Question

An otherwise healthy 26 year old female presents to her family physician with a rash on her neck. She just noticed it yesterday, but it is pruritic and painful. The patient has not been outdoors, and cannot think of anything in particular that could have caused the rash, other than perhaps using a new hairspray in preparation for her best friend's wedding several days ago. On physical exam, there is a papular and vesicular erythematous rash in a thin linear pattern that encircles her lower neck. The remainder of her physical exam is normal. What is the most appropriate initial step in the management of this patient?

A. Topical steroid cream
B. Oral prednisone
C. Reassurance
D. IgE testing
E. Oral abx

Answer 1

The most appropriate initial step for the itchy and painful rash on the patient's neck is to apply a topical steroid cream to reduce inflammation and relieve symptoms. The cream addresses the symptoms but not the cause, which may be an allergy to a new hairspray the patient used.

Step-by-step explanation:

The clinical scenario describes a 26-year-old female with a pruritic and painful rash that is likely related to the use of a new hairspray. Based on the details provided, the most appropriate initial step in the management of this patient would be topical steroid cream. This approach aligns with preferred treatment for contact dermatitis or allergic reactions, where topical corticosteroids like hydrocortisone are often prescribed first to reduce inflammation and address such symptoms. This course of action is meant to provide symptom relief, and if the rash does not improve, further steps can be taken.

It's important to note that the steroid cream treats the symptoms but not the underlying cause, which in this case, may be an allergic reaction to an ingredient in the hairspray. It is also advised for the patient to avoid using the hairspray again to prevent recurrence of the rash. The other options, such as oral prednisone, reassurance, IgE testing, and oral antibiotics, do not seem appropriate based on the information currently available.