Visual Diagnosis: A Family That Has an Itchy Rash

Abstract

1. Tamar Stricker, MD* 2. Felix H. Sennhauser, MD* 1. 2. *University Childres’s Hospital, Zurich, Switzerland. A brother and sister are brought to the clinic for evaluation of an itchy rash of 4 months’ duration. The 4-year-old girl and 8-month-old boy each have a red, raised, and scaly rash extending over their trunk and extremities. In the previous week, they had developed inflamed, cracked bumps on their feet that intermittently bled and had a yellow discharge. Both parents also have an itchy rash. There is no history of recent illness or use of any topical agents. The family had been living in crowded conditions in Switzerland for 6 months, having emigrated from eastern Europe as refugees. Both children had received their primary immunizations for diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B upon arrival in Switzerland. The girl also had received immunization against mumps, measles, and rubella. On physical examination, the girl is afebrile and appears well. Her height and weight are normal (75th to 90th percentile and 50th to 75th percentile, respectively). Dry, abraded skin lesions with occasional thickening and crusting are present over the scalp, nape of the neck, trunk, buttocks, and extremities. The lesions are more pronounced in the axillae and flexor surfaces of the legs and have an annular configuration (Fig. 1⇓ ). Honey-colored crusts with surrounding erythema cover the lower legs and feet. Results of the remainder of the physical examination are normal. Figure 1. Annular, dry, abraded lesions on lower leg. The 8-month-old boy, also afebrile and well-appearing, has …