A Scaly Periorbital Rash in a Preschool-aged Boy
Jennifer Smitten, MD, FRCPC, BC Children's Hospital, University of British Columbia, BC.
Joseph M Lam, MD, FRCPC, Assistant Clinical Professor, Department of Paediatrics, Associate Member, Department of Dermatology,
University of British Columbia, BC.
Abstract
A healthy 4-year-old boy presented with an 8-month history of a pruritic scaly eruption around his right eye associated with several small pearly papules on the face. A clinical diagnosis of an eczematous id reaction to molluscum contagiosum was made. While up to 40% of cases of molluscum contagiosum may have an associated eczematous dermatitis, these are often under-recognized or misdiagnosed.
Key Words: Pediatrics, Dermatology, Dermatitis, Molluscum, Eczema, Id reaction, Viral exanthem, Hypersensitivity.
Case 1: A scaly periorbital rash in a preschool-aged boy
A previously healthy 4-year-old boy presented with a pruritic scaly eruption around the right eye that had been present for approximately 8 months. His parents had not noticed any other rashes or skin lesions. His past medical history was unremarkable and he was not on any medications. There was no history of atopy in the patient or other family members. Family history was only significant for molluscum contagiosum in his 3-year-old brother. Review of systems was unremarkable.
On examination, the patient had a unilateral scaly eruption with mild underlying erythema on the right upper and lower eyelids (Figure 1). The left eye and both conjunctivae appeared normal. On closer inspection, additional lesions were noted that revealed the diagnosis.
Case diagnosis: Eczematous id reaction to molluscum contagiosum
On closer inspection, this patient was noted to have multiple small flesh-coloured pearly papules on the face, including one on the right upper eyelid near the lateral canthus. These lesions confirmed the diagnosis of an eczematous id reaction to molluscum contagiosum (MC) (Figure 2).
