Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at NSU
A 3-month-old girl is at the allergy clinic for evaluation of rash. She has had recurrent erythematous macular rash (1-2 mm in size) affecting his chin, below chin area, back of the neck and extremities. She is breastfed. She also has episodic nasal congestion.
Family Medical History: Father with allergic rhinitis.
Social History: They have a pet cat.
Physical Examination: Skin: macular rash (1-2 mm in size) affecting his below chin area, and back of the neck (3-4 lesions in each area).
What is the likely diagnosis?
Miliaria rubra.
Family is interested in allergy testing. Percutaneous skin testing with indoor, outdoor, and food allergens is negative. Airborne allergens: Negative for Dust mite, Cat, Dog, Cockroach, Mold mix with 10 molds. Food allergens: Negative for Tree nuts, Egg, Milk, Peanut, Soy, Wheat, Fish, Shellfish.
Miliaria rubra is also known as heat rash. No evidence of atopic or seborrheic dermatitis at this time. No evidence that food or airborne allergens play a role in the rash. Skin testing has approximately 30% better sensitivity than serum IgE (Cleveland Clinic J of Med, 2011, 78-9), and a negative skin test typically rules out environmental or food sensitization in approximately 90% of patients.
What would you recommend for treatment of miliaria rubra, also known as heat rash?
Regarding Miliaria rubra, avoidance of overheating, removal of excess clothing, cooling baths, and air conditioning are recommended for management and prevention of these related disorders.
For mild exacerbations, they can try topical hydrocortisone 1% for up to 1-3 weeks.
References
The Generalized Rash http://buff.ly/1nvYMGM and http://buff.ly/1n61l48 - 2 part series from Am Fam Physician (PDF)
Newborn Skin: Common Rashes and Birthmarks http://buff.ly/1nvYXSI and http://buff.ly/1nvZ68C - 2 part series from Am Fam Physician (PDF)
Published: 05-12-2013
Updated: 05-28-2014
Showing posts with label Rash. Show all posts
Showing posts with label Rash. Show all posts
Mind Maps: Atopic Dermatitis
Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist
Allergic (atopic) march (click here to enlarge the image).
Published: 01/24/2010
Updated: 02/03/2012
Reviewer: S. Randhawa, M.D., Allergist/Immunologist
Atopic Dermatitis Treatment - Illustrated (click here for full size image).
Allergic (atopic) march (click here to enlarge the image).
Related reading
A simplified, stepwise algorithm for the treatment of AD. Allergy, Asthma & Clinical Immunology 2011 7(Suppl 1):S4.
A simplified, stepwise algorithm for the treatment of AD. Allergy, Asthma & Clinical Immunology 2011 7(Suppl 1):S4.
Adult atopic eczema - from patient's and doctor's practical point of view - BMJ, 2011.
Published: 01/24/2010
Updated: 02/03/2012
Irritant contact dermatitis
Author: V. Dimov, M.D., Fellow, Creighton University Division of Allergy & Immunology
Reviewer: S. Randhawa, M.D., Fellow, LSU (Shreveport) Department of Allergy & Immunology
A 27-year-old female is self-referred to our clinic for evaluation of skin rash, maculopapular and pruritic which affects both hands, forearms, and the lower portion of her neck. She has had the rash for four months.
She works as a manual laborer at a parcel courier service, moving boxes. Apart from the rash, she does not report any other symptoms. The skin rash started 4 months ago. She is not on any medications and does not have any significant past medical history.
She wants to have "skin prick testing done for allergies."
Physical examination
The physical examination is positive for maculopapular rash and xerosis affecting both hands, forearms, and the lower portion of the neck.
What is the most likely diagnosis?
This is a patient with contact dermatitis which is most likely of irritant etiology. It is likely that her hands are in contact with the irritant substance and then she gets lesions wherever she scratches her skin with the contaminated hands, mostly on the forearms and lower portion of the neck.
What treatment would you suggest?
We prescribed prednisone 40 mg po daily for 5 days and hydrocortisone 1% ointment daily for 7 days and also we advised her to use skin moisturizers twice a day.
What did we learn from this case?
The occurrence of a rash on the neck and forearms does not mean that the rash originated there. Often, in the case of irritant allergic dermatitis, the irritant substance on the person's fingers and nails can cause a rash wherever they touch their skin or scratch.
One example is a patient who complains of rash affecting the eyelids which is actually caused by the nail polish applied to the fingernails. Many of these patients have lengthy evaluations for periorbital rashs while the correct diagnosis is irritant contacts dermatitis of the hands with a secondary spread to the periorbital area.
Published: 02/23/2010
Updated: 02/23/2010
Reviewer: S. Randhawa, M.D., Fellow, LSU (Shreveport) Department of Allergy & Immunology
A 27-year-old female is self-referred to our clinic for evaluation of skin rash, maculopapular and pruritic which affects both hands, forearms, and the lower portion of her neck. She has had the rash for four months.
She works as a manual laborer at a parcel courier service, moving boxes. Apart from the rash, she does not report any other symptoms. The skin rash started 4 months ago. She is not on any medications and does not have any significant past medical history.
She wants to have "skin prick testing done for allergies."
Physical examination
The physical examination is positive for maculopapular rash and xerosis affecting both hands, forearms, and the lower portion of the neck.
What is the most likely diagnosis?
This is a patient with contact dermatitis which is most likely of irritant etiology. It is likely that her hands are in contact with the irritant substance and then she gets lesions wherever she scratches her skin with the contaminated hands, mostly on the forearms and lower portion of the neck.
What treatment would you suggest?
We prescribed prednisone 40 mg po daily for 5 days and hydrocortisone 1% ointment daily for 7 days and also we advised her to use skin moisturizers twice a day.
What did we learn from this case?
The occurrence of a rash on the neck and forearms does not mean that the rash originated there. Often, in the case of irritant allergic dermatitis, the irritant substance on the person's fingers and nails can cause a rash wherever they touch their skin or scratch.
One example is a patient who complains of rash affecting the eyelids which is actually caused by the nail polish applied to the fingernails. Many of these patients have lengthy evaluations for periorbital rashs while the correct diagnosis is irritant contacts dermatitis of the hands with a secondary spread to the periorbital area.
Published: 02/23/2010
Updated: 02/23/2010
Irritant contact dermatitis to acne medication that contains benzoyl peroxide
Author: V. Dimov, M.D., Fellow, Creighton University Division of Allergy & Immunology
Reviewer: S. Randhawa, M.D., Fellow, LSU (Shreveport) Department of Allergy & Immunology
A 25-year-old Caucasian female developed worsening symptoms of facial dermatitis during the last 3 months. She started using over-the-counter hydrocortisone cream yesterday and her symptoms are better now. This is the third episode of similar complaints in the last 3 months. She reports long term use of the acne cream Proactiv, which contains benzyl peroxide, and she also uses Eucerin lotion on her face.
Medications
Her medications include Allegra (fexofenadine), Flonase (fluticasone nasal) and levothyroxine. Proactiv and Eucerin.
Past medical history
She has a long history of allergic rhinitis and conjunctivitis.
Physical examination
The physical examination is positive for facial erythema with some eyelid eczema.
What is the most likely diagnosis?
Facial dermatitis related to Proactiv, containing benzoyl peroxide. The etiology of the dermatitis is either irritant or allergic contact dermatitis to benzoyl
peroxide. Considering that she had two prior episodes that resolved and the rash is not worsening now, the most likely explanation for her condition is irritant contact dermatitis to benzoyl peroxide.
What treatment would you suggest?
The patient was advised to use hydrocortisone at the lowest of concentration of 1%, daily, on the face, for a week. She had to stop using Proactiv immediately. She could still use Eucerin daily.
Final diagnosis
Irritant contact dermatitis to acne medication that contains benzoyl peroxide.
Benzoyl peroxide (BP) is shown to be a weak allergen. In a study of 25 guinea pigs, only 5 were sensitized in the TINA test. BP is a skin irritant. However, only 11 of 155 acne patients had clinical signs of intolerance, which settled despite continued use in 10 cases.
References
Purpuric contact dermatitis to benzoyl peroxide. van Joost T, van Ulsen J, Vuzevski VD, Naafs B, Tank B. J Am Acad Dermatol. 1990 Feb;22(2 Pt 2):359-61.
Allergic contact angioedema to benzoyl peroxide. Minciullo PL, Patafi M, Giannetto L, Ferlazzo B, Trombetta D, Saija A, Gangemi S. J Clin Pharm Ther. 2006 Aug;31(4):385-7.
Allergic and irritant potential of benzoyl peroxide. Haustein UF, Tegetmeyer L, Ziegler V. Contact Dermatitis. 1985 Oct;13(4):252-7.
Contact dermatitis due to benzoyl peroxide. Morelli R, Lanzarini M, Vincenzi C, Reggiani M. Contact Dermatitis. 1989 Mar;20(3):238-9.
Related YouTube videos
Published: 01/30/2010
Updated: 01/30/2010
Reviewer: S. Randhawa, M.D., Fellow, LSU (Shreveport) Department of Allergy & Immunology
A 25-year-old Caucasian female developed worsening symptoms of facial dermatitis during the last 3 months. She started using over-the-counter hydrocortisone cream yesterday and her symptoms are better now. This is the third episode of similar complaints in the last 3 months. She reports long term use of the acne cream Proactiv, which contains benzyl peroxide, and she also uses Eucerin lotion on her face.
Medications
Her medications include Allegra (fexofenadine), Flonase (fluticasone nasal) and levothyroxine. Proactiv and Eucerin.
Past medical history
She has a long history of allergic rhinitis and conjunctivitis.
Physical examination
The physical examination is positive for facial erythema with some eyelid eczema.
What is the most likely diagnosis?
Facial dermatitis related to Proactiv, containing benzoyl peroxide. The etiology of the dermatitis is either irritant or allergic contact dermatitis to benzoyl
peroxide. Considering that she had two prior episodes that resolved and the rash is not worsening now, the most likely explanation for her condition is irritant contact dermatitis to benzoyl peroxide.
What treatment would you suggest?
The patient was advised to use hydrocortisone at the lowest of concentration of 1%, daily, on the face, for a week. She had to stop using Proactiv immediately. She could still use Eucerin daily.
Final diagnosis
Irritant contact dermatitis to acne medication that contains benzoyl peroxide.
Benzoyl peroxide (BP) is shown to be a weak allergen. In a study of 25 guinea pigs, only 5 were sensitized in the TINA test. BP is a skin irritant. However, only 11 of 155 acne patients had clinical signs of intolerance, which settled despite continued use in 10 cases.
References
Purpuric contact dermatitis to benzoyl peroxide. van Joost T, van Ulsen J, Vuzevski VD, Naafs B, Tank B. J Am Acad Dermatol. 1990 Feb;22(2 Pt 2):359-61.
Allergic contact angioedema to benzoyl peroxide. Minciullo PL, Patafi M, Giannetto L, Ferlazzo B, Trombetta D, Saija A, Gangemi S. J Clin Pharm Ther. 2006 Aug;31(4):385-7.
Allergic and irritant potential of benzoyl peroxide. Haustein UF, Tegetmeyer L, Ziegler V. Contact Dermatitis. 1985 Oct;13(4):252-7.
Contact dermatitis due to benzoyl peroxide. Morelli R, Lanzarini M, Vincenzi C, Reggiani M. Contact Dermatitis. 1989 Mar;20(3):238-9.
Related YouTube videos
Published: 01/30/2010
Updated: 01/30/2010
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