Non-Resolving Dermatitis in a 9-Year-Old Boy

July 9, 2013

A pruritic rash of 1 week's duration on the boy's elbows, knees, back, and legs did not respond to oral prednisone.

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees (Figure), back, and legs. He described the rash as itching to the point of waking him from sleep, and several areas of excoriation were noted. He had recently run through a field of tall grass but denied any other exposure history. He played in an after-school football league and the family has 1 dog in the home that has been with them for many years and has no evidence of infection or infestation. The review of systems was otherwise negative, and the patient was sent home with a brief course of oral prednisone.

He returned 4 days later with worsening symptoms.

Given the history of present illness and the images above, which of the following is the most likely diagnosis?

A.  Scabies
B.  Atopic dermatitis
C.  Guttate psoriasis
D.  Nummular eczema
E.  Folliculitis

Please choose your answer and offer your rationale in the comment section below?

Then click here for answer and discussion...