Q: My child is a three-year-old male and has had several rashes on his legs only that are of a circular shape but not ringworm or eczema. They have not responded to topical fungal ointments. We also rushed him to the ER with a fever-induced seizure and he has had occasional fevers since that time. The fevers will just pop out of nowhere and spike very high. We’ve also noticed arrhythmias.
I have an appointment with the doctor in one month. Do you know what questions I should be asking? I am concerned and looking for advice and hope you could send me in a specific direction. I also wonder if it could be caused from a systemic fungal infection or from Lyme disease. I’m concerned for my child’s health and welfare. Thanks.
A: As a general rule, ringworm responds well to anti-fungal medication such as Lotrimin, with improvement observed in 7 to 10 days in some, yet it may take up to a month of treatment for others. Resistant cases, particularly with this medication, might require scrapings sent for culture that may ultimately require a different anti-fungal be tried.
This allows you to broaden the scope of things and consider such things as granuloma annulare (GA) which presents with flesh-colored bumps or lesions appearing in a ring that strongly resembles ringworm. The most prominent areas of the body for this to appear are on the sides and backs of the hands or feet. While the bumps may take on a red hue in the beginning, the red color will disappear as the ring forms. Incidentally, the rings will be anywhere from ¼ inch to 2 inches in diameter. There will likely be no itch or scaling involved. The condition commonly disappears spontaneously but may also recur – often at the original site. The lesions may respond to topical steroid ointments or sterile saline injections but your son is so young that the first treatment may not be appropriate for him and perhaps the latter won’t either. More importantly, if ganuloma annulare is a consideration, your son should be evaluated by a dermatologist because of the associated diseases found with GA.
Then there is nummular eczema which is often confused with ringworm. The condition is exacerbated by soaps, bathing and by itchy clothing that rubs against the lesions that are round, dry, and scaly. Treatment for this form of eczema is accomplished by limiting bathing, using moisturizers that are alcohol free, and using topical steroid creams. In this instance, the lesions may recur but not at the original site.
To be considered is psoriasis (unlikely because of his young age), pityriasis, erythema migrans (found in cases of Lyme disease), or lupus. These conditions may be identified or ruled out through a skin biopsy.
Your son should be seen by a pediatric dermatologist who might shed some light on the situation. When you call for an appointment, be sure to indicate you would like to have him seen when he has full blown lesions on his body. He also should be seen by a pediatric cardiologist in the very near future who can perform a complete medical examination and take a history from you so a determination can be made as to whether there is a correlation between the arrhythmias, fevers, seizure, and the rash.
