(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: A 19-year-old boy presented with multiple keratotic lesions on the posterior neck area with well-defined margins and very intense pruritus, which seriously affected his quality of life. After visiting the hospital for physical examination, routine blood and IgE tests, the diagnosis of simple moss was confirmed. The onset of the disease may be related to many factors such as anxiety, irritability, depression and insomnia. The patient’s symptoms improved after 30 days of treatment with oral medication and topical medication.
Basic information】Male, 19 years old
Disease Type】Simple moss
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】May 2022
Treatment plan】Medication (oral B vitamin tablets + topical clobetasol propionate cream)
Treatment period】30 days of home treatment, 30 days after the follow-up
Effectiveness】The keratotic changes on the skin surface gradually softened, the lesion area was reduced, and the itching disappeared.
I. Initial consultation
In late May, the outbreak in Harbin finally came to an end. In the morning, I was at the clinic and a 19-year-old boy came in with well-defined cheeks and a very handsome face, but his eyes always contained a trace of sadness. The boy said that he had multiple patches of hardened skin on the back of his neck, accompanied by very pronounced itching that increased at night. It had been going on for two years and had not improved, and no medication had been applied. The disease in the back of the neck had gradually worsened and was seriously affecting his life. On examination, the patient was found to have multiple keratotic plaques on the posterior side of the neck with light red color and clear edges. The skin had obvious hypertrophy with leather-like changes, thickened skin texture, crossed streaks, and small flattened quadrangular planes could be seen at the top, and the upper lesions had reached the medial hairline. The clinical features are distinct and the first consideration is simple moss, also called neurodermatitis. After talking to the patient and explaining the developmental features of the disease, the patient agreed to undergo routine blood and IgE tests in order to clarify the diagnosis. The routine blood test showed a rise in eosinophils and an increase in IgE, and the results were consistent with the diagnosis of lichen simplex.
II. Treatment history
The patient had been suffering from lichen simplex for 2 years, and the treatment plan was clarified after communication with the patient, suggesting oral B vitamin tablets and topical clobetasol propionate cream for treatment. Clobetasol propionate cream is a topical, super-potent glucocorticoid that, when used, can gradually subside the symptoms of simplex moss through its own anti-inflammatory, anti-allergic and immunosuppressive effects in order to achieve the purpose of treatment. After communicating with the patient about the way of medication, the boy nodded that he had understood the method of medication and went home for home treatment.
III. Treatment effect
The patient returned by telephone 7 days after the medication was administered. The patient said that the itching symptoms were significantly relieved on the first day of medication, and the quality of sleep was significantly improved. His mental state was gradually relaxed. The keratotic plaques were gradually softened and the edges were not reduced, but I could feel that the drug was working. As of the date of the telephone call, the pruritic symptoms existed but were significantly relieved and were not enough to affect his life. The patient was instructed to continue to apply the medication to consolidate the treatment for a follow-up visit after 30 days. At the follow-up visit, the patient indicated that the pruritic symptoms had disappeared, the quality of sleep had been completely improved, and the erythema was found to have subsided significantly.
IV. Precautions
The patient’s condition improved and his discomfort was reduced after the medication, and as a doctor, I am truly happy for him. Simple moss itself is an intensely pruritic disease, and it is recommended to avoid scratching as much as possible during the treatment process, which can prevent the symptoms of skin damage from continuing to worsen. Before the disease is completely cured, you should pay attention to avoid eating spicy and irritating food and seafood and fishy hair food, and avoid washing the affected area with hot water, alcohol, vinegar, salt water and other irritating liquids to prevent the original keratinization changes from gradually worsening, which is not conducive to the treatment of the disease. Do not rub repeatedly when bathing in daily life, otherwise it may lead to gradual aggravation of keratosis. The drugs used should be used in a full course, and should not be stopped when the symptoms are just relieved, otherwise it may lead to recurrence of the disease and prolong the treatment time.
V. Personal insight
The patient suffers from simple moss, considering that it may be triggered by long-term friction, irritation and scratching. After the discomfort of the organism, in addition to choosing to use glucocorticoid drugs for treatment under the guidance of a doctor, antihistamine drugs such as cetirizine hydrochloride tablets and loratadine tablets can also be used to relieve the symptoms of itchy skin as prescribed by the doctor. Patients should note that since the disease is closely related to nervous tension and anxiety, it is important to relieve nervous anxiety while treating the disease and try to ensure sufficient sleep to help alleviate the discomfort. If the skin is excessively dry, moisturizers such as glycerin and petroleum jelly ointment can be used appropriately to improve the symptoms. Doctors should also pay attention to such details during treatment, in addition to asking patients about their symptoms and other conditions, to help them recover and strengthen their trust in the doctor.