Patient's Query
Hello doctor,
My 4-year-old daughter has patches on her skin with a red border. She was previously treated for Lyme disease, but the spots did not disappear.
When a patch appears, it stays for some time and then slowly fades away, but later a new one appears in a different place. What could this be, and should we pursue further testing or treatment?
She is on a diet without milk; she had dermatitis when she was a baby.
Kindly suggest.
Hello,
Welcome to icliniq.com.
I understand your concern.
Thank you so much for sharing your concern with me.
Based on the appearance in the photo (the attachment was removed to protect the patient's identity) and the history you describe, the skin patches are most consistent with granuloma annulare, a benign and fairly common condition in young children.
It typically presents as ring-shaped or annular patches with a pink or red border and a smooth surface, without scaling, pain, or itching.
The course you describe, where a patch appears, remains for some time, gradually fades, and later a new lesion develops at a different site, very characteristic of this condition.
It is also more commonly seen in children with a background of atopy or early childhood dermatitis, which fits your daughter’s history. Although she was previously treated for Lyme disease, this pattern is not typical of Lyme-related skin lesions.
Erythema migrans associated with Lyme disease usually enlarges progressively and resolves after appropriate antibiotic treatment, rather than recurring intermittently in different locations over time.
Therefore, in the absence of other systemic symptoms, further Lyme testing is not necessary.
Other causes, such as fungal infection or erythema multiforme, are less likely, as those conditions usually involve scaling, itching, or a more acute onset.
Granuloma annulare is a harmless, self-limiting condition, and in most children, it resolves spontaneously over months to a few years without leaving scars.
No routine blood tests or biopsies are required in typical cases. Treatment is usually not needed, although a short course of a mild topical corticosteroid may be considered if the lesions are cosmetically concerning.
You can apply one percent Hydrocortisone cream just on the affected area at bedtime for seven days only; do not exceed this.
Overall, there is nothing to be worried about.
I hope it helps with your query.
For more queries, feel free to reach out to me anytime.
Thank you.
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Answered byDr. Misha Saghir
Medically reviewed byiCliniq medical review team
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