Rosh Pediatrics Practice Exam

What is the most likely diagnosis for a 9-month-old girl with a scaling and erythematous rash in the perineal area?

1. Allergic contact dermatitis

2. Atopic dermatitis

3. Candidal infection

4. Irritant contact dermatitis

The correct answer is: Irritant contact dermatitis

For a 9-month-old girl presenting with a scaling and erythematous rash in the perineal area, the most likely diagnosis is irritant contact dermatitis. This condition is very common in infants and is typically caused by prolonged exposure to irritants such as urine, feces, or even hygiene products. The characteristics of the rash, including scaling and erythema, are consistent with irritant contact dermatitis because the perineal area can easily become inflamed from these irritants. The rash usually appears in areas that are in contact with the irritant, such as the buttocks, thighs, and genital region, which aligns with the location described. It is crucial to identify that the condition is usually not due to an allergic reaction involving a specific allergen, which wouldn't typically present with scaling but rather more distinct vesicular or weeping lesions. While other conditions like allergic contact dermatitis and candidal infection can also cause rashes in this area, they often have differing presentations. Allergic contact dermatitis would show more localized vesicular lesions due to an allergic reaction (e.g., from diaper cream), and candidal infections often exhibit a well-defined, beefy red rash with satellite lesions, which is not described here. Atopic dermatitis is