Rapid-onset rash in child
Our patient’s pruritic rash was spreading throughout his trunk and arms. An acute infection 10 days earlier shed light on the diagnosis.
Tinea corporis is a dermatophyte infection that causes flat, red, scaly lesions that progress into annular lesions with central clearing or brown discoloration. The plaques can range from a few centimeters to several inches in size, but are always characterized by the slowly advancing border.6
Varicella also affects the trunk and extremities, but a key clinical finding is crops of characteristic lesions, including papules, vesicles, pustules, and crusted lesions in different stages that manifest simultaneously.6
Insect bites usually appear as urticarial papules and plaques associated with outdoor exposure. The lesions are distributed where insects are likely to bite.6
Treat the infection, control the psoriasis
The first-line treatment for streptococcal infection is amoxicillin (50 mg/kg/d [maximum: 1000 mg/d] orally for 10 d) or penicillin G benzathine (for children < 60 lb, 6 × 105 units intramuscularly; children ≥ 60 lb, 1.2 × 106 units intramuscularly).7 For the psoriasis lesions, treatment options include topical glucocorticosteroids, vitamin D derivatives, or combinations of both.5 In most cases, guttate psoriasis completely resolves. However, one-third of children with guttate psoriasis go on to develop plaque psoriasis later in life.8
Our patient was treated with penicillin G benzathine (1.2 × 106 units intramuscularly) and a calcipotriol/betamethasone combination gel. The streptococcal infection and skin lesions completely resolved. No adverse events were reported, and no relapse was observed after 3 months.
CORRESPONDENCE
Rita Matos, MD, Rua Actor Mário Viegas SN Rio Tinto, Portugal; anasotam@gmail.com
