facial rash on an 8 year old girl

[SJC3992]

My 8 year old daughter has been having problems with a facial rash for the last several weeks.  The rash tends to occur around her mouth area (chin and under nose).  This rash is red, slightly raised, occurs in patches with no obvious scales or pustules.  She is becoming self-conscious and complains of pain/irritation.   I have applied Topicort (desoximetasone 0.05%) once to twice daily on her face which seems to improve the problem within a few days.  Unfortunately, it is returning after this gel is discontinued.  I tried an OTC anti-fungal cream for two applications 12 hours apart with no real improvement.  She also has a small to moderately sized area of cradle cap on her scalp.  The cradle cap has been present off/on since infancy.  I plan on trying an OTC dandruff shampoo to see if that will help.

Can both the facial rash and flared up cradle cap be related?  Is there other OTC options for treatment or should I bite the bullet and schedule an appointment with a dermatologist?

[Eaf1245]

My daughter is 8 1/2 years old. For at least a year she's had a rash all around her mouth. I've used gasoline thinking she was drooling it finishes and comes back again. I took her to her PCP which told us to wash her face twice daily and prescribed her fougera 1% but it's not helping. I don't understand why this is happening. Can you suggest something else to try?

Thank you!
E

[SJC3992]

Dr. Santos,

Thank you for your input.  I took my  daughter to her pediatrician.  She was concerned about tinea capitis based on looking at a sample of scalp scale under the microscope.  She sent a sample of scale and hair to be cultured and started her on oral griseofulvin.  Her facial rash was diagnosed visually as perioral dermatitis and she prescribed Metronidazole cream.

After an internet search on tinea capititis (ringworm), I was surprised by her assessment.  My daughter is caucasian and has no hair loss or hair breakage.  I guess she  is being cautious?  I also was shocked when I had to pay for the griseofulvin ($138/month) and Metronidazole cream ($45/tube).   I certainly feel that I want to treat my daughter appropriately, but I would have liked some forewarning from the pediatrician that these two products tend to be more expensive!!  I also wish she had given some recommendations as to prevention of spreading/reinfection of the possible tinea capitis.

Thanks for your help!

[Dr Santos]

Hi,

Cradle cap is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies and tends to recur in adolescence and persists into adulthood. The cause is possibly due  to an overactive sebaceous glands. There may also be a relationship with skin yeasts. Applying petroleum jelly liberally overnight may be done to  soften the scales and can be brushed off in the morning. Keratolytic or dandruff shampoos are generally not recommended as they sting eyes and may worsen the dermatitis.

  Fungal infection or tinea capitis and scabies can mimic cradle cap. It is important to know the underlying cause to determine which treatment is suitable. The facial rash may not be related to the cradle cap. but it can also be due to a fungal infection or dermatitis. Perioral dermatitis which presents as groups of itchy or tender small red papules  that may appear round the mouth, upper lip, nose, chin or cheeks. The surrounding skin may be pink, and the skin surface often becomes dry and flaky.
This condition responds well to antibiotic treatment but can recur at a later date or when the antibiotics are discontinued.  It is important to wash the face with warm water alone while the rash is present. Finish the full course of antibiotics prescribed by your doctor to prevent recurrence.

It would be best to have this evaluated further for proper diagnosis and management.  Take care and keep us posted.