Peer Reviewed

What’s Your Diagnosis?

A 1-Year-Old With an Atopic Dermatitis Flare

AUTHORS:
Reem Yassine, BSc1 • Michelle L. Gallagher, DO2

Volume 63 - Issue 2 - February 2023

  • AFFILIATIONS:
    1Medical Student, Michigan State College of Osteopathic Medicine, Macomb, MI
    2Department of Pediatrics, Michigan State University College of Osteopathic Medicine, East Lansing, MI

    CITATION:
    Yassine R, Gallagher ML. A 1-year-old with an atopic dermatitis flare. Consultant. 2023;63(2):e5 doi:10.25270/con.2022.07.000011

    Received November 7, 2021; accepted November 17, 2021. Published online July 14, 2022.

    DISCLOSURES:
    The authors report no relevant financial relationships.

    DISCLAIMER:
    The authors report that informed patient consent was obtained for publication of the images used herein.

    CORRESPONDENCE:
    Reem Yassine, BSc, Michigan State College of Osteopathic Medicine, 965 Wilson Rd, East Lansing, MI 48824 (yassiner@msu.edu)

    A 17-month-old male infant with a history of atopic dermatitis presented for a 1-day history of a moderate to severe rash over his arms, legs, and chest. The rash was bleeding, flaking, itchy, and painful.

    History. The patient's mother reported that her son began to feel warm the previous day, and he also had a decreased appetite. The patient received no antipyretics that day. According to his mother, the child had not been exposed to anyone who was ill or had cold sores, and he was not in daycare. The patient's eczema was being treated with topical hydrocortisone 2.5%. He was up to date on all childhood vaccinations.

    Physical examination. At presentation, the patient appeared pleasant, well-developed, well-nourished, alert, and oriented. On physical examination, the boy’s temperature was 36.9 °C. An papulosquamous eruption with vesicles and erosions was observed over the arms, legs, and trunk (Figure). The rash was more pronounced in areas of eczema. There were no lesions on the hands or feet. Examination of the ears, nose, and throat showed pharyngeal erythema but no other abnormalities. The remainder of the physical examination was unremarkable.

    Figure. Papulosquamous eruption with vesicles and erosions distributed over the patient’s legs.

    Based on the patient's presentation, what is the most likely cause of the acute worsening of this infant’s atopic dermatitis?

    A. Eczema herpeticum
    B. Eczema coxsackium
    C. Varicella zoster
    D. Impetiginized eczem


    Answer and discussion on next page

References

1. McGuire S, Homme J. Eczema coxsackium in a dark-skinned patient. Visual Journal of Emergency Medicine. 2020;20:100793. doi:10.1016/j.visj.2020.100793

2. Kimmis BD, Downing C, Tyring S. Hand-foot-and-mouth disease caused by coxsackievirus A6 on the rise. Cutis. 2018;102(5):353-356.

3. Lott JP, Liu K, Landry M-L, et al. Atypical hand-foot-and-mouth disease associated with coxsackievirus A6 infection. J Am Acad Dermatol. 2013 Nov;69(5):736-741. doi:10.1016/j.jaad.2013.07.024  

4. Traidl S, Roesner L, Zeitvogel J, Werfel T. Eczema herpeticum in atopic dermatitis. Allergy. 2021;76(10):3017-3027. doi:10.1111/all.14853

5. Su HJ, Chen CB. Eczema coxsackium. Med J Aust. 2021 Nov;215(9):403. doi:10.5694/mja2.51297

6. Pergam SA, Limaye AP; AST Infectious Diseases Community of Practice. Varicella zoster virus (VZV) in solid organ transplant recipients. Am J Transplant. 2009;9 Suppl 4(Suppl 4):S108-S115. doi:10.1111/j.1600-6143.2009.02901.x

7. Travers JB, Kozman A, Yao Y, et al. Treatment outcomes of secondarily impetiginized pediatric atopic dermatitis lesions and the role of oral antibiotics. Pediatr Dermatol. 2012;29(3):289-296. doi:10.1111/j.1525-1470.2011.01661.x

8. Wang V, Boguniewicz J, Boguniewicz M, Ong PY. The infectious complications of atopic dermatitis. Ann Allergy Asthma Immunol. 2021;126(1):3-12. doi:10.1016/j.anai.2020.08.002