This time, I'd like to talk about cases of skin diseases.
Although dermatology is not my area of expertise, I still need to learn about skin diseases in order to perform the necessary restorations and procedures.
I have found it more useful to learn from case studies, so I have been studying through these articles.
The case I am going to introduce is one in which what was thought to be atopic dermatitis turned out to be allergic contact dermatitis.
The case
A 50-year-old woman
She came to our hospital because of redness caused by atopic dermatitis.
She came to our hospital because of redness caused by atopic dermatitis, which started on her hands when she was a child and caused painful erosions and sometimes bleeding.
She had been treated with topical corticosteroid medication.
At the age of 40, the affected area spread to include the feet, causing severe pruritus and erosions.Interventions with oral antihistamines, oral prednisone, intramuscular triamcinolone, and omalizumab injections failed to produce sustained improvement.
Biopsies revealed spongiotic dermatitis with mucin, eosinophils, and spongiosis of some hair follicles.
Elimination of dermatitis on the face and lower extremities was improved with a 2-week oral prednisone taper and topical desoximetasone ointment starting at 40 mg.
Patch testing against the North American Contact Dermatitis Group Standard Series and external agents and emulsifiers revealed a 2+ reaction to perbalsam and methylchloroisothiazolinone/methylisothiazolinone.
Each of these allergens was associated with a personal care product she was using.
Iodopropynyl butylcarbamate
Propolis
Glutaraldehyde
Two months after she began avoiding the allergens, she showed dramatic improvement.The dermatitis on her face and feet was completely removed, and three years later, her face is problem free and she no longer needs to use topical treatments.
POINT
The diagnosis of allergic contact dermatitis (ACD) can be missed for a long time due to the lack of clinically relevant features.
People who are diagnosed with atopic dermatitis (AD) in childhood are more likely to delay the diagnosis of ACD because of the overlap of clinical symptoms between ACD and AD.
For those who are not successfully treated for AD, the underlying ACD needs to be suspected.
However, it is sometimes assumed that patients with AD are "hard to treat" or have a "treatment-resistant" condition.
Although AD and ACD may appear to be clinically similar, certain important factors may strongly suggest ACD, such as a distinct distribution of contact with exogenous substances, atypical distribution of AD, treatment-resistant occupational hand eczema, and adolescent or adult-onset AD.
Diagnostic testing with patch tests may also be important, for example, in cases of severe or widespread dermatitis.In people with both AD and ACD, allergens in the emulsifier/surfactant and fragrance categories are the main sources of sensitization.
Additionally, even if a patient has used the same product for years prior to the onset of inflammation, the product can still cause adult onset ACD.
Individuals who patch test with features suggestive of ACD may reveal a more subtle situation.
Semaan S, Raffi J, Murase JE. Allergic contact dermatitis masquerading as atopic dermatitis. Int J Womens Dermatol. 2020;6(4):329-330. Published 2020 Published 2020. doi:10.1016/j.ijwd.2020.04.005
Conclusion
This case study shows that the underlying cause of atopic dermatitis may be allergic contact dermatitis.For either condition, direct approach to the affected area is not allowed in the judo therapy industry, but it can be done if the prior medical interview is neglected or the handover is not done properly.
I thought I would look into this genre for a while, because I think that by becoming more knowledgeable about these areas, I can expand the range of things I can handle as a medical professional.
