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- Joseph S. Tadros, MD*
- Yang Yu, MD†
- Anne W. Lucky, MD†,‡
- *University of Cincinnati College of Medicine, Cincinnati, OH
- †Department of Dermatology, University of Cincinnati Medical Center, Cincinnati, OH
- ‡Division of General and Community Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH
AUTHOR DISCLOSURE
Drs Tadros, Yu, and Lucky have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Presentation
A previously healthy, full-term, 3-month-old girl presents with several annular erythematous patches and plaques on the head, scalp, and upper body. The lesions first appeared at 6 weeks of age and progressively spread to involve the face and upper trunk. Past treatments included the topical antifungal butenafine 1% cream twice daily for 3 weeks without substantial improvement. The rash does not worsen with sun exposure, and there are no pets in the household. The mother notes that the patient’s 2 older siblings both presented with similar eruptions as infants. The patient’s older sister experienced several scaly erythematous lesions on her scalp at 4 months of age that cleared by 6 months after treatment with oral griseofulvin. Her older brother also presented with a similar spot on the abdomen in his first year of life that cleared after butenafine treatment. The family history is notable only for hypothyroidism in the mother and maternal aunt.
The initial physical examination revealed several well-defined, 1.5- to 3-cm, annular, erythematous patches and plaques, some of which exhibited peripheral scale. The lesions were found on the scalp, forehead, neck, upper chest, and right arm (Figs 1 and 2). Telangiectasias were noted around the periphery of several lesions. A potassium hydroxide (KOH) examination of the peripheral scale was negative for fungal elements. Electrocardiography and cardiac examination findings were normal. Additional laboratory evaluation identified the diagnosis. …
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