Question

A 10-year-old girl was brought to clinic with a complaint of redness involving the cheeks and flexural aspects of the limbs. According to the mother, the child was usually irritable and wakeful at night and seemed to scratch at the legs. The mother was very hygiene-conscious and bathed the child daily with a well-known brand of children’s bath product. The younger sibling, 4 years old, was known to have a food allergy to eggs. Clinical examination revealed generalised dryness and redness all over the body, most notable on the flexures of the lower limbs. 

Answer

It was a case of atopic dermatitis because of the age of the patient and distribution site of flexural surface. According to the theory, the rash and itchy will mainly appear on the flexural surface in 2-10 years old children, while the rash will occur in extensor region in under 2 years baby. 

The aggrevating factor will probably be the bath product in this case because the mother was very conscious to hygiene according to the scenario. Food allergy to eggs in the sibling will indicate a trace of atopic dermatitis history. 

Four allergens in soap that lead to AD

(1) paraben 

(2) fragrances 

(3) coconut diethanolamide

(4) sodium lauryl sulphate 

Patch test may be the most appropriate investigation in this case because the trigger factor may be due to bath product which can also be allergic/irritant contact dermatitis to chemical agents.

Dr. Aye Min Htoo

Dermatologist