An 8-year-old girl with trisomy 21 presents with 2 weeks of a rapidly spreading scaly and intensely pruritic rash involving the entire body that is particularly prevalent on her hands and feet. Approximately 6 months ago, the patient’s mother noted white pruritic plaques beginning on the palmar surfaces of both of her daughter’s hands. She was given a diagnosis of eczema by her pediatrician. After failing to improve over a period of 1 month with hydrating creams, she was referred to a dermatologist, who also diagnosed eczema. The patient was given triamcinolone cream, and over 4 months, the rash showed initial improvement. However, it then quickly spread to the chest, axillae, legs, and scalp over 2 weeks, prompting the parents to seek further medical attention.

Upon presentation to our hospital, the patient is febrile and diffusely pruritic. There are irregularly thick white plaques over the palmar surfaces of the hands,...

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