Chronic Inflammatory Dermatitis with Secondary Infection in Young Adult

Case at a Glance

A 24-year-old sexually active female with a history of atopic dermatitis and hidradenitis suppurativa presents with a 3-month history of persistent, severely pruritic, weeping dermatitis affecting the posterior thighs and gluteal region, refractory to multiple topical treatments.

Patient's Story

The patient reported the onset of an intensely itchy rash on the posterior aspects of both thighs extending to the buttocks approximately 3 months prior to presentation. She described the lesions as initially appearing as red, inflamed patches that progressively worsened despite treatment attempts. The patient experienced significant functional impairment, requiring protective bandaging to prevent drainage onto surfaces. She expressed considerable distress due to the persistent nature of the condition and its impact on daily activities.

Initial Assessment

Physical examination revealed extensive erythematous, weeping dermatitis with areas of excoriation and secondary bacterial infection. The lesions demonstrated clear to light yellow serous drainage with evidence of bleeding from scratched areas. The distribution pattern suggested possible contact dermatitis, exacerbation of underlying atopic dermatitis, or flare of hidradenitis suppurativa. Given the patient's medical history of chronic inflammatory skin conditions, a multifactorial etiology was considered.

The Diagnostic Journey

The patient had been evaluated by her primary care physician on multiple occasions over the 3-month period. Various topical treatments were trialed including antifungal/corticosteroid combination therapy (nystatin/triamcinolone acetonide), topical calcineurin inhibitor (tacrolimus 0.1%), mild topical corticosteroid (hydrocortisone 1%), and antifungal monotherapy (clotrimazole), all applied three times daily. Despite aggressive topical management, no clinical improvement was observed. Dermatology consultation was requested but availability was limited.

Final Diagnosis

Chronic contact dermatitis with secondary bacterial infection, likely exacerbated by underlying atopic dermatitis in a patient with hidradenitis suppurativa. The refractory nature suggests possible allergic contact dermatitis or bacterial superinfection requiring systemic intervention.

Treatment Plan

Pending dermatology evaluation, symptomatic management focused on infection control and inflammation reduction. Recommendations included gentle cleansing with antimicrobial soap, application of topical antibiotic ointment for secondary infection, continuation of protective barrier methods, and consideration of oral antihistamines for pruritus control. Systemic antibiotics and stronger topical corticosteroids were considered pending specialist evaluation.

Outcome and Follow-up

Patient remained symptomatic at the time of case documentation while awaiting dermatology consultation scheduled for 2 months later. Interim management strategies were implemented to provide symptomatic relief and prevent further complications. The case highlights the challenges of managing complex dermatologic conditions in patients with multiple inflammatory skin disorders and the importance of timely specialist consultation for refractory cases.