Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Test your medicine knowledge: 27-year-old woman with an intensely pruritic rash

mksap
Conditions
September 26, 2015
3 Shares
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 27-year-old woman is evaluated for a 1-week history of an intensely pruritic rash on her eyelids. She applied a new brand of eye makeup just prior to the onset of the rash. She immediately discontinued its use and has been applying a moisturizing lotion to both eyelids since then without improvement in her symptoms. She notes no other areas of rash and generally feels well. The patient has no significant medical history and takes no medications.

On physical examination, vital signs are normal. There is erythema, mild edema, and some serous crusting over the upper eyelids bilaterally. No erythema is present on the scalp, face, neck, upper back, shoulders, arms, or fingers. The remainder of the examination is normal.

A 2-week course of which of the following is the most appropriate treatment for this patient?

A: Betamethasone dipropionate
B: Clobetasol propionate
C: Halobetasol propionate
D: Hydrocortisone valerate

MKSAP Answer and Critique

The correct answer is D: Hydrocortisone valerate.

This patient has allergic contact dermatitis of her eyelids, and a low-potency hydrocortisone ointment such as hydrocortisone valerate is the most appropriate treatment. Treatment courses should be of limited duration (2 weeks or less), which can be controlled by dispensing a small size tube (15 g) when treating areas of thin, sensitive skin such as the face or skin folds. There are multiple formulations of hydrocortisone that range in potency (hydrocortisone valerate, fumarate, and more); not all are low potency, and it is important when selecting a topical hydrocortisone to consider the anatomic site to be treated. The eyelids are very thin skin and are exposed to multiple irritants and allergens. Cosmetics, including nail products, shampoo, and fragrances, frequently result in an allergy on the eyelids, even when not directly applied to that location, because of the thin eyelid skin. This patient has mild allergic contact dermatitis; she should avoid the trigger, and topical glucocorticoids will relieve her symptoms.

The other three medications are all very potent topical glucocorticoids. The potencies of topical glucocorticoids in the United States are designated by classification into one of seven groups, with group 7 (1% and 2.5% hydrocortisone) being the least potent and group 1 being the most potent (up to 600 times more potent than the group 7 agents). Higher-potency glucocorticoids can rapidly lead to adverse effects, including lightening of the skin, atrophy, and telangiectasias, when used on areas of thin skin such as the eyelids. In addition, patients are at risk of ocular exposure and eventual cataract formation if chronically exposed. Therefore, treatment of facial lesions is usually limited to low-potency (groups 6 and 7) glucocorticoids.

Key Point

  • Hydrocortisone valerate is a very-low-potency topical glucocorticoid that is safe to use on the eyelids.

This content is excerpted from MKSAP 17 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 17 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

How a neurosurgeon balances life and work

September 25, 2015 Kevin 0
…
Next

Conversations lead to better health, not interrogations

September 26, 2015 Kevin 5
…

Tagged as: Dermatology

Post navigation

< Previous Post
How a neurosurgeon balances life and work
Next Post >
Conversations lead to better health, not interrogations

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

Related Posts

  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • KevinMD at the Richmond Academy of Medicine

    Kevin Pho, MD
  • Medicine won’t keep you warm at night

    Anonymous
  • Delivering unpalatable truths in medicine

    Samantha Cheng
  • Merging the wisdom of pain medicine and addiction medicine to optimize outcomes

    Julie Craig, MD

More in Conditions

  • The power of coaching for physicians: transforming thoughts, changing lives

    Kim Downey, PT
  • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

    Althea Halchuck, EJD
  • An obstetrician-gynecologist reveals the truth about reproductive planning and how to navigate society’s expectations

    Yuliya Malayev, DO, MPH
  • Nose-brain connection: The surprising link between allergies and mental health revealed

    Kara Wada, MD
  • Is the rise in mental illness due to greater awareness or a true increase in incidence?

    Zahid Awan, MD
  • A patient’s perspective on the diminishing relationship between doctors and patients

    Michele Luckenbaugh
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Raw humanity on night float: inspiring patient encounters and overcoming challenges

      Johnathan Yao, MD, MPH | Physician
    • Is AI the solution for the shortage of nephrologists? ChatGPT weighs in.

      Amol Shrikhande, MD | Tech
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • Why HIPAA is failing and what you need to know to protect your data [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • What Drug Did FDA Just Approve for COVID?
  • PET Scan for Alzheimer's Dx; Predicting Colon Cancer Survival
  • What Happens When We Classify Kids' Weight as a 'Disease'?
  • Sotagliflozin Gets FDA's Blessing for Heart Failure
  • Cardiorespiratory Monitoring Can Be Telling of Outcomes in Extremely Preterm Infants

Meeting Coverage

  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Trial Results Spark Talk of Curing More Metastatic Cervical Cancers
  • Cross-Border Collaboration Improves Survival in Pediatric Leukemia Patients
  • Monoclonal Antibody Reduced Need For Transfusions in Low-Risk MDS
  • Less-Invasive Surgery for Pancreatic Cancer Proves Safe, Effective
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Raw humanity on night float: inspiring patient encounters and overcoming challenges

      Johnathan Yao, MD, MPH | Physician
    • Is AI the solution for the shortage of nephrologists? ChatGPT weighs in.

      Amol Shrikhande, MD | Tech
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • Why HIPAA is failing and what you need to know to protect your data [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...