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JAMA Clinical Challenge

Periocular Rash

Image of Periocular Rash
A 5-year-old boy with erythematous periocular rash (figure reprinted from Arch Ophthalmol. 2011;129[3]:306-309).

Huan J. Chang, MD, MPH
A healthy 5-year-old boy presented with a 3-month history of an erythematous rash around his left eye (Figure). He initially received a diagnosis of eczema and was treated with pimecrolimus, 1% cream. The dermatitis did not respond, and he was further treated for presumed superimposed impetigo with oral erythromycin estolate and topical mupirocin calcium ointment. The eruption continued to progress. Physical examination revealed a large annular erythematous scaling plaque with papules and pustules surrounding the left eye with associated upper eyelid swelling. Visual acuity was unaffected, the globes were not proptotic, canthi were normal, conjunctivae were noninflamed, pupils were reactive and responsive to light, and extraocular eye movements were intact.

See the full article for an explanation and discussion.

Author Affiliation: Dr Chang (tina.chang{at}jama-archives.org) is Contributing Editor, JAMA.