Psoriasis

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Contact Dermatitis

A 27-year-old woman developed the pictured lesion 2 days after wearing a new pair of earrings. What is the most likely diagnosis?

A   Atopic dermatitis

B   Irritant dermatitis

C.  Nummular dermatitis

D   Seborrheic dermatitis

E    Allergic dermatitis

Option A (Atopic dermatitis) is incorrect. Atopic dermatitis is a subacute and chronic

dermatitis that is often called an itch that rashes. It has dry, scaly, pruritic patches and

plaques with excoriations located in the flexural regions.

Option B (Irritant contact dermatitis) is incorrect. Irritant contact dermatitis is the result of direct toxic injury to the skin and will occur in any individual given sufficient exposure. This is in contrast to allergic contact dermatitis, where individuals with atopy are more likely to develop it. Irritant contact dermatitis is differentiated from allergic contact dermatitis by the acute speed of the reaction (less than 12 hours usually), a very sharp border without spread and an absence of papules in the acute phase.

Option C (Nummular dermatitis) is incorrect. Nummular dermatitis presents as pruritic, coin-shaped erythematous plaques that are dry and scaly.

Option D (Seborrheic dermatitis) is incorrect. Seborrheic dermatitis presents with a

greasy, yellow, erythematous, scaly plaque primarily in the perioral area or other areas rich in sebaceous glands, such as the scalp margin and sternum.

Option E (Allergic contact dermatitis) is correct. This patient has allergic contact dermatitis, most likely the result of nickel in her new earrings. Allergic contact dermatitis should be suspected when there is exposure to an allergen and a reaction develops at least 48 hours later. As pictured,  there in an erhythematous base and a slightly white scale with a defined border.

CONTACT DERMATITIS

BASIC INFORMATION

Contact dermatitis is an acute or chronic skin inflammation, usually eczematous dermatitis resulting from exposure to substances in the environment. It can be subdivided into "irritant" contact dermatitis (nonimmunologic physical and chemical alteration of the epidermis) and "allergic" contact dermatitis (delayed hypersensitivity reaction).

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