Angiokeratoma circumscriptum. This vascular ectasia may be present at birth but has been reported to develop in childhood and even adulthood. There is a higher incidence in females. Lesions are most commonly found on the lower extremities but may be found elsewhere. Lesions consist of small nodules or larger plaques characterized by a dark red to purple color and a warty, hyperkeratotic scale sometimes in a linear distribution. These lesions may bleed when traumatized.
Phytophotodermatitis. In addition to perfumes, a number of plants, grasses, fruits, and vegetables contain psoralen as a photosensitizer. The child who helps mother or father slice limes before a trip to the park may develop an identical eruption on the hands. Celery and parsley may present similar problems. It is important to recognize this entity since some affected infants and children have been mistakenly thought to have bruising from child abuse.
Hand-foot-mouth disease. This common and benign viral disease of childhood is usually caused by the A16 strain of coxsackievirus, although other strains of the same virus have been implicated. It most often occurs in late summer and early fall. The prodrome consists of low-grade fever and malaise. Shortly thereafter, vesicular lesions arise on the soft palate, tongue, buccal mucosa, and uvula. The lips are usually spared. Occasionally, these lesions may be painful and cause some difficulty in eating. The cutaneous lesions develop 1 or 2 days after those in the mouth. They consist of asymptomatic round or oval vesiculopustules that evolve into superficial erosions. The edges of the palms and soles are a favored location.