Saturday, June 24, 2006

A writer's rash


39 y, white man, working as a writer with a publishing company, no significant PMH, no h/o tobacco, alcohol or illicit drugs, in a monogamous relationship for the past year, presents with intensely pruritic, spreading rash involving the lateral aspects of the trunk, Rt more than left for the past few days.
Apparently, he had a two small macular eruptions in the Rt axilla, about 5-6 weeks ago, that responded to topical emollients.
Does not recall any exposure to new chemicals; travel outside Baltimore or recent febrile illness. HIV test done few months ago was negative.
Exam shows erythematous maculopapular rash extending from the axilla to the iliac crest.

Which of the following statements regarding the pathology is incorrect?

1. The most likely mechanism of the rash is contact irritation.
2. This pathology is an important common cause of occupational disability
3. About 1/3rd of patients with chronic venous stasis develop contact dermatitis to neomycin.
4. Treatment includes avoidance of exposure and medium to strong potency topical steroids.
5. Patch testing is helpful in diagnosis of chronic cases to identify specific allergens.