Punched‐out erosions with scalloped borders: Group A Streptococcal pustulosis

Abstract

We present a case of an infant with severe atopic dermatitis infected with Streptococcus pyogenes who presented with pustules, honey‐colored crusts, and punched‐out erosions with scalloped borders mimicking eczema herpeticum or eczema coxsackium. We draw attention to this case to highlight the similar clinical appearance between bacterial and viral infections in the setting of atopic dermatitis and the importance of a broad workup and coverage while awaiting results.

The infectious complications of atopic dermatitis

“…The lesions may appear as punched-out erosions with scalloped borders that mimic EH. 25 Although SSTI and systemic infections in AD present with overt signs that facilitate diagnosis and antibiotic treatment, the so-called infected eczema associated AD exacerbation is not as clearly defined. 26 Patients with severe AD exacerbation tend to have more generalized cutaneous signs and symptoms.…”

Complete blood count profiles in children with eczema herpeticum

“…1 The clinical diagnosis of EH may be challenging as the morphology of EH may be mistaken for AD exacerbation and bacterial infection. 2 Difficulty in diagnosis may impact treatment decisions, while confirmatory testing for herpes simplex virus (HSV) is pending.…”

“…For example, streptococcal pustulosis may present with punched scalloped borders that mimic EH. 2 Large studies of EH in children are rare. Our results corroborate Wollenberg et al's finding that lymphopenia is more pronounced in patients with EH.…”

Complete blood count profiles in children with eczema herpeticum

“…Our current findings may have clinical implications for treatment when CBC profiles are taken together with physical examination as EH may be difficult to distinguish from some bacterial skin infections. For example, streptococcal pustulosis may present with punched scalloped borders that mimic EH (2).…”