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16-Year-Old Female with Spreading, Itchy Rash on Cheek

Can you diagnose this case?

David L. Kaplan, MD – 2015 Series Editor

Signs and Symptoms

A 16-year-old girl is bothered by a spreading, itchy rash of 1 week’s duration on the left preauricular cheek. The otherwise healthy teenager denies taking any new medications or using new cosmetics.

What is the cause of this rash?

Choose one to reveal diagnosis and discussion

Excoriated acne
Candidiasis
Impetigo
Contact dermatitis
Factitial rash

Answer: Impetigo

See the full case at Consultant360

A culture of material from one of the lesions confirmed the clinical impression of impetigo. When patients do not respond to appropriate impetigo therapy, consider candidiasis, which can mimic impetigo. Excoriated and factitial lesions typically are more eroded and feature blood crusting rather than the serum crusting noted in this eruption. A contact dermatitis generally does not erupt as several small, discrete lesions.

This patient’s impetigo responded to topical mupirocin; a topical cephalosporin is also an effective treatment.

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