MKSAP: 24-year-old woman with atopic dermatitis

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 24-year-old woman with longstanding atopic dermatitis is evaluated for an acute worsening of her disease in the past week. She has had increased pruritus and now has multiple painful areas within the involved skin. She has been applying petrolatum jelly and triamcinolone ointment and washing with gentle cleansers without improvement. She is otherwise well and takes no medications.

On physical examination, vital signs are normal. She has eczematous plaques with scattered pustules in the involved areas. The remainder of the physical examination is unremarkable.

Which of the following is the most likely cause of this patient’s acute flare?

A. Herpes simplex virus infection
B. Soap allergy
C. Staphylococcus aureus infection
D. Topical glucocorticoids

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