Itchy rash near the navel
An 8-year-old boy presented with a pruritic periumbilical rash that he’d had for several months. The rash intensified during the day and improved at night. Some days the rash was much worse than others.
The patient’s mother noted he had recently begun tucking the front of his shirt into his pants. Over-the-counter steroid creams had provided intermittent improvement. He had no significant past medical history and took no other medications.
Examination revealed a 4-cm patch of erythema, scaling, and excoriation without a clear border and no central clearing (FIGURES 1 AND 2). The rest of the skin exam was unremarkable.
FIGURE 1
The periumbilical rash
A pruritic rash near the navel, which worsened during the day and improved at night.
FIGURE 2
A closer look
What is your diagnosis?
What therapy would you advise?
