Itchy Abdominal Rash
Author: Eliza Skemp, BS
Reviewed By: Caden Carver, BS
Date: February 4, 2024
Case Presentation: A 36-year-old female presents to the clinic for complaint of an itchy rash on her abdomen that has been present intermittently for about a month. The patient is a nurse and normally wears scrubs to work; however, today she is wearing her new favorite pair of jeans that she also wore over the weekend. She denies any change in diet, new fragrances, body soaps, or lotions, but notes she recently switched laundry detergent brands. Her only medication is an albuterol inhaler for asthma. The skin exam shows multiple papules on an erythematous base localized to the periumbilical region as seen in the image above.
Question 1. What is the most likely diagnosis in this patient?
a. Atopic dermatitis
b. Allergic contact dermatitis
c. Irritant contact dermatitis
d. Herpes zoster
e. Tinea corporis
Question 2. What is the most likely source of this rash?
a. Fungal infection
b. Viral infection
c. Nickel metal allergy
d. Change in laundry detergent
e. Medication reaction
Question 3. How would you classify this type of reaction?
a. Type I hypersensitivity reaction
b. Type II hypersensitivity reaction
c. Type III hypersensitivity reaction
d. Type IV hypersensitivity reaction
Question 4. What mediates this type of reaction?
a. Direct chemical damage of the skin barrier
b. Pre sensitized T-cells
c. Preformed IgE antibodies
d. Immune complex formation
e. Dermatophyte inoculation
Question 5. What is the gold standard for a definitive diagnosis?
a. Clinical presentation
b. Allergy patch testing
c. Biopsy
d. KOH skin scraping
Question 6. What is the most appropriate treatment for this patient’s presentation?
a. Topical clobetasol
b. Oral prednisone
c. Topical clindamycin
d. Cephalexin
Question 7. What should be recommended to this patient in addition to her treatment?
a. Avoid contact with the offending agent
b. Topical emollients
c. Oral antihistamines
d. Desensitization with injections or pills
e. A, B, and C
f. All of the above
Question 8. The Patient returns one week later with signs of excoriation and honey colored crusting to the lesions. Which of the following is the most likely diagnosis?
a. Cellulitis
b. Impetigo
c. Seborrheic dermatitis
d. Erysipelas
Question 9. What pathogen is most commonly responsible for this infection?
a. Streptococcus Agalactiae
b. Streptococcus Pyogenes
c. Staphylococcus Aureus
d. Staphylococcus Epidermidis
Question 10. What is the most appropriate treatment for this secondary infection?
a. Oral cephalexin
b. Oral doxycycline
c. Topical mupirocin
d. Topical retinoid
Answer Key: 1.B, 2. C, 3. D, 4. B, 5. B, 6. A, 7. E, 8. B, 9. C, 10. C
References:
Nardi NM, Schaefer TJ. Impetigo. [Updated 2023 July 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Accessed January 28,2024. https://www.ncbi.nlm.nih.gov/books/NBK430974/
Rishor-Olney CR, Gnugnoli DM. Nickel Allergy. [Updated 2023 Jul 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Accessed January 28, 2024. https://www.ncbi.nlm.nih.gov/books/NBK557638/
Murphy PB, Atwater AR, Mueller M. Allergic Contact Dermatitis. [Updated 2023 Jul 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Accessed January 28, 2024. https://www.ncbi.nlm.nih.gov/books/NBK532866/
