Can you identify this spreading, itchy rash?

Dermclinic
A Photo Quiz to Hone Dermatologic Skills

A 16-year-old girl is bothered by a spreading, itchy rash of 1 week’s duration on the left preauricular cheek. The otherwise healthy teenager denies taking any new medications or using new cosmetics.

What are you looking at here?

A. Excoriated acne.

B. Candidiasis.

C. Impetigo.

D. Contact dermatitis.

E. A factitial rash.

(Answer and discussion on next page)

ANSWER—Case 1: Impetigo

A culture of material from one of the lesions confirmed the clinical impression of impetigo, C. When patients do not respond to appropriate impetigo therapy, consider candidiasis, which can mimic impetigo. Excoriated and factitial lesions typically are more eroded and feature blood crusting rather than the serum crusting noted in this eruption. A contact dermatitis generally does not erupt as several small, discrete lesions.

This patient’s impetigo responded to topical mupirocin; a topical cephalosporin is also an effective treatment.