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Patient Case: Contact Dermatitis

Patient Case: Contact Dermatitis

Discussion

A 27-year-old female presents with a two-week history of a red, itchy rash on her face and hands. The rash started a few days after she began using a new scented moisturizer. She describes burning and stinging sensations, especially after washing her face. The symptoms improve slightly when she stops using the product but return whenever she applies it again.

She has no personal or family history of atopic dermatitis, asthma, or allergic rhinitis. She denies any recent illness or medication changes.

On examination, there are well-demarcated, erythematous patches with mild swelling and scaling on her cheeks and the backs of her hands. Some areas show excoriations from scratching. There are no vesicles or signs of infection. A clinical diagnosis of contact dermatitis is made.

She is advised to discontinue the suspected product, use gentle, fragrance-free emollients, and apply a low-potency topical corticosteroid to reduce inflammation. She is also counseled on identifying and avoiding potential irritants in skincare products.

Questions
1. What is the most likely diagnosis in this patient?

a) Atopic dermatitis
b) Seborrheic dermatitis
c) Contact dermatitis
d) Psoriasis

2. Which of the following best supports the diagnosis of contact dermatitis?

a) Chronic rash in flexural areas with a history of asthma
b) Rash triggered by a new skincare product and improving after discontinuation
c) Greasy, yellow scales on the scalp and eyebrows
d) Thick, silvery plaques on extensor surfaces

3. What is the most appropriate initial management for this patient?

a) Continue using the moisturizer to "build tolerance"
b) Discontinue the suspected product and use topical corticosteroids
c) Treat with oral antifungal medication
d) Apply systemic corticosteroids as first-line therapy

4. Which of the following is the best strategy to prevent future episodes?

a) Avoid all skin products permanently
b) Use mild, fragrance-free skincare products and patch test new products
c) Take daily oral antihistamines indefinitely
d) Apply over-the-counter antibiotic creams regularly

Reveal answers

Answers

  1. (c) Contact dermatitis
    • The rash developing after exposure to a new skincare product, along with burning and stinging sensations, strongly suggests contact dermatitis. Atopic dermatitis (a) is more chronic and often associated with asthma or allergic rhinitis. Seborrheic dermatitis (b) presents with greasy, yellowish scales, and psoriasis (d) typically has thick, silvery plaques.
  2. (b) Rash triggered by a new skincare product and improving after discontinuation
    • Contact dermatitis is characterized by a clear link between exposure to an irritant/allergen and skin reaction. Atopic dermatitis (a) is usually chronic with a history of atopy. Seborrheic dermatitis (c) affects oily areas, and psoriasis (d) features persistent plaques rather than acute reactions to a product.
  3. (b) Discontinue the suspected product and use topical corticosteroids
    • The first step in managing contact dermatitis is to remove the trigger (the scented moisturizer). Low-potency topical corticosteroids help reduce inflammation. Building tolerance (a) is not recommended, oral antifungals (c) are not needed, and systemic corticosteroids (d) are only for severe, widespread cases.
  4. (b) Use mild, fragrance-free skincare products and patch test new products
    • The best way to prevent contact dermatitis is to avoid irritants and patch test new products before full application. Avoiding all skin products (a) is unnecessary, daily antihistamines (c) are not needed unless there is an allergic component, and antibiotic creams (d) are only required if secondary infection occurs.

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