Asymptomatic facial rash in a boy

Case history

An 8-year-old boy presents with an asymptomatic but unsightly facial rash that has been present for nine months (Figure 1). It is confined to the skin around his mouth, on the sides of his nose and below his eyes (where there are a few papules).

When the rash first appeared, the patient was treated with 1% hydrocortisone cream. This suppressed the rash initially, but when treatment was ceased the rash recurred and subsequently became resistant to the cream. Topical miconazole was ineffective. Topical mometasone furoate 0.1% cream was initiated. Again there was a good initial response, but this was lost with ongoing treatment and attempts to cease the treatment resulted in increasingly severe flares of the rash.