Indie is a three-year-old girl with pruritic erythema on the face and extremities present from the age of 18 months, when she weaned from breastmilk.

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<p>Indie is a three-year-old girl with pruritic erythema on the face and extremities present from the age of 18 months, when she weaned from breastmilk.</p><p>Atopic dermatitis has been diagnosed but treatment with topical steroids/tacrolimus and emollients have had no effect, despite good adherence. There is associated intermittent diarrhoea, fatigue and hair loss.</p><p>Indie was born at term, vaginally, and eats a varied diet. Developmental milestones are within the expected range.</p><p>Her younger brother has similar milder symptoms. No other family members are affected.</p><p>On examination, weight and height are on the third centile. There are scaly erythematous plaques involving the fingers and toes, inner canthus and perioral and perinasal areas (pictured).</p><p>Blood tests show a mild normocytic normochromic anaemia, leucopenia and reduced ALP, with otherwise normal LFT, EUC, iron studies, B12, coeliac serology and immunoglobulin E.&nbsp;</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.