Pierre, 48 years old, Inflammatory flare-up

Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.

Quiz

32 respondents

Question of 1

What is your diagnosis? (only one correct response)

Mycosis

Wrong answer!

It was atopic dermatitis.

Let’s rule out differential diagnoses:

Psoriasis

Also found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.

Histology if necessary.

Atopic dermatitis:

Flare-ups with periods of remission, history of atopy, pruritus, xerosis.

Location of the lesions: face, skin folds, limbs.

Jagged eczema lesions.

No infectious contact or animals.

Mycosis (ringworm):

Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic. Animal contact and mycology if necessary.

Atopic dermatitis

True

Atopic dermatitis

It is indeed atopic dermatitis.

Let’s rule out differential diagnoses:

Psoriasis

Also found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.

Histology if necessary.

Atopic dermatitis:

Flare-ups with periods of remission, history of atopy, pruritus, xerosis.

Location of the lesions: face, skin folds, limbs.

Jagged eczema lesions.

No infectious contact or animals.

Mycosis (ringworm):

Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic. Animal contact and mycology if necessary.

PSORIASIS:

Psoriasis

Wrong answer!

It was atopic dermatitis.

Let’s rule out differential diagnoses:

Psoriasis

Also found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.

Histology if necessary.

Atopic dermatitis:

Flare-ups with periods of remission, history of atopy, pruritus, xerosis.

Location of the lesions: face, skin folds, limbs.

Jagged eczema lesions.

No infectious contact or animals.

Mycosis (ringworm):

Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic. Animal contact and mycology if necessary.

Dermatological treatment:

Topical corticosteroids can be prescribed as firstline therapy. What is dangerous is steroid phobia!

In short: potent class such as betamethasone.

Initial treatment: Once a day paying attention to the maximum amount, should be started early and continued until clearing.
In the event of failure: Phototherapy, immunosuppressant, biotherapy/ hospitalisation.
Maintenance treatment:

- Either once or twice a week if flare-ups are frequent

- Or discontinue topical corticosteroids and resume

Dermo-cosmetic support:

Use of emollients: at least once a day – that is the basic principle behind maintenance treatment for AD! Moisturises, reduces micro-inflammation and pruritus, regulates the microbiome, eliminates the need for cortisone.