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Fingernail pitting
2%
6/250
Arthralgias
4%
10/250
Wheezing
61%
152/250
Gluten hypersensitivity
30%
74/250
Cyanosis
0%
1/250
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The patient described in the question stem is suffering from atopic dermatitis (eczema), which commonly occurs with asthma, characterized by wheezing on physical examination. Eczema is part of the "atopic triad" of conditions that commonly appear together in patients with a predisposition to allergic reactions: eczema, asthma, and allergic rhinitis. Physical exam findings in acute eczema include a moist rash; however, in chronic eczema the rash is dry and hyperkeratotic. Burgess et al. discuss the relationship between eczema and asthma. The current understanding holds that eczema is the first step in a progressive atopic pathogenesis that eventually leads to asthma and/or allergic rhinitis. Zug et al. review eczematous dermatitis, including the treatment of the disease, which includes general skin care, avoidance of triggers, skin hydration, and topical corticosteroids when necessary. Use of systemic corticosteroids is not generally recommended. Figure A displays a classic presentation of eczema. Note the thickened, dry skin at the flexor/extensor region. Illustration A is a table comparing dermatitis herpetiformis and atopic dermatitis. Incorrect Answers: Answer 1: Fingernail pitting is associated with psoriasis, not eczema. Answer 2: Eczema is not associated with arthralgias. Arthritis is associated with psoriasis. Answer 4: Gluten hypersensitivity, or Celiac disease, is associated with dermatitis herpetiformis. Answer 5: Late cyanosis is seen in patients with ASD, VSD, and PDA. These disorders are not associated with eczema.
2.8
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