Dermatitis and Eczema Practice Questions

Q: A patient presents with erythematous, well-demarcated plaques with greasy scales on the scalp and central face. What is the most likely diagnosis?

Seborrheic dermatitis. ***Seborrheic dermatitis*** - Characterized by **erythematous, well-demarcated plaques** with **greasy, yellowish scales**, commonly affecting the **scalp, face (especially nasolabial folds, eyebrows), and chest**. - The distribution and characteristic greasy scales are highly indicative of seborrheic dermatitis, often associated with *Malassezia* yeast overgrowth. *Psoriasis* - Typically presents with **silvery, thick scales** on erythematous plaques, often located on extensor surfaces (elbows, knees) and the scalp. - While it can affect the scalp, the scales are usually silvery and dry, not greasy. *Lichen planus* - Manifests as **pruritic, purple, polygonal, planar papules and plaques** (the 6 Ps), commonly on the flexor surfaces of wrists, ankles, and oral mucosa. - The appearance of lesions (purple, polygonal) and typical locations differ significantly from the patient's presentation. *Tinea capitis* - A **fungal infection** of the scalp, presenting with **scaling, alopecia, and often inflammation or pustules**. - While it can cause scaling on the scalp, greasy scales on the central face are not typical, and it primarily presents as an infection rather than an inflammatory condition with the characteristic greasy scales of seborrheic dermatitis.

Q: A 35-year-old woman presents with erythematous, scaly plaques in the nasolabial folds, eyebrows, and scalp. What is the most likely diagnosis?

Seborrheic dermatitis. ***Seborrheic dermatitis*** - This condition is characterized by **erythematous, scaly plaques** in areas rich in sebaceous glands, such as the **nasolabial folds, eyebrows, and scalp**, matching the patient's presentation. - It's a common, **chronic inflammatory dermatosis** influencing areas with high sebum production. *Psoriasis* - While psoriasis also causes **erythematous, scaly plaques**, they are typically **sharply demarcated** and often found on extensor surfaces (elbows, knees), and the lower back, which is not the primary presentation here. - Psoriasis scales are often described as **silvery-white**, distinct from the usually greasy yellow scales seen in seborrheic dermatitis. *Tinea corporis* - This is a **fungal infection** (ringworm) that presents as **annular (ring-shaped) lesions** with a raised, erythematous border and central clearing. - The distribution in the nasolabial folds, eyebrows, and scalp is **atypical for tinea corporis**, which usually affects the trunk or limbs. *Rosacea* - Rosacea primarily involves **facial erythema, telangiectasias (visible small blood vessels), papules**, and pustules, predominantly affecting the central face. - It typically **lacks the prominent scaling** seen in the described plaques and does not commonly affect the scalp in this manner.

Q: A 5-year-old child presents with intense itching and erythematous papules on the extensor surfaces of the arms and legs. What is the most likely diagnosis?

Atopic dermatitis. ***Atopic dermatitis*** - **Atopic dermatitis** (eczema) is the most likely diagnosis given the **intense itching** (pruritus is the hallmark feature) and **erythematous papules**. - In children aged **2-5 years**, atopic dermatitis commonly affects **extensor surfaces** of the arms and legs, representing the transition from infantile to childhood patterns. - While flexural involvement becomes more typical in older children (>5 years), extensor distribution at age 5 is still very common and characteristic. - The intense pruritus described is pathognomonic for atopic dermatitis. *Psoriasis* - **Psoriasis** does present on extensor surfaces with well-demarcated **erythematous plaques with silvery scales**, particularly on elbows and knees. - However, **intense itching is NOT a primary feature** of psoriasis; it is typically mildly pruritic or non-pruritic. - The prominent pruritus in this case makes psoriasis unlikely. *Contact dermatitis* - **Contact dermatitis** results from exposure to an **allergen or irritant**, causing a localized rash. - The distribution typically conforms to the contact area and would be less likely to present symmetrically on multiple extensor surfaces without a clear exposure history. - The pattern described is more consistent with an endogenous dermatitis. *Scabies* - **Scabies** causes intense itching (worse at night) with characteristic **burrows, papules, and excoriations**. - Typical sites include **interdigital spaces, wrists, axillae, waistline, and genitalia**, not primarily extensor surfaces of arms and legs. - The distribution pattern does not fit scabies.

Q: A 40-year-old female presents with a pruritic rash on her hands after using a new soap. Patch testing shows a positive reaction to the fragrance mix. What is the most appropriate management?

Avoidance of fragrance-containing products. ***Avoidance of fragrance-containing products*** - A **positive patch test** to a fragrance mix confirms an **allergic contact dermatitis** reaction to fragrances. - The most effective management for allergic contact dermatitis is the **identification and complete avoidance of the offending allergen**. *Topical antibiotics* - Topical antibiotics are indicated for **bacterial skin infections**, such as impetigo or infected eczema. - This patient presents with an **allergic reaction**, not an infection, so antibiotics would not address the underlying cause. *Systemic corticosteroids* - Systemic corticosteroids are used for **severe, widespread inflammatory conditions** or acute severe allergic reactions. - While they can reduce inflammation, they are typically **not the first-line treatment** for localized allergic contact dermatitis and carry more significant side effects than avoidance. *UVB phototherapy* - **UVB phototherapy** is a treatment for chronic skin conditions like **psoriasis** or **severe eczema**. - It is **not indicated for acute allergic contact dermatitis**, as it does not address the allergic trigger.

Q: A 27-year-old woman presents with a painful blistering rash on her right shoulder after a hiking trip. She reports recent exposure to poison ivy. What is the most likely diagnosis?

Contact dermatitis. ***Contact dermatitis*** - The patient's history of **recent exposure to poison ivy** and the development of a **painful blistering rash** are classic signs of allergic contact dermatitis. - Poison ivy contains **urushiol oil**, a potent allergen that triggers a **type IV hypersensitivity reaction** characterized by inflammation, pruritus, erythema, and vesicles or bullae. *Impetigo* - Impetigo is a **bacterial skin infection** characterized by **honey-crusted lesions** or pustules, often associated with *Staphylococcus aureus* or *Streptococcus pyogenes*. - It usually occurs in children and is not typically linked to environmental allergen exposure or a primary blistering rash in this manner. *Herpes zoster* - Herpes zoster (shingles) is caused by the **reactivation of the varicella-zoster virus** and presents as a **painful vesicular rash** in a **dermatomal distribution**. - While blistering can occur, the key differentiator here is the lack of a dermatomal pattern and the clear history of direct exposure to an irritant (poison ivy). *Bullous pemphigoid* - Bullous pemphigoid is an **autoimmune blistering disease** that typically affects **elderly individuals** with large, tense bullae on an erythematous or non-erythematous base. - It does not usually present acutely after environmental exposure like poison ivy, nor is it common in a 27-year-old.

Q: Identify the skin condition shown in the image.

Intertrigo. ***Intertrigo*** - This condition is characterized by **redness, maceration, and sometimes erosion** within skin folds, often exacerbated by **heat, moisture, and friction**. - It commonly affects areas such as the **groin, axillae**, and beneath the breasts. *Miliaria* - This refers to **heat rash** caused by blocked sweat ducts, leading to small, itchy, sometimes painful bumps or blisters. - While it occurs in hot, moist environments, it typically presents as **small papules** or vesicles rather than broad areas of maceration in skin folds. *Atopic dermatitis* - Also known as eczema, it is characterized by **dry, itchy, inflamed skin**, often with a chronic, relapsing course. - While it can appear in skin folds (**flexural eczema**), it typically involves papules, lichenification, and xerosis, which are not the predominant features here. *Bacterial skin infection* - While a bacterial infection (e.g., impetigo, cellulitis) can cause redness and inflammation, it often presents with **purulent discharge, crusting, or significant warmth/tenderness**, which are not consistently described. - Intertrigo can become secondarily infected, but the primary condition itself is not bacterial in origin.

Q: What condition is likely to be present in the child shown in the image, whose mother has asthma?

Atopic dermatitis. ***Atopic dermatitis*** - The image shows an infant with **red, scaly, and irritated skin**, particularly on the cheeks and around the mouth, consistent with the characteristic presentation of **atopic dermatitis (eczema)** in infants. - Atopic dermatitis often occurs in individuals with a family history of **atopy**, which includes conditions like **asthma**, allergic rhinitis, and food allergies; a mother with asthma significantly increases the child's risk. *SLE* - **Systemic lupus erythematosus (SLE)** is a **chronic autoimmune inflammatory disease** that rarely presents in infancy with such prominent skin findings, especially without other systemic symptoms. - Skin manifestations of SLE typically include a **malar (butterfly) rash** or **discoid lesions**, which are different from the diffuse eczematous rash seen here. *Erythema* - **Erythema** simply refers to **redness of the skin** caused by inflammation or dilation of blood capillaries. - While the infant's skin is erythematous, erythema is a **symptom**, not a specific diagnosis, and does not fully describe the scaly, papular nature of the rash or the underlying condition. *TEN* - **Toxic epidermal necrolysis (TEN)** is a **severe, life-threatening skin condition** characterized by widespread epidermal detachment, forming large blisters and skin sloughing, often triggered by medications. - The skin lesions in the image do not show the extensive blistering and denudation characteristic of TEN, and a history of an asthmatic mother is not a risk factor for TEN.

Q: What condition is likely to develop in a child with a mother who has asthma?

Atopic dermatitis. ***Atopic dermatitis*** - **Atopic dermatitis** is strongly associated with a family history of **atopy**, which includes **asthma**, allergic rhinitis, and eczema. - Children of mothers with asthma have a significantly increased risk of developing atopic conditions due to **genetic predisposition** and shared immunological pathways. - This is part of the **atopic march** where children often develop atopic dermatitis first, followed by other atopic conditions. *SLE* - **Systemic lupus erythematosus (SLE)** is a systemic autoimmune disease not directly linked to a maternal history of asthma. - While it has a genetic component, it is distinct from the **atopic** disease spectrum. *Erythema multiforme* - **Erythema multiforme** is a hypersensitivity reaction typically triggered by infections (especially HSV) or medications. - It is not associated with maternal asthma or the atopic disease spectrum. - It presents with characteristic target lesions on skin and mucous membranes. *TEN* - **Toxic epidermal necrolysis (TEN)** is a severe, life-threatening skin reaction, most often drug-induced. - There is no known direct association between maternal asthma and the development of TEN in offspring.

Q: A child presents with a rash in the neck folds as shown in the image. The area appears erythematous with satellite lesions and maceration. What is the most likely diagnosis?

Intertrigo. ***Intertrigo*** - The image shows a reddened, inflamed rash in skin folds (neck creases), which is characteristic of **intertrigo**. This condition results from skin-on-skin friction, moisture, and warmth. - The rash appears to have satellite lesions and a somewhat macerated appearance, which would be consistent with secondary fungal (e.g., Candida) or bacterial infection, common complications of intertrigo. *Heat rash* - **Heat rash (miliaria)** typically presents as small, itchy red bumps or clear blisters, often found in areas prone to sweating. - While it can occur in skin folds, the diffuse, raw-looking erythema and presence of potential satellite lesions shown in the image are less typical for simple heat rash. *Eczema* - **Eczema (atopic dermatitis)** is characterized by dry, itchy, inflamed skin, often with scaling, crusting, or lichenification during chronic stages. - While eczema can affect skin folds, the appearance in the image (intense redness, maceration, potential satellite lesions) is more suggestive of an irritant or infectious process like intertrigo rather than typical eczema. *Impetigo* - **Impetigo** is a bacterial skin infection characterized by honey-colored crusts, vesicles, or bullae, typically appearing anywhere on the body, especially around the nose and mouth. - The rash in the image lacks the characteristic honey-colored crusts or vesiculobullous lesions associated with impetigo.

Question 1

A 5-year-old boy presents with a red, itchy rash on his cheeks and the flexural surfaces of his limbs. What is the likely diagnosis?

Accepted Answer

Atopic dermatitis

Answer

Psoriasis

Answer

Contact dermatitis

Answer

Tinea corporis

Question 2

A patient presents with erythematous, well-demarcated plaques with greasy scales on the scalp and central face. What is the most likely diagnosis?

Accepted Answer

Seborrheic dermatitis

Answer

Psoriasis

Answer

Lichen planus

Answer

Tinea capitis

Question 3

A 35-year-old woman presents with erythematous, scaly plaques in the nasolabial folds, eyebrows, and scalp. What is the most likely diagnosis?

Accepted Answer

Seborrheic dermatitis

Answer

Psoriasis

Answer

Tinea corporis

Answer

Rosacea

Question 4

A 5-year-old child presents with intense itching and erythematous papules on the extensor surfaces of the arms and legs. What is the most likely diagnosis?

Accepted Answer

Atopic dermatitis

Answer

Contact dermatitis

Answer

Scabies

Answer

Psoriasis

Question 5

A 40-year-old female presents with a pruritic rash on her hands after using a new soap. Patch testing shows a positive reaction to the fragrance mix. What is the most appropriate management?

Accepted Answer

Avoidance of fragrance-containing products

Answer

Topical antibiotics

Answer

Systemic corticosteroids

Answer

UVB phototherapy

Question 6

A 27-year-old woman presents with a painful blistering rash on her right shoulder after a hiking trip. She reports recent exposure to poison ivy. What is the most likely diagnosis?

Accepted Answer

Contact dermatitis

Answer

Impetigo

Answer

Herpes zoster

Answer

Bullous pemphigoid

Question 7

Identify the skin condition shown in the image.

Accepted Answer

Intertrigo

Answer

Miliaria

Answer

Atopic dermatitis

Answer

Bacterial skin infection

Question 8

What condition is likely to be present in the child shown in the image, whose mother has asthma?

Accepted Answer

Atopic dermatitis

Answer

SLE

Answer

Erythema

Answer

TEN

Question 9

What condition is likely to develop in a child with a mother who has asthma?

Accepted Answer

Atopic dermatitis

Answer

SLE

Answer

Erythema multiforme

Answer

TEN

Question 10

A child presents with a rash in the neck folds as shown in the image. The area appears erythematous with satellite lesions and maceration. What is the most likely diagnosis?

Accepted Answer

Intertrigo

Answer

Heat rash

Answer

Eczema

Answer

Impetigo

Dermatitis and Eczema — MCQs

Dermatitis and Eczema — MCQs

On this page

Practice by Chapter

Want unlimited practice?