A young Hispanic woman brings in her six-month old son for a check-up at the pediatric clinic. She has just moved from Guatemala and states that he is up to date with all his vaccines. The infant cries when his mother walks away from the examination table and calms down when she comes back to hold him. He babbles, repeats sounds that his parents make and responds to his own name. He just began passing objects from one hand to the other. He sits without support and can stand for some seconds on his own. On physical exam, there is a blueish-gray macular rash on his buttocks. The mother reports that the rash appeared a few days after birth and hasn’t changed in size and color. What is the next step in management of the rash?
A. Call child protective services
B. Prescribe topical nystatin and hydrocortisol
C. Reassess on a follow-up visit
D. Reassure the mother that …show more content…
Mongolian spots (congenital dermal melanocytosis) is an asymptomatic macular, blue-gray rash commonly present at birth or appearing on the sacral region of infants within the first weeks of life. It results from entangled melanocytes in the dermis as they migrate from the neural crest to the epidermis. In most cases, it resolves spontaneously during the first four years of life.
Choice "A" is not the best answer. The possibility of child abuse should always be explored when lesions that resemble bruises are encountered. However, in this case, bruising is unlikely in view of a congenital onset, chronicity of the lesion and appearance.
Choice "B" is not the best answer. Diaper rash is a form of chemical contact dermatitis, which results from prolonged contact of the skin with wet diapers. This makes the skin more susceptible to physical, chemical and enzymatic damage, and also to superimposed fungal infections especially from Candida albicans. It often presents as a multiform erythematous rash in the diaper areas with papulovesicular and/or bullous
A. Call child protective services
B. Prescribe topical nystatin and hydrocortisol
C. Reassess on a follow-up visit
D. Reassure the mother that …show more content…
Mongolian spots (congenital dermal melanocytosis) is an asymptomatic macular, blue-gray rash commonly present at birth or appearing on the sacral region of infants within the first weeks of life. It results from entangled melanocytes in the dermis as they migrate from the neural crest to the epidermis. In most cases, it resolves spontaneously during the first four years of life.
Choice "A" is not the best answer. The possibility of child abuse should always be explored when lesions that resemble bruises are encountered. However, in this case, bruising is unlikely in view of a congenital onset, chronicity of the lesion and appearance.
Choice "B" is not the best answer. Diaper rash is a form of chemical contact dermatitis, which results from prolonged contact of the skin with wet diapers. This makes the skin more susceptible to physical, chemical and enzymatic damage, and also to superimposed fungal infections especially from Candida albicans. It often presents as a multiform erythematous rash in the diaper areas with papulovesicular and/or bullous