Derm Dx: Linear, streaky vesicles at birth

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An infant in the pediatric clinic has been exhibiting interesting skin findings. At birth, she had a linear and streaky distribution of vesicles on her trunk and extremities, which subsequently progressed to verrucous plaques at age 2 months and hyperpigmented streaks at age 5 months.

The infant appears to have a small patch of alopecia at the scalp crown. The patient underwent an MRI after birth, which demonstrated that she likely had a small right frontal stroke, but otherwise she is neurologically intact.

An ophthalmologic examination is normal. The patient’s CBC and complete metabolic panel after birth were significant only for a peripheral eosinophilia. An examination of the mother demonstrates pigmented streaks on the trunk and leg (image below).

View the slideshow for images of the patient’s physical exam findings at various time points. What’s your diagnosis?

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