head Lice
excoriated crusts and
live crawlers
Live crawlers are seen
scampering across
the scalp where she
has been itching for
weeks.
Head Lice
nits on hair shafts and
fecal material on the
skin above the ear
A 10 year old girl
complained of scalp
pruritus for several
weeks. Nits were
visible on hairs above
the ear. Note the
brown scaly fecal
material on the skin
below the hair line.
Lyme Disease
disseminated discrete and confluent
annular 1-3 cm red plaques
The parents found a tick behind the ear of
this 27-month-old girl one week before
she was evaluated in the office for a
equivocal low grade fever and widely
disseminated annular red plaques. The
tick was tested with PCR and found to
be negative for the DNA of Borelia
burgdorfi. However, the following
week serologic tests were positive for
Lyme disease (both IgG and IgM). She
was treated with oral amoxicillin, and
the eruption cleared in 2 days.
Lyme Disease Erythema Chronicum
Migrans
12 cm annular red plaque
with central 1.5 X 3
cm red patch
This healthy 9-year-old
boy developed fever,
head ache, sore throat,
myalgias, and an
annular red plaque
where a bite was
noted a week ago. A
tick was never
recovered.
Lyme Disease Erythema Chronicum
Migrans
10 cm edematous plaque with
purple center and red
advancing border
This healthy 4-year-old boy
developed a flu-like syndrome
associated with a solitary
asymptomatic expanding
plaque on the back and side of
his right knee. He lived in an
area endemic for Lyme
disease, and his mother pulled
many ticks from his skin
during daily tick inspections
during the summer.
Lyme Disease Erythema Chronicum
Migrans
multiple expanding 3-5 cm
annular red plaques
This healthy 10-year-old boy
developed multiple
expanding annular red
plaques on his trunk and
extremities. He
complained of mild sore
throat, head ache,
arthralgias, and myalgias.
The skin lesions and
symptoms resolved within
2 days of starting oral
doxycycline.
Viral Infections
Measles
confluent red eruption;
marked photophobia
A 6 year old girl
developed fever,
headache,
photophobia, and a
red papular eruption
on the face that
spread over 3 days to
the trunk and
extremities. Serologic
studies were positive
for measles.
Measles
red confluent papular
eruption
A 5 year old boy developed
fever, headache, and
sore throat followed
several days later by a
red papular rash on the
face. Five days later the
rash was confluent on
his face and
disseminated over the
trunk and extremities
including the palms and
soles.
Measles
confluent papular
eruption
A 6 year old girl
developed fever,
headache,
photophobia, and a
red papular eruption
on the face that
spread over 3 days
to the trunk and
extremities.
Serologic studies
were positive for
measles.
Measles
Roseola
truncal discrete edematous
pink 2-5 mm papules
This 10-month-old with 3 day
history of bounding fever
to 103 degrees
Fahrenheit axillary. He
was less active than usual
but not ill otherwise. The
fever resolved on day 4,
he was happy and playful,
and he developed a pink
papular rash over his
trunk and proximal
extremities.
Erythema Infectiosum
symmetric red discrete
and confluent
edematous papules
and plaques
This healthy 6-year-old
girl developed an
asymptomatic
symmetric red
papular eruption on
her face, extremities,
and trunk which
became confluent on
her face a week ago.
Erythema Infectiosum
Erythema Infectiosum
diffuse symmetric red
papular eruption
This 22-year-old
school teacher
developed a diffuse
red papular eruption
5 days earlier
during a fifth
disease epidemic in
her school last
spring.
Erythema Infectiosum
symmetric stocking glove purpura
This 18 year old girl awoke one
morning with asymptomatic
symmetric purpura of the hands
and feet which spread to involve
the proximal extremities as well.
The exanthem faded over 7-10
days. Although an enanthem is
not usually reported with
Parvovirus infection, she also
developed some erythema of
the buccal mucosa and white
plaques on a red base on the
dorsum of the tongue.
Gianotti-Crosti Syndrome
symmetric grouped discrete and confluent red
edematous papules and plaques
This 2-year-old girl had an upper respiratory tract
infection 3 days before she developed a
minimally pruritic red papular eruption on her
face, arms, and legs with a few lesions on
her palms and soles. She had copious
rhinorrhea and swollen tonsils with exudate.
A throat culture was sent and she started
zithromycin for 3 days when the culture was
reported as negative. Her respiratory
symptoms began to improve, but the skin
eruption persisted. Note that the eruption
was most prominent on the cheeks and
extensor surfaces of the arms and legs
typical of Gianotti-Crosti syndrome which can
be triggered by Hepatitis B virus, Epstein-Bar
virus, and many other respiratory and
gastrointestinal viruses. The asymptomatic or
minimally pruritic eruption usually resolves
without treatment or scarring over 6 to 8
weeks.
Gianotti-Crosti Syndrome
Herpes Labialis
widespread 2-4 mm
vesicles, pustules,
and erosions
This 18-year-old girl
developed painful
grouped
vesiculopustules in
the mouth
associated with
fever and difficulty
eating and drinking
4 days ago.
Eczema Herpeticum
scattered discrete and
confluent clusters of
uniform 2-3 mm
vesicles and crusted
vesicles on a red base
This 5-year-old boy with
mild atopic dermatitis
developed eczema
herpeticum with
involvement primarily
of his face and hands.
The lesions were itchy
and painful,and
cleared within 3 days
with oral acyclovir.
Eczema Herpeticum
scattered discrete and
confluent clusters of
uniform 2-3 mm vesicles
and crusted vesicles on a
red base
This 5-year-old boy with mild
atopic dermatitis
developed eczema
herpeticum with
involvement primarily of
his face and hands. The
lesions were itchy and
painful,and cleared within
3 days with oral acyclovir.
Herpes Simplex
clusters of uniform 2-3
mm vesicles some
with crusting on a
red base
This 12-year-old boy
developed tingling
on his chin 3 days
before the
outbreak of a
vesicular eruption.
Culture was
positive for Herpes
Simplex Virus.
Whitlow
swollen red toe with clustered
discrete and confluent uniform 3
mm vesicles and pustules with
some crusting and erythema
streaking over the top of the foot
This healthy 4-year-old girl
developed a nontender swollen
red toe with clustered vesicles
and pustules. Viral culture was
positive for Herpes simplex virus.
She was treated with parenteral
acyclovir for 2 days and
completed a 7 day course orally.
The lesions improved within a
week with decreased edema and
erythematous. The vesicles and
crusts dried and peeled.
Neonatal Varicella
2 mm red papules and 2-4
mm vesicles and
pustules some with
central crusts
An 11-day-old boy
developed an eruption
of red macules and
papules which evolved
to vesicles and vesicles
with central crusts over
several days. His
mother had a history of
chickenpox 1 day
before of delivery which
was normal.
Chicken Pox Varicella
vesicles with
hemorrhagic crust
This otherwise healthy
toddler developed
increasing numbers
of vesicles and
pustules in various
stages of
development over
the course of
several days. She
had previously
received the
Varivax vaccine.
Chicken Pox Varicella
Chicken Pox Varicella
Herpes Zoster
clustered discrete and
confluent 2-5 mm red
to purple papules and
vesicles in
dermatomal pattern
This 13-year-old type 1
diabetic girl
complained of burning
and severe pain on
the right side of her
trunk. Mutinucleated
giant cells were seen
on Tzanck smear
confirming the clinical
diagnosis of shingles.
Neonatal Herpes Zoster
dermatomal clustered
uniform 3-5 mm
vesicles on a red
base
A healthy newborn boy
developed an
eruption comprised
of uniform vesicles
to confluence on left
side of his scalp.
His mother had a
history of varicella
during the second
trimester. The
lesions cleared
without
complications.
Hand-Foot-Mouth Syndrome
acrally distributed lancet
shaped red hemorrhagic
papules and vesicles
This 28-year-old woman had a
2 day history of diarrhea,
fever, and abdominal pain.
The skin eruption involved
the hands, feet, and hard
palate where she had
several red punched out
erosions. Her daughter had
similar symptoms and a
blistering rash on the hands
and feet a week earlier.
Hand-Foot-Mouth Syndrome
Hand-Foot-Mouth Syndrome
Hand-Foot-Mouth Syndrome
Plantar Wart
well demarcated,
round 1 cm plaque
comprised of rough
papules that disrupt
the normal
dermatoglyphics
This wart responded
well to topical
keratolytics (27
percent salicylic
acid).
Molluscum Contagiosum
uniform 2-3 mm pearly
papules some with a
central dell scattered
and organized in a
linear cluster
This healthy 4-year-old girl
had a few scattered
molluscum on the trunk.
However, after
accidentally scratching
her abdomen she
developed
autoinnoculation of
multiple papules on her
abdomen and lower
chest.
Molluscum Contagiosum
Molluscum Contagiosum
linear cluster of 2-3
mm pearly papules
with central
dimpling
This healthy 16-year-
old boy developed
an asymptomatic
cluster of
molluscum papules
behind his right
knee.
Molluscum Contagiosum
