Case 071: Dermatitis

PATIENT PRESENTATION

Chief Complaint

“Help! I have bumps on my neck and arms that get worse when I’m in the sun.”

History of Present Illness

Jessie is a 35-year-old Hispanic female that presents to clinic with complaints of pruritic papules along the posterior of her neck and right forearm. She states she used to get them as a child when she went to the beach, but they never really bothered her until she recently moved.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs/symptoms of atopic dermatitis is Jessie exhibiting?

   Hint: See Atopic Dermatitis in PPP

2. What comorbidities does Jessie have that are related to “atopic triad”?

   Hint: See Atopic Dermatitis in PPP

3. List 5 reasonably expected outcomes Jessie can expect from treatment of her AD.

   Hint: See Atopic Dermatitis in PPP

4. Enumerate 3 non-pharmacological treatments Jessie can implement to improve her AD.

   Hint: See Atopic Dermatitis in PPP

5. What should be considered first line pharmacological therapy for treatment of Jessie’s AD? Be sure to list the dosage form, route, dose/strength, and frequency.

   Hint: See Atopic Dermatitis in PPP

FOLLOW-UP

Four weeks later, Jessie returns and states that she is now pregnant. Can she continue using her current therapy? Why or why not? What agents used for treatment of AD are contraindicated in pregnancy?

Hint: See Diaper Dermatitis in PPP

CASE SUMMARY

Global Perspective

Atopic Dermatitis (AD) is a common skin issue that is usually associated with pruritic rashes. It is also known as Eczema. The presentation of the rashes can differ based on the age of the patient, as well as other factors. Infants typically present with lesions on the face, scalp, neck, trunk, and antecubital surfaces. In childhood, face and scalp lesions are less common, while in adulthood, lesions are usually present on antecubital surfaces, and the hands and feet. AD is often associated with other allergic issues, such as allergic rhinitis, and asthma. Its incidence is increasing worldwide, especially in more industrialized countries. While patients can often identify triggers (dust mites, pollen, skin infection, certain soaps/detergents, hot and cold temperatures, changes in humidity) often it is difficult to identify one trigger and remove it, warranting the need for pharmacological therapy.

Key References