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Perioral rashes
  1. Peter A Lio1,
  2. Kachiu C Lee2
  1. 1Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department of Dermatology, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Peter A Lio, Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, 1455 N. Milwaukee Ave, 2nd Floor, Chicago, IL 60622, USA; p-lio{at}northwestern.edu

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Select one best answer from the following for questions 1–3 given below:

  1. Lichen planus

  2. Oral leukoplakia

  3. Acrodermatitis enteropathica

  4. Perioral dermatitis

  5. Phytophotodermatitis

  6. Atopic dermatitis

  7. Herpes simplex virus (HSV) infection

Answers to the following questions can be found on page 240.

Question 1

A 9-year-old girl presents for a rash around her mouth (figure 1). Her past medical history is significant for facial eczema as a toddler, and she has been treating the area with hydrocortisone 2.5% ointment. While using this medication for the past 3 weeks, the rash has not gotten any better. In fact, the rash has actually spread to involve the area around her nose and eyes. She notes that it is slightly itchy, but otherwise asymptomatic. She has no other pertinent history and is otherwise well. What is the most likely diagnosis?

Figure 1

Erythematous monomorphic papules around the mouth.

Question 2

An 8-month-old boy presents with an extensive perioral rash (figure 2). His mother states that he developed the rash approximately 1 month prior, shortly after he was weaned off breast milk. Additionally, he has been having intermittent diarrhoea over the same time period. Initially, his mother thought that he was having an allergy to the infant formula and has thus tried switching him to different brands of formula without improvement of his symptoms. She is worried that he might be developing eczema, since his older sister also has eczema. What is your diagnosis?

Figure 2

Eczematous and erosive patches around the mouth. Image from Color Atlas & Synopsis of Pediatric Dermatology, Second Edition, McGraw-Hill, 2009, used with permission.

Question 3

A 6-year-old girl presents with 2 days of painful, swollen blisters around the mouth (figure 3). She is afebrile but uncomfortable and is having trouble eating due to the pain. She has never had anything like this and is otherwise healthy. What is your diagnosis?

Figure 3

Grouped vesicles with mild surrounding erythema on the lips and perioral area. Image from Color Atlas & Synopsis of Pediatric Dermatology, Second Edition, McGraw-Hill, 2009, used with permission.

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