What is the diagnosis and treatment for a patient presenting with a red rash on the face, chest, and hands, sore cuticles, and occasional eating issues, who recently started using a new cream?

Diagnosis: Contact Dermatitis from New Cream

This patient has allergic contact dermatitis caused by the new cream, and the first step is immediate discontinuation of the offending agent, followed by treatment with a mid-potency topical corticosteroid such as mometasone furoate 0.1% ointment or triamcinolone 0.1% cream applied twice daily to affected areas. 1

Immediate Management

Discontinue the Offending Agent

• Stop using the new cream immediately – the temporal relationship between cream use and rash onset strongly suggests allergic contact dermatitis 1, 2
• Resolution with avoidance of the substance confirms the diagnosis 1

Topical Corticosteroid Therapy

• Apply mometasone furoate 0.1% ointment or fatty cream twice daily to the face, chest, and hands for 2-3 weeks 3
• Alternative: triamcinolone 0.1% cream applied 3-4 times daily to affected areas 1, 4
• For facial involvement, hydrocortisone may be used initially if concerned about potency, but mid-potency steroids are generally safe and more effective 4

Barrier Restoration

• Apply fragrance-free emollients to the entire body at least once daily, not just affected areas, to restore skin barrier function 3
• Use urea- or glycerin-based moisturizers liberally 3, 5
• Switch to soap-free cleansers and avoid alcoholic solutions 3, 5

Treatment of Sore Cuticles (Fissures)

For the sore cuticles, apply propylene glycol 50% in water for 30 minutes under plastic occlusion nightly, followed by hydrocolloid dressing. 5

Alternative approaches for fissures include:

• Antiseptic baths with potassium permanganate (1:10,000 concentration) 5
• Topical silver nitrate solutions to accelerate wound closure 5

Symptom Management

For Pruritus

• Oral H1-antihistamines such as cetirizine 10mg daily, loratadine 10mg daily, or fexofenadine 180mg daily provide relief of itching 5
• Topical polidocanol-containing lotions can soothe pruritus 5

Reassessment Timeline

• Reassess after 2 weeks – if the rash worsens or shows no improvement despite treatment, consider systemic corticosteroids 1, 5
• For extensive involvement (>20% body surface area), oral prednisone tapered over 2-3 weeks may be necessary 1
• Rapid discontinuation of systemic steroids can cause rebound dermatitis, so taper appropriately 1

When to Consider Patch Testing

• If the diagnosis remains uncertain after treatment failure, or if you need to identify the specific allergen in the cream, patch testing is the gold standard 1, 2
• This helps identify which ingredient in the cream caused the reaction and guides future avoidance 2

Common Pitfalls to Avoid

• Do not continue using the new cream – even intermittent exposure will perpetuate the dermatitis 1
• Avoid alcohol-containing lotions or gels – these worsen xerosis and can exacerbate inflammation 5
• Do not use oral antihistamines as primary treatment – they provide minimal benefit beyond sedation and do not treat the underlying inflammation 3
• Do not use short courses of systemic steroids (<2 weeks) if extensive disease requires them – this leads to rebound dermatitis 1