Rosh Emergency Medicine Practice Test

What is the best way to educate a patient with a pruritic rash that worsened after antifungal treatment?

1. Advise him that topical corticosteroid therapy will relieve itching

2. Advise the patient to avoid sun exposure

3. Assure him that no treatment is required and the rash will resolve in 1-2 weeks

4. Assure him that the rash will resolve with oral corticosteroids in 1 week

The correct answer is: Advise him that topical corticosteroid therapy will relieve itching

Advising the patient that topical corticosteroid therapy will relieve itching is appropriate in this scenario because corticosteroids are effective anti-inflammatory agents commonly used to soothe pruritic rashes. When a rash worsens, particularly after initiating antifungal treatment, it is important to consider the possibility of an inflammatory reaction or a different underlying condition, such as contact dermatitis or a drug reaction. Topical corticosteroids can help reduce inflammation and alleviate the associated itching, providing symptomatic relief while further evaluation is conducted. In cases where a rash does not improve or worsens after treatment, it is critical to assess whether the original condition was misdiagnosed, or if there is a secondary reaction to either the antifungal medication or another irritant. Other management options, like avoidance of sun exposure or reassurance that no treatment is needed, may not appropriately address the patient's discomfort or the ongoing issue. Additionally, immediate reliance on systemic corticosteroids may not be necessary and could have potential side effects that are generally not warranted unless there is significant involvement or systemic symptoms. Overall, topical corticosteroids offer a balanced approach to manage symptoms effectively while further investigation into the rash's underlying cause can be conducted.