An infant with generalized rash and abnormal hair

Abstract

HISTORY OF PRESENT ILLNESS A 14-month-old girl presented with a severe erythematous pruritic rash that has been persistent since birth and involved her entire body, including the scalp. She was breast-fed for a total of 7 months and fed with cow’s milk formula supplementation from 41⁄2 months of age. She exhibited severe failure to thrive at 8 months of age that required gastrostomy tube feeding, which resulted in satisfactory weight gain. Homogenized cow’s milk was introduced at 12 months of age and was well tolerated. Her rash persisted, with recurrent exacerbations, but no precipitating factors were identified. Previous treatments included skin moisturizers; 0.03% tacrolimus ointment (Protopic; Fujisawa, Deerfield, IL), which resulted in significant improvement; and 0.05% fluticasone propionate cream (Cutivate; Glaxo Wellcome, Research Triangle Park, NC), which resulted in some improvement. Results of review of other systems were unremarkable, except for occasional recurrent wheezing.