How would you treat this asymptomatic rash?

A 7-year-old female presented for evaluation of an asymptomatic rash on her legs of a few days duration. She is otherwise healthy and denies any new exposures.

How would you treat this patient?

A. Just reassure the parents
B. Skin biopsy 
C. Blood work for bleeding tendencies
D. Abdominal ultrasound of the abdomen
E. Start tetracycline class antibiotics

(Answer and discussion on next page)

Answer: Just reassure the parents

This patient has Majocchi’s purpura or benign pigmented purpura. This benign lymphocytic capillaritis is of unknown etiology and can appear alarming. A skin biopsy will confirm the diagnosis when the clinical diagnosis is uncertain. Both blood work for bleeding dyscrasias and an ultrasound to detect an enlarged spleen would be normal. Tetracycline class antibiotics are helpful to diagnose Rocky Mountain spotted fever or other tick born diseases. A topical steroid may hasten the healing process, but no treatment is necessary.