Bilateral Lower Extremity Dermatitis Following Minor Trauma
Case at a Glance
A 22-year-old female presented with acute onset of pruritic erythematous lesions on bilateral lower extremities following minor scratching trauma two days prior to presentation.
Patient's Story
The patient reported developing red, itchy spots on her ankles and shins after scratching the areas with moderate intensity two days earlier. She described the scratching as neither aggressive nor gentle. Initially, the areas became red and then progressively more pruritic. The left lower extremity involvement was localized to the ankle region, while the right leg demonstrated more extensive involvement extending throughout the shin area. The patient denied any previous similar episodes and reported no known allergies, though her last allergy testing was performed several years ago.
Initial Assessment
Physical examination revealed erythematous papular lesions distributed on bilateral lower extremities, with asymmetric involvement - left ankle region and right shin extending more proximally. The lesions appeared consistent with post-traumatic dermatitis. The patient was currently taking Beloretin 30mg daily for acne management since April.
The Diagnostic Journey
Clinical presentation suggested post-traumatic contact dermatitis or irritant dermatitis secondary to mechanical trauma. Differential diagnosis included allergic contact dermatitis, though the temporal relationship to scratching and lack of known allergen exposure made this less likely. The asymmetric distribution pattern was noted as potentially significant.
Final Diagnosis
Post-traumatic dermatitis/irritant contact dermatitis of bilateral lower extremities
Treatment Plan
Conservative management was recommended including topical hydrocortisone cream and fragrance-free moisturizer application for a two-week trial period. Patient education provided regarding avoiding further trauma to the affected areas.
Outcome and Follow-up
Patient was advised to seek medical evaluation if no improvement was observed after two weeks of conservative treatment or if symptoms worsened. Follow-up appointment scheduled as needed based on treatment response.