Face

Early recalcitrant persistent zits

You are asked to see a 9-year-old girl with a history of asymptomatic erythematous papules on her chin and cheeks (fig. 1). She has been compulsive about applying tretinoin 0.05% cream nightly and washing with benzoyl peroxide for 4 months, and she and her mother see no improvement. She is health, and growing and developing normally. What's the diagnosis
fig. 1

Progressive papulopustular periorificial process

An unhappy mother tells you that she is not leaving the office until you make her daughter’s face normal again. The healthy 11-year-old girl has had an asymptomatic slowly progressive eruption which started around her mouth 3 years ago and spread around her nose and eyes over the last year. What’s your diagnosis?