What is the best course of treatment for a patient with a resolving furuncle (boil) on their right leg, who has developed a pruritic (itchy) rash with wheals and dermatitis, possibly due to an allergic reaction to Suave, without systemic symptoms such as fever or difficulty breathing?

Management of Resolving Furuncle with Suspected Allergic Contact Dermatitis

Stop using Suave immediately and treat the allergic contact dermatitis with a moderate-to-high potency topical corticosteroid (such as hydrocortisone 1% cream applied 3-4 times daily) combined with oral antihistamines for the pruritic rash, while allowing the improving boil to continue healing on its own. 1, 2

Immediate Management Steps

Discontinue the Offending Agent

• Stop all application of Suave products to the affected leg immediately. 2
• The temporal relationship between Suave application and development of wheals with dermatitis strongly suggests allergic contact dermatitis, which is a delayed hypersensitivity reaction. 2
• When a causative substance is suspected, the first step is determining whether the problem resolves with avoidance. 2

Treat the Allergic Rash

For the pruritic rash with wheals and dermatitis:

• Apply topical hydrocortisone 1% cream to the affected rash areas 3-4 times daily. 1
• Localized allergic contact dermatitis lesions are successfully treated with mid- or high-potency topical steroids. 2
• If the rash covers more than 20% of the leg surface area, consider systemic steroid therapy (prednisone 0.5-1 mg/kg/day tapered over 2-3 weeks) to prevent rebound dermatitis. 2

Add oral antihistamines for itch control:

• Start with non-sedating second-generation antihistamines such as cetirizine 10 mg daily, loratadine 10 mg daily, or fexofenadine 180 mg daily. 3
• For nighttime pruritus, consider first-generation antihistamines like hydroxyzine 10-25 mg at bedtime due to sedative properties. 3
• Apply topical anti-itch remedies such as menthol 0.5% or polidocanol cream for additional symptomatic relief. 3

Monitor the Resolving Furuncle

• Continue basic wound care for the improving boil without additional topical agents. 3
• Since the furuncle is already decreasing in size and redness, no additional antibiotic therapy is needed unless signs of spreading infection develop. 3
• Keep the area clean with soap-free cleansers and avoid irritants. 3

Reassessment Timeline

Evaluate progress after 2 weeks:

• If the allergic rash worsens or shows no improvement after 2 weeks despite topical corticosteroids and antihistamines, escalate treatment. 3, 2
• For persistent or worsening symptoms, consider adding GABA agonists (gabapentin 900-3600 mg daily or pregabalin 25-150 mg daily) for refractory pruritus. 3
• The allergic contact dermatitis should resolve within 2-3 weeks with proper avoidance and treatment. 2

Important Caveats

Avoid common pitfalls:

• Do not apply topical corticosteroids to the resolving furuncle itself, only to the surrounding allergic rash. 3
• Rapid discontinuation of systemic steroids (if needed) can cause rebound dermatitis—always taper over 2-3 weeks. 2
• Oral antihistamines provide limited benefit for contact dermatitis itself but are effective for symptomatic itch relief. 3, 2
• If the boil worsens, develops increased warmth, spreading erythema, or systemic symptoms (fever, chills), this would indicate bacterial infection requiring oral antibiotics. 3

When to seek additional evaluation:

• If the rash fails to improve after 2 weeks of appropriate treatment, patch testing may be needed to identify the specific allergen. 2
• Consider dermatology referral if the diagnosis remains uncertain or if the rash becomes chronic despite treatment. 3