What is the diagnosis and treatment plan for a 25-year-old female with a history of anxiety, presenting with a recurrent pruritic rash on her forearms, chest, and back, previously diagnosed with eczema and treated with Triamcinolone (triamcinolone), who reports allergies to dogs and cedar wood?

History of Present Illness (HPI)

The patient is a 25-year-old female with a history of anxiety, presenting for follow-up after an urgent care visit two months ago for a rash. At that time, she was diagnosed with eczema and treated with triamcinolone, which initially worked but is no longer effective. The rash is itchy and located on her forearms, chest, and back. She has a history of allergies to dogs and cedar wood and was referred to an allergist for further evaluation.

Differential Diagnosis

• Single Most Likely Diagnosis
  • Atopic Dermatitis (Eczema): The patient's initial diagnosis of eczema, response to triamcinolone, and recurrence of symptoms suggest that atopic dermatitis is the most likely diagnosis. The location of the rash on the forearms, chest, and back is also consistent with this condition.
• Other Likely Diagnoses
  • Contact Dermatitis: Given the patient's allergies to dogs and cedar wood, contact dermatitis is a possible diagnosis, especially if she has been exposed to these allergens recently.
  • Seborrheic Dermatitis: This condition can cause a rash on the chest and back, and can be itchy, making it a possible diagnosis.
  • Allergic Contact Dermatitis: This condition is similar to contact dermatitis but is caused by an allergic reaction to a specific substance, which could be relevant given the patient's history of allergies.
• Do Not Miss Diagnoses
  • Bullous Pemphigoid: Although less likely, bullous pemphigoid is a serious condition that can cause itchy blisters and should not be missed, as it can be treated with immunosuppressive medications.
  • Dermatomyositis: This is an autoimmune condition that can cause a rash and muscle weakness, and although rare, it is important to consider due to its potential severity.
• Rare Diagnoses
  • Pityriasis Rubra Pilaris: A rare skin condition that can cause a rash and itching, although it is less likely given the patient's presentation.
  • Cutaneous T-Cell Lymphoma: A rare type of skin cancer that can cause a rash and itching, although it is unlikely given the patient's age and presentation.