Over the years many amazing cases have been presented during the PEMPix presentation at the American Academy of Pediatrics’ annual national Conference and Exhibition during the Section on Emergency Medicine Sessions. PEMPix Classic is a new featured series on PEMBlog that will highlight some of those classic cases.

The Case

A male toddler presents with a worsening rash of four months duration. Initially there were small blisters on the upper extremity extensor surfaces. Then it spread to the diaper area. Next, to the head and face with posterior scalp hair loss.

History is negative for fever, vomiting, diarrhea, and anorexia. He has had normal development. The family has tried several topical treatments including antibiotics, steroids, and antifungals. Three months ago, the family spent three weeks in Mexico. Otherwise there have been no relevant environmental exposures.

His examination revealed normal vitals, he is the 50th percentile for weight, and really he looks great except for his skin.

What is the diagnosis?

A. Eczema herpeticum
B. Hemophagocytic lymphohistiocytosis
C. Epidermolysis bullosa
D. Acrodermatitis enteropathica
E. Staphylococcal scalded skin syndrome