Circular Erythematous Lesions at Hairline in Toddler

Case at a Glance

An 18-month-old male presented with two circular, pink lesions near the hairline that developed over a two-week period, initially appearing as small punctate marks before enlarging to approximately 10mm in diameter.

Patient's Story

The parents noticed small dot-like lesions appearing near their toddler's hairline approximately two weeks prior to presentation. Initially resembling insect bites, these lesions gradually enlarged, with the largest reaching the size of a dime (approximately 10mm). The child showed no signs of discomfort, did not scratch or touch the affected areas, and maintained normal behavior and activity levels. The family has two dogs at home, the child attends daycare regularly, and occasionally plays in their backyard. No recent travel or new exposures were reported.

Initial Assessment

Physical examination revealed two well-demarcated, circular, pink lesions located near the hairline. The lesions appeared dry with symmetrical borders and demonstrated central clearing with normal pigmentation in the middle and no associated scaling or flaking. The child appeared well and showed no signs of systemic illness. Thorough examination of the scalp with hair parting revealed no additional lesions.

The Diagnostic Journey

The clinical presentation of circular lesions with central clearing raised suspicion for dermatophyte infection (tinea capitis). Differential diagnosis included other causes of circular rashes such as nummular eczema, granuloma annulare, or insect bite reactions. The location at the hairline, the characteristic morphology with central clearing, and the gradual expansion over time were consistent with fungal etiology.

Final Diagnosis

Clinical diagnosis of tinea capitis (scalp ringworm) based on characteristic appearance and location of lesions.

Treatment Plan

Topical antifungal therapy was initiated with close monitoring for treatment response. Parents were educated about the contagious nature of the condition and appropriate hygiene measures. Follow-up was scheduled to assess treatment efficacy and monitor for additional lesions.

Outcome and Follow-up

The patient was referred for pediatric dermatology consultation for confirmation of diagnosis and optimization of treatment regimen. Parents were advised to monitor for new lesions and ensure proper hygiene practices to prevent spread to family members or daycare contacts.