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Crusting and Hyperkeratosis in an Infant

Question:
Rajesh Kumar Meena*, Sanghamitra Ray**, Prakash Chand Jain**
*Department of Pediatrics, North DMC Medical College, Hindurao Hospital, New Delhi, India, **Department of Pediatrics, Dr BSA Medical College and Hospital, New Delhi, India.

Address for Correspondence: Dr. Sanghamitra Ray (M.D. Pediatrics), Flat No- 176, Pocket-1, Sector 1, Dwarka, New Delhi 110075. India. Email: dr.sanghamitra.ray@gmail.com

A 5 months old female infant presented with generalized rash over the body. She was born of normal vaginal delivery with uneventful antenatal and post-natal period. She was exclusively breast fed and did not suffer from any previous medical illness. Both parents were illiterate and from a lower socio-economic status and had very poor hygiene. On evaluation pleomorphic rash all over the body consisting of macule, papule and vesicular rash with severe crusting and hyperkeratosis was seen (Fig 1). Routine investigations of the baby were mostly unremarkable except for slightly raised leucocyte count with eosinophilia. Mother had tested negative for syphilis and HIV during antenatal period.

Figure 1: Crusting and hyperkeratosis over the cheek

What is the diagnosis?