Catalog of Clinical Images

Id (Autoeczematization) Reaction: Initial Dermatitis was located between the patient's toes
(Picture on left). Approximately one week later a more generalized puritic erruption arose on the
the patient's chest (Picture on right). The precise etiology for this secondary process is unclear.

Diagnosis
dermatitis, contact allergic autoeczematization id reaction
Body Site
hand arm
Age
13 years
Pigmentation
light

Organization
scattered
Color
red
Morphology
papulosquamous (bump, scale)
Pattern
asymmetric symmetric
Comments
This 13 year old boy developed an itchy allergic contact dermatitis from a topical antibiotic
which was placed on a surgical wound on his left wrist for 10 days and occluded with a sterile
dressing. The dermatitis was discovered when the dressing was removed and was treated with a
high potency topical steroid. However, 2 days later he developed a widely disseminated itchy red
papular eruption that responded quickly to a tapering course of oral prednisone.
Autoeczematization or an "id" reaction, manifested as a widespread presumably
immunologically mediated eczematous dermatitis, can occur in association with any intense
localized dermatitis such as atopic dermatitis, allergic contact dermatitis, seborrheic dermatitis,
or dermatophytosis.
Description
red excoriated lichenified plaque in shape of dressing with disseminated red papules

Douglas Hoffman, MD

Diagnosis
id reaction autoeczematization
Body Site
trunk diaper area
Age

22 months
Pigmentation
Organization
scattered
Color
red
Morphology
papulosquamous (bump, scale)
Pattern
symmetric generalized, disseminated
Comments
This 22-month-old male developed widespread red scaly pruritic papules ten days after diagnosis
of candidal diaper dermatitis. He initially presented with a moist, bright red pustular diaper rash
with multiple red satellite papules. He was improving on topical Nystatin when the secondary
eruption occurred. He was well without fever, and there was no mucosal involvement. The new
eruption involved his trunk, face, neck and extremities. He recovered with continued application
of nystatin to the diaper area and a low potency corticosteroid to all areas except the face.
Description
This 22-month-old male developed widespread red scaly pruritic papules ten days after diagnosis
of candidal diaper dermatitis. He initially presented with a moist, bright red pustular diaper rash
with multiple red satellite papules. He was improving on topical Nystatin when the secondary
eruption occurred. He was well without fever, and there was no mucosal involvement. The new
eruption involved his trunk, face, neck and extremities. He recovered with continued application
of nystatin to the diaper area and a low potency corticosteroid to all areas except the face.
Categories
papulosquamous eruptions

Diagnosis
id reaction dermatitis, stasis
Body Site
total body leg
Age
55 years
Pigmentation
light
Organization
Color
red
Morphology
papulosquamous (bump, scale)
Pattern
Comments
A 55 year old man with chronic stasis dermatitis developed a severe flare on his left leg possibly
associated with a contact allergic reaction to a topical lubricant. Within 24 hours he erupted with
a diffuse pruritic eczematous rash. He improved quickly with tepid tap water compresses and
tapering oral steroids. Although he was also treated with oral antibiotics, cultures from exudate
from the leg grew only normal skin flora.
Description
diffuse red scaly papules
Categories
papulosquamous eruptions

Diagnosis
id reaction autoeczematization
Body Site
face
Age
3 years
Pigmentation
dark
Organization
dense
Color

red
Morphology
papulosquamous (bump, scale)
Pattern
symmetric generalized, disseminated
Comments
This healthy preschooler with inflammatory tinea capitis developed a widespread eczematous
eruption which was most prominent on the face, neck and ears 2 weeks after starting therapy
with oral griseofulvin for tinea capitis. The dermatophytid reaction improved with a 2 week
tapering course of oral corticosteroids. She subsequently completed a 10 week course of oral
griseofulvin 20/mg/kg/day.
Description
diffuse red scaly 1-3 mm papules
Categories
papulosquamous eruptions

Diagnosis
id reaction autoeczematization
Body Site
back
Age
3 years
Pigmentation
dark
Organization
Color
Morphology
papulosquamous (bump, scale)
Pattern
Comments
A toddler with inflammatory tinea capitis developed a widespread pruritic eczematous eruption
two weeks into a course of oral griseofulvin. He was treated with lubricants and topical steroids
and continued on griseofulvin for 10 weeks. The rash decreased over 10 days and did not recur
when the topicaL steroid was discontinued.
Description
disseminated round scaly plaques
Categories
papulosquamous eruption

Diagnosis
scabies autoeczematization id reaction
Body Site
back arm
Age
6 weeks
Pigmentation
light
Organization
linear
Color
Morphology
papulosquamous (bump, scale)
Pattern
Comments
A 6 week old was evaluated for a widespread ecaematous eruption. Burrows were also scattered
over much of the skin surface and multiple scrapings were positive for viable female scabidic
mites. He responded to 5 percent permethrin cream applied at the first visit and repeated a week
later. The entire family and baby sitter were also treated. Lesions and symptoms gradually
resolved over 4 weeks.
Description
multiple linear 3-5 mm burrows and widespread eczematous papules
Categories
papulosquamous eruptions vesiculobullous eruptions infections and infestations neonatal
dermatology