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Actinic prurigo — SCE Dermatology MCQ

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HardPhotodermatologyActinic prurigoSCE Dermatology

A patient with known Hailey–Hailey disease develops a sudden painful monomorphic vesicular eruption over a previously stable axillary plaque, with fever and rapid extension. Which complication requires the most urgent targeted treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Herpes simplex superinfection needing systemic antiviral treatment

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · E = shown as D · B = shown as E

B is correct. Hailey–Hailey skin is vulnerable to secondary infection. A sudden painful monomorphic vesicular eruption with fever and rapid extension should raise concern for HSV, analogous to eczema herpeticum, and warrants prompt viral sampling where feasible and systemic antiviral treatment without avoidable delay. Candida and bacterial infection can also exacerbate flexural disease but do not typically produce this monomorphic painful vesicular syndrome. Potent steroid monotherapy could worsen untreated viral infection. Patch testing has no role during an acutely infected, erosive flare.

Reference: British Association of Dermatologists: Hailey–Hailey disease: https://www.bad.org.uk/pils/hailey-hailey-disease