Physician Assistant Diagnoses Young Patient’s Rash and Eases Mom’s Mind

Andrea R, a physician assistant, shares how she diagnosed a young patient’s rash and put her mother’s mind at ease with VisualDx:

“A 20-month-old female patient presented to the clinic with a rash per mother x2 weeks. The child was a new patient to the clinic and her mother was previously told by urgent care and primary care provider that her daughter had a contact dermatitis. The mother presented to dermatology for another opinion as mother has been using all dye-free, allergen-free products. Mother admitted patient had a minor cold prior to this rash.

I looked up photos on VisualDx to show mother what I thought the diagnosis was. The patient’s mother was immediately reassured and relieved to have a more concrete diagnosis after being shown photos that correlated with her daughter’s unilateral laterothoracic exanthem. Patient was given topical steroids and hydroxyzine and seen back 2 weeks later with resolution of patient’s exanthem and solidified mother’s trust in the specialty of seeing a dermatology provider.”

What is unilateral laterothoracic exanthem?

Asymmetric periflexural exanthem of childhood, also called unilateral laterothoracic exanthema, begins as a one-sided rash in young children or toddlers, but rarely in adults. The rash most commonly appears near the armpits, chest, back, groin, or buttocks, and may be associated with fever, swollen lymph nodes, diarrhea, rhinitis, and itch. The eruption may follow a recent respiratory or gastrointestinal illness.  This is a harmless rash that will go away on its own without risk for long-term skin changes or scarring.

What should we be aware of when making a diagnosis?

The asymmetry of the eruption extending from a flexural area in combination with the young age suggests the diagnosis. Patients may have had an antecedent febrile viral illness. When patients or their parents show the eruption, it often demonstrates a “Statue of Liberty” (one arm extended upward) or “touchdown” (both arms extended upward) motion / position.

How can we treat this?

Oral antihistamines and topical steroids may provide symptomatic relief.