Sara Fahad Almatrafi, Mazin Mohammed Aljabri
History: A nine year old school girl, medically fit, complained of rash over her left axillae for 10 days. The patient was in her usual state of health until she noticed a rash that started gradually over the left axillae as solitary annular eczematous lesion which started to disseminate to the ipsilateral hemi thorax, abdomen and left thigh following dermatome, not crossing the midline, associated with itchiness and pain especially after sweating. The patient had no history of contact with topical medication, deodorant or any antiperspirant, no history of same lesion before, no history of medication exposure, no history of animal contact, no family history of same lesion, no history of fever, throat pain, cough or runny nose and other systemic review was unremarkable. Examination: Patient looked well, afebrile, vital signs were all with in normal. Over the left axillae there was a solitary 4 × 5 cm annular erythematous to brownish eczematous lesion covered with fine scales over the periphery of the lesions, surrounded by other smaller erythematous papules and plaques covered with fine scales that goes down to the ipsilateral trunk and one solitary plaque 2 × 3 cm over her left thigh. The right axillae, trunk and thigh were unremarkable. Wood lamp test was done over all the lesions which came negative. Investigation: Laboratory results showed a complete blood count and chemistry within the normal ranges. Bacterial cultures and titters were negative as were also viral serology, including those for herpes simplex virus 1 and 2, parvovirus B19, Cytomegalovirus (CMV), human herpes virus 6 and 7, and Epstein-Barr Virus (EBV). Skin biopsy was suggested by the physician but the parents refused as they know about the disease process. Management: Parents were educated about the disease process, skincare routine for such area, and to avoid topical irritant if any. Topical corticosteroid with miconazole was applied twice a day for two weeks, Fucidin cream twice a day for 5 days, Antihistamine syrup once a day PRN. The patient did not come to the follow-up due to (COVID 19) pandemic at the time but her mother sent us the picture of the lesion through teledermatology services. The patient is improving by our approach and all lesions have started to resolve on its own.