Diagnosis: Allergic Contact Dermatitis (Axillary Region)
This patient has allergic contact dermatitis (ACD) affecting the axillary area, triggered by Foskina soap, and requires immediate discontinuation of the causative product with topical hydrocortisone 2.5% cream applied 3-4 times daily for 7-10 days.
Clinical Reasoning
The presentation of red, intensely pruritic patches in the axillary area with clear temporal relationship to Foskina soap use is diagnostic of allergic contact dermatitis 1. The axillary involvement is particularly significant because atopic dermatitis typically spares the groin and axillary regions, making ACD the more likely diagnosis in this distribution pattern 2.
Medical Assessment for PhilHealth Encoding
Diagnosis: Allergic Contact Dermatitis, bilateral axillary region, secondary to soap allergen (Foskina)
Clinical Findings:
- Erythematous patches, bilateral axillae
- Intense pruritus
- Clear temporal relationship to new soap product
- Onset [DAY]
Treatment Plan
Immediate Management
Primary Treatment:
- Hydrocortisone cream 2.5% - Apply to affected areas 3-4 times daily 3, 1
- Dispense: 15 grams tube
- Duration: 7-10 days
- Cost: Approximately ₱150-200 (within PhilHealth Konsulta formulary budget)
Critical Intervention:
- Complete avoidance of Foskina soap - This is the most important step, as resolution depends entirely on allergen avoidance 4, 5
- Switch to hypoallergenic, fragrance-free soap alternatives 5
Dosing Rationale
Low-potency topical corticosteroid (hydrocortisone 2.5%) is appropriate for axillary involvement due to the thin, sensitive skin in intertriginous areas 4. The FDA-approved dosing for adults is application 3-4 times daily to affected areas 3.
Additional Recommendations
Symptomatic Relief:
- Cool compresses to affected areas for immediate itch relief 5
- Avoid scratching to prevent secondary infection 5
- Wear loose, breathable cotton clothing 5
Follow-up:
- Return in 7-10 days if no improvement
- If symptoms worsen or spread despite treatment, patch testing may be needed to identify specific allergen 2, 1
Medical Certificate
This certifies that patient has been seen and examined today with the diagnosis of: Allergic Contact Dermatitis, bilateral axillary region, secondary to soap allergen
Recommendation: Complete avoidance of causative soap product (Foskina), topical hydrocortisone 2.5% cream application 3-4 times daily for 7-10 days. Patient is fit to return to work/school with above treatment plan.
Patient Education (Tagalog)
Ang inyong kondisyon ay tinatawag na "allergic contact dermatitis" - ito ay reaksyon ng balat sa sabon na Foskina. Ang pula at kati ay dahil sa allergy sa sangkap ng sabon na ito.
Mahalagang gawin:
- Huwag nang gumamit ng Foskina soap - ito ang pinakamahalagang hakbang
- Gumamit ng hydrocortisone cream 3-4 beses araw-araw sa apektadong bahagi
- Lumipat sa hypoallergenic na sabon (walang pabango)
- Iwasan ang kamot kahit makati
Inaasahang resulta:
- Ang kati at pula ay dapat gumaan sa loob ng 3-5 araw
- Kumpleto ang paggaling sa 7-10 araw kung iwasan ang sabon
- Kung lumala o kumalat, bumalik agad para sa patch testing 1
Clinical Pitfalls to Avoid
Common diagnostic error: Assuming this is atopic dermatitis - but the axillary distribution strongly argues against AD, which characteristically spares these areas 2.
Treatment error: Using high-potency steroids in intertriginous areas can cause skin atrophy - low-potency hydrocortisone is safer for axillary use 4.
Management failure: Not emphasizing complete allergen avoidance - only 17% of patients remember their allergen after 10 years, so written documentation is critical 4.