HOME HELP CONTACT US SUBSCRIPTIONS CME ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Leonard, D. Articles by Zenel, J. A. Search for Related Content PubMed Articles by Leonard, D. Articles by Zenel, J. A. Related Collections Nutrition and Nutritional Disorders Skin Disorders Gastrointestinal Disorders

(Pediatrics in Review. 2007;28:312-318.)
© 2007 American Academy of Pediatrics

Visual Diagnosis: Three Infants Who Have Perioral and Acral Skin Lesions

Douglas Leonard, MD¹
Rafet Koca, MD²
Ceyda Acun, MD³
Saniye Çinar, MD²
Emel Etürk, MD²
Gonca Üstünda, MD⁴
Sarah Herron, DO⁵
Mark M. Butterfly, MD⁵
Joseph A. Zenel, MD¹

The first 300 words of the full text of this article appear below.

	Case 1 Presentation

 
A 5-month-old exclusively breastfed boy presents with a 2-month history of mild diarrhea and perioral, facial, scalp, and perineal skin lesions. The skin lesions first began around the corners of the mouth and the back of his head and later appeared over his perineum and buttocks. Despite treatment with topical antibiotic and antifungal agents as well as systemic antibiotics prescribed by primary care practitioners, the lesions did not improve. In fact, within the past few days, he has developed small blisters on his hands and feet.

The infant weighed 3,900 g at birth and was born at term. Similar skin lesions, with the same distribution, appeared in an older brother when that brother was 4 months of age. The older brother's rash resolved after he was weaned from breastfeeding.

Physical examination reveals an alert child whose vital signs are within normal limits. There are erythematous, scaly, crusting plaques on the facial cheeks and perioral region; the occiput; the hands and feet; and over the scrotum, penis, and buttocks (Figs. 1, 2). Vesiculobullous lesions that have erythematous borders are on the wrist and ankles. The remainder of the physical findings are within normal limits.

View larger version (84K):   Figure 1. Erythematous, scaly, and crusting plaques on the facial cheeks, perioral region, and occiput.

View larger version (103K):   Figure 2. Erythematous, scaly, and crusting plaques over the scrotum, penis, and buttocks.

Laboratory examination reveals normal complete blood count, serum electrolyte concentrations, alanine transaminase, aspartate transaminase, blood urea nitrogen, and creatinine as well as urinalysis, stool examination, serum immunoglobulins, chest radiograph, and abdominal ultrasonography. Testing for antiendomysial antibody and antigliadin antibodies (IgA and IgG) is negative. The serum alkaline phosphatase level is 50 U/L (normal, 85 to 270 U/L).

Additional serum testing reveals the diagnosis.

	Case 2 Presentation

 
An 8-month-old African-American male presents to the emergency department with fever and worsening eczema. He was diagnosed as . . . [Full Text of this Article]