(BMJ) - A 7-yo boy presented w/ a rash on his chin, cheeks, and nose x 2 mos. Thinking it was eczema, his mother applied triamcinolone cream. The rash improved initially, but then returned and spread. Exam: monomorphic erythematous papules. What is it?
Candidiasis
Folliculitis
Prepubertal acne
Periorificial dermatitis
Impetigo
You are correct. Periorificial dermatitis, also known as perioral dermatitis, is a common benign condition. Lesions are 1- to 2-mm, skin-colored to erythematous monomorphic papules on the perioral region, nose, cheeks, and/or periocular region. Pustules are not typical of this condition. Patients may c/o mild pruritus and lesions can be chronic. Known triggers include chronic topical steroid use, including those that are inhaled via a mask. Patients should discontinue all steroids if possible, including OTC preparations. Tx includes metronidazole 0.75% cream, or oral tetracyclines or macrolides.
(BMJ) - A 21-yo male wrestler presented w/ a painful rash on his face and neck. No fever, headache, or eye complaints. Exam: vesicular lesions on an erythematous base scattered on face and right side of neck + a tender lymph node. What is the diagnosis?
Lichen simplex chronicus
Herpes gladiatorum
Scabies
Syphilis
Tinea corporis
You are correct. Herpes gladiatorum (or "mat herpes") is common in wrestlers and is spread by direct skin-to-skin contact, most often on the right side of the body. Recurrent infection is usually milder than the initial outbreak. The patient was treated with acyclovir and returned to training 1 week following crusting of lesions.