A 17-year-old female presents with a pruritic rash localized to the wrist. Papules and vesicles are noted in a bandlike pattern, with slight oozing from some lesions. Which of the following is the most likely cause of the rash?
a/. Herpes simplex
b/. Shingles
c/. Atopic dermatitis
d/. Seborrheic dermatitis
e/. Contact dermatitis
Answer
The answer is e
Contact dermatitis causes pruritic plaques or vesicles localized to an area of contact. In this case, nickel in a bracelet or wristband would be the inciting agent. Contact dermatitis may produce vesicles with weeping lesions. The process is related to direct irritation of the skin from a chemical or physical irritant. It may also be immune mediated. Zoster would be painful and occur in a dermatomal distribution. Herpes simplex produces grouped vesicles, but they are painful and also unlikely to occur around the wrist. Atopic dermatitis usually affects skin creases (especially the antecubital fossae) and the hands. It may be vesicular but is more often associated with skin thickening (lichenification) as a result of constant scratching. Seborrheic dermatitis presents as red, scaly nonpruritic lesions localized to the eyebrows, nasolabial folds, scalp, and retroauricular areas.
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Dermatology
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