THE CASE: This 20-month-old patient with eczema has had a flare during the past week.
What do you suspect caused the exacerbation?
A. New brand of soap
B. New brand of diapers
C. Bubble bath
D. Bacterial infection
E. Fungal infection
(Answer and discussion on next page.)
DISCUSSION: This child with the eczema flare has a bacterial infection. A culture of a specimen from the blistery, impetiginous rash grew Staphylococcus aureus. A reaction to soap or bubble bath generally causes a more widespread rash. The distribution does not resemble that of an eruption caused by new diapers. Fungal infection was considered in the differential but was ruled out by the positive bacterial culture.
Case and image courtesy of David L. Kaplan, MD, University of Missouri Kansas City, University of Kansas.