A 35-day-old baby girl presented with a history of sudden onset of skin lesions of 4 days’ duration. The skin lesions initially appeared on the cheeks, but progressed to involve the trunk and limbss within 4 days. There was a history of upper respiratory tract infection 10 days prior to the onset of the skin lesions. The skin lesions were associated with fever. There was no history or symptoms suggestive of systemic involvement. The child was not on any drugs prior to the onset of the skin lesions.
On examination, the child was febrile with a temperature of 100 °F and a pulse rate of 120 beats/min, and weighed 3.8 kg. Cutaneous examination revealed multiple, erythematous, nodular lesions on the face (Fig. 1). A few large bullous lesions were present on the thighs and gluteal region. Multiple tender nodules and a few annular lesions with well-defined discrete papules at the margins and central erythema were also seen on the trunk and limbs. There was no involvement of the mucous membranes. Systemic examination was within normal limits.
The investigations revealed a hemoglobin of 7.2 g%, a total count of 30,000 cells/mm3 with a differential count of 79% neutrophils, and an erythrocyte sedimentation rate of 50 mm at 1 h.
Urine examination, USG, and pus culture were normal. Human immunodeficiency virus (HIV) screening in the baby and mother was negative. The histopathologic section revealed a dense inflammatory cell infiltrate involving the epidermis and upper dermis, composed mainly of neutrophils. The epidermis also showed edema and spongiotic vesicles. The inflammatory cell infiltrate was distributed around small blood vessels, as well as the entire upper dermal tissue, together with leukocytoclasis (Fig. 2).
The baby was treated with oral prednisolone, at a dose of 1 mg/kg body weight, and oral potassium iodide (100%), five drops, three times daily. With this regimen, the skin lesions regressed in 4 weeks. Steroids were gradually tapered and oral potassium iodide was continued for four more weeks and then stopped. The lesions resolved with secondary cutis laxa. There was no relapse at the end of a follow-up period of 12 months.