Persistent Groin Rash in 3-Year-Old Following Outdoor Camping Trip

Case at a Glance

A 3-year-old male presents with a persistent rash in the groin creases that developed several days after a camping trip in Arkansas. The rash consists of small, red, circular, slightly raised bumps without purulent heads, persisting for nearly two weeks despite initial assumption of insect bites.

Patient's Story

The patient is a healthy 3-year-old boy who went on a family camping trip to southwest Arkansas from June 25-29. He is not yet potty trained and wears diapers continuously. His height is approximately 38 inches and weight around 40 pounds. A few days after returning from the camping trip, parents noticed small red bumps appearing in the groin creases. Initially dismissed as possible insect bites, especially since the father had sustained multiple chigger bites during the same trip, the family expected the lesions to resolve spontaneously.

Initial Assessment

Physical examination revealed small, red, circular bumps located in the groin creases. The lesions were slightly raised without visible heads or purulent material. The rash was localized to the diaper area and groin folds. No systemic symptoms were reported.

The Diagnostic Journey

The differential diagnosis included several possibilities given the presentation and recent outdoor exposure. Chigger bites were initially considered due to the temporal relationship with camping and the father's confirmed chigger exposure. However, the persistence of lesions beyond the typical healing time for insect bites raised suspicion for other conditions. Molluscum contagiosum was considered given the characteristic appearance of small, raised bumps. Contact dermatitis or other forms of dermatitis were also in the differential, particularly given the diaper-wearing status and potential for irritation in the groin area.

Final Diagnosis

Suspected molluscum contagiosum versus contact dermatitis, with chigger bites as a less likely differential given the prolonged course.

Treatment Plan

Conservative management was recommended initially, including observation and monitoring for changes in the lesions. Topical hydrocortisone cream and fragrance-free moisturizer were suggested for a two-week trial period to address any inflammatory component or irritation.

Outcome and Follow-up

Parents were advised to monitor the lesions closely and seek medical attention if no improvement was seen after two weeks of topical treatment, or if any concerning changes developed. Follow-up with pediatric dermatology was recommended if the lesions persisted or worsened despite conservative treatment.