Why has this red rash resisted topical antifungals?

A topical antifungal cream has not cleared the red, bumpy rash on a 6-year-old girl’s chin and paranasal area. What are you looking at here? 

A. Contact dermatitis.
B. Acne.
C. Rosacea.
D. Perioral dermatitis.
E. Atopic dermatitis.

Answer and discussion on next page.

 
Answer: Perioral dermatitis
This child had perioral dermatitis, D. Acne generally does not occur before age 9; rosacea rarely affects children. The sudden onset of atopic dermatitis in a 6-year-old would be highly unusual. Contact dermatitis is more pruritic. The most common cause of perioral dermatitis in children is an ingredient that is added to toothpaste, such as a tartar-control agent, baking soda, whitener, flavoring, or coloring. Typically, removing the offending dentifrice and substituting a plain, white toothpaste is all that is needed.