A 16-week-old preterm infant presented with a 6-week hx of erythema and crusting over the lips, nose, and small joints of the hands and feet. Viral and bacterial swabs were negative. She was breastfed and there were no concerns regarding development.
Zinc deficiency
Fetal alcohol syndrome
Eczema
Impetigo
Hand, Foot, and Mouth Disease
You are correct. The infant’s serum zinc level was <2 µmol/L (normal range 10-18). Oral zinc supplementation at 1 mg/kg per day cleared the eruption within 48 h. Clinicians should consider zinc deficiency in premature infants, even if breastfed, who present with perioral and acral lesions. Zinc deficiency presenting in infancy may be due to acrodermatitis enteropathica, an autosomal-recessive disease leading to impaired zinc absorption.
An 87-yo woman with afib, cerebrovascular disease, and HTN had a nonpruritic pustular rash (sparing mucosa, palms, soles) that started 3 days after initiating terbinafine for intertrigo. Cx of lesions negative, WBC 15.7 K/uL, CRP elevated. What is it?
Folliculitis
Generalized exanthematous pustulosis
Urticarial fixed drug eruption
Stevens Johnson Syndrome
Toxic epidermal necrolysis
You are correct. Sometimes referred to as toxic pustuloderma, exanthematous pustulosis is triggered by a medication in 90% of cases. This patient’s eruption resolved completely after terbinafine was discontinued.