HPI: A 3-year-old male presented for evaluation of a rash that started at his right forehead, and progressed over four months to involve his right eyebrow, right eyelids, and his right malar cheek. He had been treated with a topical anti-fungal cream, which produced a burning sensation and was quickly discontinued. Original fungal culture was negative at the PCP’s office. No other treatments had been tried.
At presentation to pediatric dermatology, a fungal culture was obtained and placed he was placed on weight-based griseofulvin dosing for presumed tinea infection of the face. No improvement was noticed on medication after several weeks and the fungal culture returned negative. At a return appointment with us, a skin biopsy was performed from the forehead.
Past Medical History: None
Family History: Rosacea, skin cancer
Medications: Rarely acetaminophen and melatonin
Physical Exam: An edematous nummular plaque at the right forehead (Fig. 1) extending to eyebrow and upper eyelid, associated loss of hair at the medial eyebrow, similar nummular plaque at the right upper cheek, all with scale; otherwise a well-developed, well-nourished, developmentally appropriate 3-year-old boy.
Laboratory Results: Negative fungal culture
Click here for the Diagnosis.