Marcus, a five-year-old boy, presents to his GP with a lesion on his forehead covering his medial right eyebrow.

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Marcus, a five-year-old boy, presents to his GP with a lesion on his forehead covering his medial right eyebrow. His parents are increasingly concerned as they have seen multiple doctors and the lesion is worsening. 

Marcus’ parents report that the rash started as red patch of dry skin around his right eye four months ago. 

The initial GP advised that the rash was eczematous and started pimecrolimus 1% cream topically. This had no effect, and his parents arranged a repeat review — during which they were advised the rash was impetigo.

Oral cefalexin and topical mupirocin were then issued. But again, these failed to help. His parents also tried topical clotrimazole but, upon seeing no improvement, sought the opinion of another GP.