Eczema exercises diagnostic skills
Bilateral eczema like this is more common in young girls, especially those with an atopic history. This patient was into body piercing, which raised the issue of a contact allergy, perhaps to nickel. The Elastoplast may also have been a contributing allergen, but the expectation would be for surrounding skin to be involved. There was no eczema elsewhere.
If the eczema had been unilateral you would have to consider mammary Paget’s disease, a ductal nipple carcinoma, as a possible diagnosis. He did have a skin biopsy which showed a spongiotic dermatitis. Patch testing is scheduled