Patient Profile
Patient: Miss Riya Sen, 22-year-old female
Chief Complaint: Chronic itchy rash on arms and neck, worse in winter
History & Examination
- Medical history: Allergic rhinitis; family history of eczema
- Symptoms: Dry, scaly patches with intense pruritus
- Physical exam: Lichenified plaques on flexural surfaces, excoriations, mild erythema
Investigations
- Serum IgE: Elevated
- Skin prick test: Positive for dust mites and pollen
- Biopsy: Not required unless atypical presentation
Diagnosis
Atopic Dermatitis (moderate) based on clinical features and atopic background.
Management Plan
Pharmacological
- Topical corticosteroids: Mometasone furoate 0.1% for flares
- Emollients: Ceramide-based moisturizers twice daily
- Oral antihistamines for itch relief as needed
Supportive Care & Education
- Avoid triggers: wool, harsh soaps, known aeroallergens
- Lukewarm baths; consider colloidal oatmeal
- Daily barrier care and fingertip-unit guidance for steroid use
Follow-Up Plan
- 2 weeks: Assess response to topical steroids
- Monthly: Monitor flare frequency; optimize regimen
- Annual: Allergy review; skin surveillance if prolonged steroid use
Outcome Goals
- Symptom control with minimal flares
- Improved skin barrier and quality of life
- Safe steroid use and adherence to emollients
Long-Term Considerations
- Phototherapy or biologics (e.g., dupilumab) if refractory
- Psychological support for chronic disease burden
References
- Micali G. Clinical Cases in Dermatology: Modern Management of Acne, Actinic Keratosis, and Atopic Dermatitis. EMJ Dermatol. 2020;8(Suppl 5):2–8.
- DermNet NZ Case Library — Dermatology Cases.