A skin rash and a green amulet

Abstract

A 4½-year-old boy presented with complaints of pruritic red rash of 3 days duration that began on the abdomen, then spread. On examination, an erythematous blanchable plaque with a few overlying vesicles and focal crusting was distributed on the upper abdomen and anterior chest. The erythematous plaque extended to the left axilla, anterior and posterior neck regions, and upper back, with few scattered lesions on forearms and face and sparing of mucous membranes and lower body ( Figure 1). The patient was started on intravenous antibiotics, oral methylprednisolone, hydroxyzine hydrochloride, and topical steroids. The rash resolved over 5 days, and the patient was discharged. His parents reported that over the past 6 months, they had placed an amulet around the child's neck, for "warding off the evil eye." Around 20 days prior to admission, the mother felt that the green cloth of the amulet was soiled, so she had it washed and removed a globular object from it, then reinserted it and sewed it back into the green cloth covering. On examination of the amulet, a green cloth covering with black stains (Figure 2), within this cloth covering, a globular object was noted (Figure 3). His mother mentioned that the black stains on the green cloth appeared recently after she manipulated the amulet in order to wash the green cloth covering. The child gave a history of occasionally putting this amulet in his mouth.