A 4-month-old boy, born at term, presents to a pediatric dermatology clinic for 3 months of worsening rash. At 1 month of age his parents noticed dry, red scaly patches on the head and neck, extremities, trunk, and scrotum. One month before presentation, the mother noticed “red dots” on his scalp. The rash is itchy, and his scratching resulted in intermittent bleeding initially, and later the bleeding became more significant. The mother tried treatment with clotrimazole, zinc oxide, and low-potency hydrocortisone ointment. The hydrocortisone has been the most effective at controlling the rash.

Review of systems reveals bloody stools earlier in infancy, which were attributed to milk protein allergy. The patient has not had any other episodes of easy bleeding or bruising. He was circumcised and had tongue-tie repair without excessive bleeding. His medical history is otherwise negative, and there is no family history of eczema or other skin disorders....

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