Case 2: How would you treat this pruritic eruption that resists topical corticosteroids?

July 6, 2009

For the past year, a 15-year-old boy has had a pruritic eruption on his shins. His mother suspects that his soccer shin guards are the cause; however, he wears them over his socks. Topical corticosteroids have not been effective.

For the past year, a 15-year-old boy has had a pruritic eruption on his shins. His mother suspects that his soccer shin guards are the cause; however, he wears them over his socks. Topical corticosteroids have not been effective.

The patient has a family history of seasonal allergies.

What is your clinical impression?

A. Atopic dermatitis.
B. Dermatophyte infection.
C. Staphylococcal infection.
D. Contact dermatitis.
E. Folliculitis.

(answers on next page)

Case 2: Atopic dermatitis

The legs of this patient with atopy, A, were irritated by his shin guards, which resulted in an itchy sensation and subsequent scratching. Because the rash had not responded to topical corticosteroids, the boy was given ultra thin hydrocolloid dressing (Duoderm Extra Thin) to wear when he played soccer.

Staphylococcal infections are typically painful. Unlike the eruption in this patient, folliculitis features multiple erythematous papules and pustules. Contact dermatitis can be patchy, although the pattern seen in this patient would not be typical. The presence of multiple lesions would be unusual for a dermatophyte infection.