Palms and soles. ***Palms and soles*** - **Pompholyx**, also known as **dyshidrotic eczema**, is characterized by recurrent outbreaks of **vesicles and bullae** predominantly on the palms and soles. - These lesions are typically very **itchy** and can cause significant discomfort. *Groin* - Conditions like **tinea cruris** (jock itch) or **intertrigo** commonly affect the groin, presenting with erythema and scaling rather than vesicles. - While eczema can occur in the groin, classical pompholyx has a predilection for the acral regions. *Scalp* - The scalp is more commonly affected by conditions such as **seborrheic dermatitis** or **psoriasis**, which manifest as scaling, redness, and flaking. - Vesicular eruptions are rare on the scalp unless due to specific conditions like herpes zoster. *Trunk* - The trunk is a common site for various dermatoses, including **atopic dermatitis**, **psoriasis**, or **pityriasis rosea**, but these typically present with different morphologic features (e.g., plaques, patches). - Pompholyx is specific to palms and soles and does not usually involve the trunk.

Dermatitis and Eczema — MCQs

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Dermatitis and Eczema — MCQs

Q: Rakesh, a 7-year-old boy, presents with a 3-year history of itchy, excoriated papules on his forehead and exposed parts of his arms and legs. The condition is most severe during the rainy season and improves completely in winter. What is the most likely diagnosis?

Atopic dermatitis. ***Atopic dermatitis*** - The **chronic itchy dermatitis** starting at age 4 and the presence of **excoriated papules** are consistent with atopic dermatitis, which is one of the most common chronic dermatoses in children. - While atopic dermatitis in school-age children typically affects **flexural areas** (antecubital and popliteal fossae), it can also involve the face and extensor surfaces, particularly as a continuation from earlier infantile patterns. - The **seasonal variation** can occur in atopic dermatitis due to changes in humidity, allergen exposure, and temperature, though the pattern of worsening in rainy season is somewhat atypical. - Given the chronic course and age of onset in early childhood with persistent itchy papules, atopic dermatitis remains the most likely diagnosis among the given options. *Insect bite hypersensitivity* - This would typically present with localized **urticarial papules** or **vesicles** at discrete bite sites, not a diffuse chronic condition lasting 3 years. - While insect bites can be seasonal and cause itchy excoriated papules, the **continuous 3-year duration** with consistent distribution patterns is not typical for bite reactions. *Scabies* - Scabies presents with intense itching (worse at night) and **pathognomonic burrows** in characteristic sites: finger webs, wrists, axillae, belt line, and genitalia. - The **distribution** described (forehead and exposed extremities) is not typical for scabies, nor would it show complete improvement seasonally without treatment. - Untreated scabies would not spontaneously resolve completely in winter. *Urticaria* - Urticaria manifests as **transient, migratory wheals** (hives) that typically resolve within 24 hours, even in chronic cases. - The description of persistent **excoriated papules** over 3 years is incompatible with urticaria, which is characterized by evanescent lesions, not fixed papules.

Practice by Chapter

Atopic Dermatitis

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Seborrheic Dermatitis

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Contact Dermatitis: Irritant

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Contact Dermatitis: Allergic

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Nummular Eczema

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Dyshidrotic Eczema

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Stasis Dermatitis

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Asteatotic Eczema

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Lichen Simplex Chronicus

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Autoeczematization (Id Reaction)

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Photosensitive Eczemas

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Treatment Strategies for Eczematous Disorders

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