Simple cases

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Case 5

35-year-old woman presents with an acute rash

They just started a few hours ago.

Good question. A more detailed inquiry should be made. It could be a contact allergy.

Yes, they burn like crazy. Some fluid is running from my scalp down on my face.

Good question. The reaction is very acute with weeping blisters. Such reactions usually appear in a time frame of 24-72 hours.

Yes, I think I am allergic to nickel in costume jewelry and maybe on jeans buttons.

Worthwhile question. A pre-existing allergy, either Type I or Type IV, is not a requirement for such a severe reaction. Neither is an atopic diathesis.

No, no one else.

This question doesn't help. Any possible answer could be given, without advancing the diagnostic process.

Yes, as a kid I was outdoors a lot and had quite a few sunburns.

Poor question. This information is irrelevant.

I actually haven't done anything unusual. I did dye my hair black again, but I do that often and never had problems.

Good question. The history with allergic contact dermatitis is often a challenge, as the patients cannot imagine they are allergic to something they have been using for a long time.

Choose the right efflorescences:

Correct. Papules are seen typically in this disease.

Correct. Small vesicles with fluid are seen on scalp and face.

False. No pustules are seen here, but they can rarely develop.

Correct. This disorder starts with an erythema.

Choose the right diagnosis:

False, but a major differential diagnostic consideration. Toxic contact dermatitis is usually sharply circumscribed without distant spread, more painful and more likely to have blisters than allergic contact dermatitis but overlaps occur.

False. Atopic scalp dermatitis can occasionally be severe but it is rarely so acute, and the history points in a different direction.

False. This is part of differential diagnostic considerations but is more localized and not so acute.

Correct. After multiple uses, the patient became sensitized to a chemical in her black hair dye.

Choose the right therapy(ies):

Correct. Will help in acute stage.

Correct. A short course is indicated in such a severe allergic reaction.

Correct. This simple measure will help remove debris and disinfecty.

Correct. May be needed to control secondary infection if topical measures fail.

Correct. This is the most practical way to try to control the itch.

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