CASE
Many a worried parent has brought his or her infant to a dermatology specialist with a florid rash that worsens despite everything that is done to treat it. Such was the case of this 7-month-old boy whose body was almost completely covered with a rash. The parents had brought a large bag filled with the many products and prescriptions they had tried on the child, often several on any given day, including tea tree oil, hand lotion, glycerine, and ammonium lactate lotion. The last made the child's condition so much worse that he was taken to the emergency department in the middle of the night and was given prednisolone syrup, which calmed things down for the few days he was on it.
History The rashes had begun at about 1 month of age, about the same time the child had begun having problems with his ears. An older sibling had had similar problems and still had a rash of some sort more often than not. These conditions were very similar to ones that had been experienced by their mother at that age.
Examination This was one of the most miserable children this examiner had ever seen; he was writhing during the examination and trying to scratch but not having much success. The patient's face (Figure 1), scalp, chest, arms, and legs were covered with a dry, scaly rash that also had focal areas of excoriation and redness. His skin in general was quite dry, even in uninvolved areas. Factoring in the examination findings as well as the family history of atopy, atopic dermatitis (AD) was clearly the condition we were dealing with.
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