Photo by javaistan from unsplash
A 5-year-old girl was presented with a hyperkeratotic lesion on the left buttock present for greater than 1 year. Her mother stated that the lesion would fluctuate in size and… Click to show full abstract
A 5-year-old girl was presented with a hyperkeratotic lesion on the left buttock present for greater than 1 year. Her mother stated that the lesion would fluctuate in size and color. The patient complained of occasional pain at the site. They also reported a large, pigmented patch on the trunk that was present since birth. The child had no systemic symptoms. She was otherwise healthy and met all developmental milestones. Mupirocin ointment had been tried without improvement. The lesion was a brown plaque, measuring 3 1.5 cm in diameter, with a keratotic center and a violaceous rim (Figure 1). Full skin examination also revealed a large, geographic, tan patch at the left axilla/trunk with three to four smaller brown macules within the patch, consistent with café au lait spots. The child had no other cutaneous findings. A shave biopsy of the hyperkeratotic lesion was performed (Figures 2 and 3).