Photo Quiz

New-Onset Full-Body Rash Following Sore Throat in a Child

 

Am Fam Physician. 2019 May 1;99(9):575-576.

A five-year-old girl presented with a new-onset, full-body, pruritic rash. Treatment at home before presentation to the clinic included topical antibiotic cream with no improvement. The patient had a sore throat about one week before the rash appeared but was otherwise asymptomatic. She had no significant medical history, and her vaccinations were up to date.

Physical examination revealed numerous small, erythematous plaques covering the bilateral arms, legs, chest, abdomen, back, face, and scalp (Figure 1 and Figure 2). The rash spared the palms and soles. No excoriations were present. Rapid testing was negative for streptococcal infection. The antistreptolysin O titer was 892 IU per mL.

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FIGURE 1


FIGURE 1

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FIGURE 2


FIGURE 2

Question

Based on the patient’s history and physical examination findings, which one of the following is the most likely diagnosis?

A. Guttate psoriasis.

B. Nummular eczema.

C. Pityriasis rosea.

D. Tinea corporis.

Discussion

The answer is A: guttate psoriasis. Guttate psoriasis accounts for less than 2% of psoriasis cases.1 Between 56% and 97% of new-onset guttate psoriasis cases are preceded by a streptococcal infection, typically by two to three weeks2; however, the condition may be chronic and unrelated to streptococcal infection. Guttate psoriasis often spontaneously resolves after a few weeks. Persistent lesions can be treated with exposure to sunlight and topical corticosteroids. Antibiotics can be added if throat culture is positive for beta-hemolytic streptococcus. Guttate psoriasis is most often diagnosed in children and in adults younger than 30 years.

Diagnosis of guttate psoriasis is based on clinical presentation, although biopsy can be performed for difficult cases. The condition is characterized by an acute eruption of numerous small, teardrop-shaped, erythematous papules

Author disclosure: No relevant financial affiliations.

Address correspondence to Leah Johnson, MD, at l.johnson@slmef.org. Reprints are not available from the authors.

References

show all references

1. Psoriasis, psoriasiform, and pityriasiform dermatoses In: Wolff K, Johnson RA, Saavedra AP, Roh EK, eds. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 8th ed. New York, NY: McGraw-Hill; 2017....

2. Prinz JC. Psoriasis vulgaris—a sterile antibacterial skin reaction mediated by cross-reactive T cells? An immunological view of the pathophysiology of psoriasis. Clin Exp Dermatol. 2001;26(4):326–332.

3. Psoriasis In: Usatine R, Smith MA, Mayeaux EJ, et al., eds. The Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013.

4. Rash In: Stern SD, Altkorn D, Cifu AS, eds. Symptom to Diagnosis: An Evidence-Based Guide. 3rd ed. New York, NY: McGraw-Hill; 2015.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

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