Visual Diagnosis: Two Infants Who Have Skin Lesions That React to Minor Trauma

Abstract

1. Abdulla Gori, MD* 2. Carlos Torneria, MD* 3. Victoria M. Kelly, MD† 4. Barrett J. Zlotoff, MD† 5. Michael E. Contreras, MD† 1. *Assistant Professor, Pediatrics, Case Western Reserve University, Cleveland, Ohio 2. †Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, NM A 2-year-old girl presents to the outpatient clinic for a routine health supervision visit. She was born at term with congenital hydronephrosis requiring antibiotic prophylaxis. Except for one episode of pyelonephritis during infancy, her past medical history has been uneventful. Growth and development are normal for age. Family history is unremarkable. Routine physical examination reveals a happy, playful, well-developed toddler who has nine skin lesions located on the abdominal wall and back. The lesions range from red to tan to brown and appear as macules, papules, or plaques (Fig. 1). Stroking one of the lesions triggers a wheal and flare reaction at the lesion site (Fig. 2). No respiratory symptoms develop at that time. Findings on the rest of her physical examination are unremarkable. Figure 1. Red to tan to brown abdominal macules and papules. Figure 2. Wheal and flare reaction of skin lesion after stroking. On additional questioning, her parents recall that the skin lesions developed during infancy, gradually increasing in number. They were not concerned because the lesions did not appear to have any associated signs or symptoms. A clinical diagnosis is made. A 5-month-old girl presents to the clinic with a 4-month history of a recurrent “blister” on her left fourth finger. Between episodes of blistering, the finger remains swollen and red. The patient's mother denies any history of a burn or trauma to the finger. She reports that her daughter often sucks on the finger. Despite bandaging, the blistering continues to occur. The infant is otherwise asymptomatic; she has had no febrile episodes or abdominal or respiratory symptoms. The infant was born at term via vaginal delivery without complications. Past medical history and family history are unremarkable. Physical examination reveals a well-nourished infant in no acute distress. Skin examination reveals a 1×2-cm reddish-brown papule with an overlying bulla on the …