PA Student Diagnoses Girl’s Recurring Rash with VisualDx

Brooke S., a PA student at Indiana University, shares how she used VisualDx to diagnose a young girl’s recurring rash:

“A 6-year-old African American girl came in with a scaly plaques and papules months on her elbows that she had had for 3 months. Reports they are pruritic, and she has ‘flares.’ The patient was adopted and no family history was available. Based on her presentation I used VisualDx to diagnose that she had atopic dermatitis.”

What is atopic dermatitis?

Atopic dermatitis (eczema) is a chronic, relapsing, pruritic condition. It is commonly recognized by a constellation of the following principle characteristics: (1) pruritus (itch); (2) facial and extensor involvement during infancy that changes to flexural involvement in late childhood; (3) a chronic relapsing course; and (4) a personal or family history of atopy (atopic dermatitis, food allergies, allergic rhinitis, and/or asthma).

Infants and children are most often affected, with 85% of cases appearing in the first year of life and 95% of cases appearing by 5 years. Uncommonly, the condition may persist into, or even arise in, adulthood. Less than 1% of adults are affected by atopic dermatitis.

What should we be aware of when making a diagnosis?

In older children and teenagers, thickened, scaly, erythematous plaques most often involve the flexural surfaces, particularly the antecubital and popliteal fossae, the posterior neck, and the extremities in general. There is generally less exudate. Associated physical findings include hyperlinear palms and keratosis pilaris on the upper arms, legs, cheeks, and buttocks. Impetiginized plaques may develop thick crusts.

Children with atopic dermatitis may have unacknowledged contact allergies contributing to their skin symptoms.

How can we treat this?

• Topical steroid creams or ointments to treat localized eczema. Use lower-strength steroids on the face and medium-to-high-strength steroids on the trunk and on the arms and legs.
• Be careful when using topical steroids in skin folds and occluded areas because of the risk of atrophy.
• Medications that allow you to reduce steroid exposure (steroid-sparing agents), such as topical tacrolimus or pimecrolimus, may be used for milder disease or for treating sensitive areas, such as the face. These medications are not approved for use with children under the age of 2. These medications have a warning that their use may have a small risk of causing cancer.
• Oral antihistamines to reduce itching.