Endgames Case Review

Peri-orificial rash in an infant

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3606 (Published 07 September 2017) Cite this as: BMJ 2017;358:j3606
  1. Hui Min Liew, consultant,
  2. Jin Ho Chong, consultant
  1. Dermatology, KK Women’s and Children’s Hospital, Singapore
  1. Correspondence to H-M Liew liew.hui.min{at}singhealth.com.sg

A 6 month old girl was brought to the paediatric dermatology outpatient clinic with a rash, irritability, and poor weight gain for two months. She was born at 32 weeks’ gestation with intrauterine growth restriction as a result of placental insufficiency. She was exclusively breastfed. There was no family history of skin disorders. On examination, she had scaly erythematous plaques around her eyes, nose, mouth, ears, and neck (fig 1).

Fig 1 Scaly erythematous plaques around the eyes, nostril, mouth, ears, and neck

She had been recently prescribed mild topical corticosteroids to treat presumed atopic dermatitis, but there had been no improvement.

Skin swab and scraping for bacterial and fungal microscopy and culture were taken. The serum zinc level of the child and her mother, and the full blood count and liver function tests for the child were obtained.


  • 1. What are the differential diagnoses?

  • 2. Which differential diagnosis is most likely?

  • 3. …

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