A 7-Year-Old Boy with New Facial Rash

Differential Diagnosis

• Acne vulgaris
• Coxsackie virus
• Molluscum contagiosum
• Perioral dermatitis of childhood
• Lip licker’s eczema

Diagnosis

This patient was diagnosed with perioral dermatitis of childhood, also called periorificial dermatitis. This is a benign inflammatory eruption characterized by erythematous papules and pustules around the mouth.

Learnings/What to Look for

• Lesions are typically clusters of erythematous or skin-colored papules, vesicles, and/or pustules. They are often asymptomatic but may be mildly pruritic
• Development of perioral dermatitis is often preceded by exposure to topical corticosteroids. Use of mask-delivered inhaled corticosteroids is a common cause in young children
• Various cosmetic products, including fluorinated toothpastes, have also been reported as potential precipitants of this condition
• Unlike periorificial dermatitis, perioral coxsackie disease is often associated with rash elsewhere on the body sometimes with fevers, oral ulcers, or diarrhea. Lip-licker’s eczema features dry, irritated skin well demarcated around the lips without discrete papules or vesicles. Molluscum contagiosum lesions are typically smooth, dome-shaped papules and are rarely in a perioral distribution

Pearls for Urgent Care Management

• Treatment is often initiated with topical antibiotics, such as metronidazole, clindamycin, erythromycin, or sulfacetamide
• Topical nonsteroidal anti-inflammatory creams may reduce inflammation

Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/JUCM).