The correct answer is F. Use topical corticosteroid until clear.

The patient has findings classic for atopic dermatitis. However, the treatment course to date has been insufficient with only 4 days of steroid application with a weaker topical corticosteroid. Therefore, the patient’s best course of action is to use a topical corticosteroid for a longer trial prior to considering further therapy.

The addition of oral cetirizine would be useful if there were an allergic component to the disease; however, topical corticosteroids should be trialed first. The addition of topical metronidazole ointment is unlikely to be helpful in this case. Patch testing may be performed, but there are few diagnostic reasons for it at this point as there has been little treatment performed for atopic dermatitis. A topical retinoid may be more drying and not helpful in the case of atopic dermatitis. Starting an oral prednisone regimen may be a treatment course for a flare, but a topical regimen should be used regularly to monitor for improvement.

References:

Oberlin KE, Nanda S. Atopic dermatitis made easy: The Schachner Ladder. Pediatr Dermatol. 2019;36(6):1017-1018.

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