Recurrent Dry, Bumpy Skin Patches in Young Adult

Case at a Glance

An 18-year-old male presenting with chronic, recurrent dry patches of skin with associated pruritus and follicular involvement, primarily affecting the upper extremities and extensor surfaces.

Patient's Story

The patient reports a several-month history of dry, scaly skin patches that appear cyclically on his upper arms, thighs, knees, and elbows. He describes the lesions as moderately pruritic with small papular bumps that appear to be centered around hair follicles. The patches typically resolve spontaneously over time, only to recur in similar or different locations. The patient sought evaluation due to the persistent and recurring nature of the condition.

Initial Assessment

Physical examination revealed dry, scaly patches with small follicular papules on the extensor surfaces of the upper and lower extremities. The lesions appeared consistent with a chronic dermatitis pattern. No signs of secondary bacterial infection were noted. The patient appeared otherwise healthy with no systemic symptoms.

The Diagnostic Journey

Based on the clinical presentation of chronic, recurrent dry patches with follicular involvement on extensor surfaces in a young adult, differential diagnosis included keratosis pilaris, atopic dermatitis, contact dermatitis, or other forms of chronic dermatitis. The follicular pattern and distribution were key diagnostic features considered.

Final Diagnosis

Chronic dermatitis with follicular involvement, likely keratosis pilaris or atopic dermatitis variant, pending further evaluation and treatment response.

Treatment Plan

Initial conservative management was recommended including: 1) Topical hydrocortisone 1% cream twice daily for inflammatory component, 2) Fragrance-free moisturizer application multiple times daily to address xerosis, 3) Gentle skin care routine avoiding harsh soaps or irritants, 4) Two-week trial period to assess treatment response.

Outcome and Follow-up

Patient was advised to continue the prescribed regimen for two weeks and return for follow-up evaluation. Instructions were given to seek earlier medical attention if symptoms worsened or failed to improve with conservative treatment. Long-term management strategies would be discussed based on treatment response.