Progressive Pruritic Eruption Following Beach Vacation in Young Female

Case at a Glance

A 22-year-old female presented with a week-long history of progressive, intensely pruritic papular eruption that began on the feet and spread to involve flexural areas and sites of skin-to-skin contact following a beach vacation.

Patient's Story

The patient developed small, skin-colored, barely visible but intensely pruritic bumps on her feet approximately one week after arriving at a seaside destination. The eruption progressively spread to involve her legs, inner arms, hands, abdomen (with particular involvement of a surgical scar), axillae, and lower back. She noted that areas where skin contacted skin or clothing were most severely affected, including arm folds, popliteal fossae, and axillary regions. The lesions evolved from small, skin-colored papules to more erythematous and some developing white centers. The pruritus was severe enough to significantly disrupt sleep.

Initial Assessment

Physical examination revealed a widespread papular eruption with predilection for flexural areas and sites of mechanical friction. The distribution pattern suggested contact dermatitis, though the timeline and morphology required consideration of other etiologies. The patient had recently used old tanning products, worn unwashed new clothing, and had sun exposure prior to symptom onset.

The Diagnostic Journey

Differential diagnosis included allergic contact dermatitis (from cosmetic products or clothing), irritant contact dermatitis, folliculitis, scabies, or drug eruption (considering recent isotretinoin discontinuation). The distribution pattern favoring flexural areas and sites of occlusion, combined with the temporal relationship to new exposures, supported a contact dermatitis diagnosis.

Final Diagnosis

Allergic contact dermatitis, likely secondary to either expired tanning oil or unwashed clothing dyes/chemicals, with possible contribution from mechanical irritation in flexural areas.

Treatment Plan

The patient initiated self-treatment with oral antihistamines (bilastine 20mg, cetirizine 10mg) and topical therapies including aloe vera, dimetindene maleate gel, and hydrocortisone cream. Recommendations included continuation of topical corticosteroids, oral antihistamines, cool compresses, and strict avoidance of suspected triggers. Proper washing of all new clothing before wear was advised.

Outcome and Follow-up

Initial response to topical hydrocortisone was noted with some improvement in pruritus, though erythema persisted. The patient was counseled on the importance of identifying and avoiding the causative agent to prevent recurrence. Close monitoring was recommended given the progressive nature of the eruption despite initial treatment measures.