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Abstract: This case is a 10-year-old boy who came to the hospital with erythema and scaling with itching on his hands for more than 1 year, and the itching had recently increased. After admission, the patient was found to be non-allergic to dust mites, beef and mutton, seafood, etc. The relevant immunological indexes were all negative, and the preliminary diagnosis was chronic eczema. The patient was given medication, and the condition was controlled after treatment, and the pruritus and skin lesions had improved significantly.
Basic information】Male, 10 years old
Disease Type】Chronic eczema
Hospital】Nanning Second People’s Hospital
Date of consultation】May 2022
Treatment plan】Medication (loratadine syrup, vitamin C tablets, dextran cream, mucopolysaccharide polysulfate cream)
Treatment period】4 weeks of outpatient treatment, regular follow-ups
Effectiveness】The disease has been controlled, itching and lesions have been significantly improved.
I. Initial consultation
The patient is an active boy. According to his mother’s description, a year ago, after repeated contact with soap, the patient developed molting on his five fingers, which did not improve after a few days and was accompanied by itching. During the communication with the mother, we observed that the patient was still scratching the affected area with her hands. Although the mother stopped her from scratching, the patient felt uncomfortable, so we hoped to help the patient reduce the symptoms and cure the disease through treatment. Subsequently, the patient was found to be negative for allergens such as household dust mites, beef and mutton, and other protein foods, including seafood, and negative for ANA and other related immunological indicators.
II. Treatment history
The patient underwent skin examination and was found to have flaking and erythema on the five fingers of the hand, with hypertrophy of some skin keratinization infiltration, and light red papules on the back of the palmoplantar area, accompanied by itching, without chapping. The routine blood and liver and kidney function tests were not abnormal, and the physical examination showed that the general condition was fair, the urine and stool were normal, and the diet and sleep were also fair. The patient’s family genetic history and drug allergy history were not special, and there was no history of smoking or alcohol consumption. Allergen tests for dust mites, beef and mutton, and other protein foods, including seafood, were negative, and immunological tests such as ANA were negative. Because of the symptoms of soap exposure, it was suspected to be an allergen. The above features were combined to diagnose chronic eczema, and after communication with the patient’s mother, the following plan was made.
1. oral medications: e.g. loratadine syrup, vitamin C tablets.
2. Topical medications: Denide cream and mucopolysaccharide polysulfate cream were applied at bedtime and the affected area was wrapped with plastic wrap and removed the next morning to relieve the patient’s symptoms of itching and flaking.
III. Treatment effect
After 1 month of treatment, the patient visited the doctor for a follow-up consultation. The patient himself described happily: Uncle doctor, my hands are not as itchy as before. The mother also said: The child’s itchiness really decreased, the lesion flaking reduced, the papule disappeared, no chap during the medication, no recurrence compared to the first treatment, really thank you! I then instructed the patient’s mother to stop using other medications when the patient’s symptoms disappear, but vitamin C needs to be taken for another month, while eating more vegetables and fruits.
IV. Notes
I am glad that the patient’s itchy hand symptoms were relieved after treatment and the disease gradually recovered. In daily life, avoid contact with allergens, for example, the patient’s trigger is contact with soap, so avoid contact with soap and other items, touch the lesions with as little water as possible and do not scratch. Diet, more water, or according to their own conditions and preferences, the juice of fruits and vegetables, not only to replenish water, but also to replenish the vitamins, minerals and other nutrients contained in fruits and vegetables. For eczema patients, they should avoid eating a lot of spicy and irritating food to avoid aggravating the condition and cracking the hands. In addition, patients should pay attention to the hand hygiene cleaning, daily cleaning products as mild nature of the supplies as possible.
Five, personal feelings
Chronic eczema generally occurs in the hands, manifesting itself as keratinized skin molting, there will be flaking hypertrophy, if continued scratching leads to severe eczema, it will appear dry, cracked phenomenon. Eczema is generally caused by hand contact with allergic substances, and more allergic substances, mainly irritating substances, such as formaldehyde and other gases, as well as paints, detergents and other items, should be avoided. If symptoms such as red rash and itching are found, medical treatment should be sought promptly. Patients should also avoid allergens, i.e. triggers, if they know their own allergens, as long as less contact, the disease is less likely to recur, such as the patient do not contact soap, and other detergents, you can largely reduce the possibility of recurrence. If you don’t know the triggering factors, you need to pay more attention in your life, and you can also go to the hospital for allergen-related tests.