Body-wide, pruritic, papular rash • scalp lesion • excoriation • Dx?

Atopic dermatitis is characterized by symmetric involvement of the flexural sur­faces of the body with a pruritic, erythematous rash that may have a fine scale.³ It usually manifests prior to 2 years of age, is recurrent, and is commonly associated with allergic rhinitis and asthma.³ Treatment involves trigger avoidance, topical emollients, topical corticosteroids, dilute bleach baths, and topical calcineurin inhibitors.^3,4 For patients with significant nocturnal symptoms and sleep loss, oral antihistamines may be helpful.⁴

Morbilliform drug eruptions are the most common type of dermatologic drug reaction.⁵ These rashes occur approximately one to 2 weeks after exposure to a causative drug; they consist of pruritic, erythematous papules or macules that start centrally and may spread to the proximal extremities.⁵ Treatment involves discontinuation of the offending agent. Symptomatic relief may be achieved with oral antihistamines or topical or systemic corticosteroids.⁵

Treatment of dermatophytid reactions

While the initial impulse in the treatment of a dermatophytid reaction may be to discon­tinue oral antifungals, these treatments actually help resolve the underlying dermatophyte infection and should be continued. For children with tinea capitis, at least 6 weeks of treatment with an oral antifungal agent is warranted. Medications approved by the US Food and Drug Administration include terbinafine (for patients >4 years of age) and griseofulvin (for patients >2 years of age). Dosages are weight-based. (Fluconazole and itraconazole are not approved for this indication.) Lubricants, topical corticosteroids, and oral antihistamines can be used for acute management of pruritus.¹

Our patient was treated successfully with griseofulvin and an oral antihistamine. However, he experienced headaches attrib­uted to griseofulvin and was switched to terbinafine 5 mg/kg/d for 4 weeks. His tinea capitis was resolved at 8 weeks.

CORRESPONDENCE
Richard Temple, MD, CAPT, MC, USN. Department of Family Medicine, Naval Medical Center Camp Lejeune, 100 Brewster Blvd, Camp Lejeune, NC 28547; Richard.w.temple2.mil@mail.mil.