Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
A 2-year-old child has had red, weeping, crusted lesions of the face, scalp, diaper area, and extremities since about age 2 months, with multiple periods of exacerbation and improvement. Attempts to remove potentially irritating substances have not appeared to modify the course of the rashes. The baby is noted to be constantly scratching and rubbing involved areas. There is a strong family history of hay fever and asthma. Which of the following is the most likely diagnosis?
Options:
A. Atopic dermatitis
B. Cellulitis
C. Contact dermatitis
D. Lichen simplex chronicus
E. Seborrheic dermatitis
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
A is correct sali.
This is atopic dermatitis. The presentation illustrated is typical for babies. Secondary bacterial infections and regional lymphadenitis may complicate the clinical picture. The dermatitis often improves by age 3 or 4, but periodic exacerbations may continue to occur into adulthood. Older children and adults tend to have more localized lesions, typically with erythema and lichenification. Common sites of involvement in older children and adults include the antecubital and popliteal fossas, eyelids, neck, and wrists. Once the diagnosis is made, the physician must remember not to make the mistake of automatically attributing all subsequent skin lesions the children develop to the atopic dermatitis, since they remain vulnerable to all other dermatologic diseases as well.
Cellulitis (choice B) is a streptococcal, or less commonly staphylococcal, acute infection of
subcutaneous tissues that causes local erythema, tenderness, and frequently lymphangitis and regional lymphadenopathy. The skin is usually warm, edematous, and erythematous, and may exhibit a "peau d'orange" (orange peel) appearance.
Contact dermatitis (choice C) can resemble atopic dermatitis on the initial evaluation of the patient, but the long history illustrated in the question stem would not be typical of contact dermatitis.
Lichen simplex chronicus (choice D) is characterized by itchy, dry skin that may progress to
well-demarcated, hyperpigmented, lichenified plaques of oval, irregular, or angular shape.
Seborrheic dermatitis (choice E) is an inflammatory scaling disease, usually affecting the scalp and face. It may initially resemble atopic dermatitis in infants, but, unlike atopic dermatitis, it tends to remain confined to the head and scalp. (The diaper area may be initially involved, but this usually clears with time.)
