A 6-year-old boy has a rash on his hands and feet that erupted shortly after he started first grade. His parents are concerned that he may be allergic to something at school, such as chalk. He is otherwise healthy.
What do you suspect is the cause of the boy's rash?
A. Atopic dermatitis
B. Contact dermatitis
D. Dermatophyte infection
Answer and Discussion on Next Page
Eczema Herpeticum: An Uncommon Complication of Atopic Dermatitis
Is this perioral rash related to this girl's atopic dermatitis?
This child has atopic dermatitis. The hyperlinearity of the palms confirms the presence of atopy. The stress of starting school was sufficient to exacerbate his condition. The rash was controlled with a mild topical corticosteroid.
Contact dermatitis is a possibility, and patch testing warrants consideration. Psoriasis can be ruled out by the absence of nail pitting and lack of involvement of other areas of the body. Dermatophyte infection of the palms would be unusual in this age group; it can be ruled out with a potassium hydroxide evaluation.
Case and images courtesy of David L. Kaplan, MD, University of Missouri Kansas City, University of Kansas.