Peculiar pattern over the deltoid
Patel DP, Shwayder T. Peculiar pattern over the deltoid. Pediatr Dermatol 2017; 34(Suppl 1):S172-S173.
A 10 month old Korean girl, who recently immigrated to the United States, presented for management of multiple infantile hemangiomas. On physical exam, she was noted to have two groups of nine parallel slightly depressed erythematous macules on the upper left deltoid. Thelesions represent a scar caused by the Bacille Calmette-Gurein (BCG) vaccine administered to this patient on day 80 of life with a percutaneous, multipuncture device. The vaccine is not administered in the United States, yet is utilized in parts of the world where Mycobacterium tuberculosis is endemic. In fact, the scars from the multi puncture tool may be used to establish the nationalities of unidentified cadavers as the scar is distinct from scars seen with the intradermal administration. To date, Japan, the United Kingdom and South Africa have solely used the multi puncture method, and it has been partially used in the Republic of Korea and Brazil. While a sign of successful vaccination around the world, the scar is uncommonly seen by dermatologists outside of these countries. We suggest physicians reassure parents that this is the normal response to the vaccination and that there is no concern for non accidental injury or pathological process.