Managing Persistent Allergic Contact Dermatitis in a 34-Year-Old Male – Case Report from Village Dermatology in Katy & Houston, Texas
by: Ashley Baldree
At Village Dermatology, we frequently see patients with allergic contact dermatitis (ACD) – a common but sometimes stubborn skin condition that can cause itching, redness, and inflammation. This case highlights how timely evaluation and treatment adjustments can help patients achieve relief, especially when symptoms persist despite initial therapy.
Patient Background
A 34-year-old male presented for follow-up of allergic contact dermatitis initially evaluated on July 21, 2025. At his first visit, he was prescribed a prednisone taper to control inflammation. He returned four days into treatment, reporting worsening rash and discomfort, particularly over the knees.
Clinical Examination
A full skin exam was performed, including the scalp, head, face, neck, upper and lower extremities, and feet. The patient was in good general health, alert, and oriented. Examination revealed well-demarcated, geometric, eczematous patches on the knees, consistent with allergic contact dermatitis. However, the inflammation appeared to be progressing.
Treatment Plan and Adjustments
Given the persistent and worsening nature of the rash, the treatment plan was modified:
Intramuscular Kenalog Injection – A 60 mg dose was administered to rapidly reduce inflammation and help control the flare.
Gabapentin 300 mg – Prescribed for nightly use to help relieve itching and burning sensations associated with the dermatitis.
Revised Prednisone Taper – Adjusted dosing to ensure better control over the flare while minimizing long-term steroid risks.
The patient received counseling on skin care and allergen avoidance:
Use only hypoallergenic, fragrance-free soaps and moisturizers.
Avoid new cosmetics, hair products, nail products, plants, metals, and sunscreens until the cause is identified.
Understand that ACD may take several weeks to fully resolve and may require patch testing if the allergen is unknown.
Medication Safety Counseling
We discussed the risks and side effects of prednisone, Kenalog, and gabapentin, including skin thinning, mood changes, dizziness, and potential long-term health effects with extended use. The patient verbalized understanding and agreed to the treatment plan.
Outcome Goals
Our aim is to reduce the inflammation quickly, control symptoms, and prevent recurrence through trigger identification and avoidance. Follow-up will be on an as-needed basis, with the option for further diagnostic testing if symptoms persist.
Key Takeaway for Patients in Katy & Houston, Texas
Persistent allergic contact dermatitis may require treatment escalation, including intramuscular steroids and supportive medications, when topical or oral therapy alone is not enough. At Village Dermatology, our goal is to provide personalized, effective treatment plans to help patients get back to healthy, comfortable skin.
If you are experiencing a stubborn skin rash that isn’t improving with initial treatment, schedule a consultation with our dermatology team in Katy or Houston, Texas.
