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Abstract: Mr. Li came to the hospital because he had red spots with clear borders on the palm area, back area and thigh area for 3 weeks, accompanied by mild itching, and the number was gradually increasing. After examination at the hospital, he was diagnosed with erythema multiforme. Subsequently, he was given a course of oral medication with topical medication according to the doctor’s instructions, and the local symptoms gradually subsided.
Basic information】Male, 36 years old
Disease Type】Polycythematous erythema
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】April 2022
Treatment plan】Medication (vaxilovir hydrochloride capsule + mometasone furoate cream + penciclovir cream)
Treatment period】30 days of home treatment
Effectiveness of treatment】There was gradual improvement of symptoms
I. Initial consultation
Patient Mr. Li, 36 years old, described that he had red spots with clear borders on the palms of his hands, feet and back after he had a fever and sore throat 3 weeks ago, and because he had high-risk sexual behavior 2 years ago, he suspected that he had syphilis, so he went to the clinic. The patient’s palms, feet, back and other parts of the body appear scattered multiple red spots with clear borders, mild edematous papules can be seen, the diameter of the skin damage is usually about 1 cm, individual skin damage on the surface of the feet can be up to 3 cm in diameter. these red spots can be seen typical ring-shaped changes, the middle of the purple and dark brown, showing typical iris-like changes. The probability of considering erythema multiforme is high based on the clinical presentation alone.
However, considering the patient’s own concerns, a syphilis spirochete test and dermatopathological examination were performed. The syphilis spirochete test showed negative antibodies, basically excluding syphilis. The pathology results showed that there was significant cellular necrosis at the specimen site, reticular keratin layer could be seen, and vacuolated interfacial dermatitis-like changes could be seen. Based on the pathological results and clinical manifestations, the diagnosis of erythema multiforme was met.
II. Treatment history
The red spots that appeared on the patient’s body had lasted for 3 weeks and seriously affected the patient’s physical and mental health. The patient was advised to choose to use oral medication with topical medication for treatment. The main oral medications are vaxilovir hydrochloride capsules, and the topical medications are mometasone furoate cream and penciclovir cream. Vaxilovir hydrochloride capsules are able to suppress the erythema-like changes caused by herpes simplex virus infection inside the body from the inside out to a certain extent. And mometasone furoate cream is a glucocorticoid, which can relieve local skin itching symptoms through its own anti-inflammatory, anti-allergic and immunosuppressive effects, and penciclovir cream helps to quickly relieve the symptoms.
III. Treatment effect
After 30 days, the patient returned to the clinic and said that after 7-8 days of medication, the red spots on the body gradually turned dark brown, no new red patches appeared, and the itching level completely disappeared. The edges of the red spots on the body gradually became blurred after about 15 days of medication. By the day of the follow-up, the damage on the skin surface had basically faded completely, and there was no obvious abnormal feeling. On examination, the patient saw that the scattered red spots on the skin of the hands had basically disappeared completely, leaving light brown pigmentation, and the large red spots on the back area had completely disappeared. The patient was instructed to observe at home and to follow up promptly if there was any abnormality.
IV. Notes
I am glad that the patient’s condition has improved, but I also need to remind the patient that before the disease is completely cured, it is recommended not to drink alcohol and eat less spicy and stimulating food to avoid affecting the treatment cycle of the medication. The disease can lead to similar lesions inside the oral mucosa, and once oral mucosal erosion occurs, you can choose to use recombinant human epidermal growth factor gel. If the symptoms of erythema on the body continue to worsen, consider the possibility of transforming into severe erythema multiforme, and follow up with the hospital in time to avoid blind use of drugs.
V. Personal insight
Erythema multiforme is related to herpes simplex virus infection to a certain extent, and the treatment is mainly based on antiviral drugs, so the patient of this article is given a combination of penciclovir cream treatment. The mild erythema multiforme itself has a certain degree of self-limitation, and some people can gradually heal themselves in 1-2 months, so there is no need to panic as this patient did, as long as they receive regular treatment and follow the medical prescription, they can get better treatment effect.