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Abstract: The patient recently found that the skin scratched by the baby always quickly appeared a bulging red tract with itching, which disappeared after a while, leaving no trace of skin. Examination revealed that it was induced urticaria, typically characterized by the location where the skin was scratched to induce a windbag-like rash with itching, which would disappear again after a few minutes. Through western medicine + herbal treatment, the patient’s skin sensitivity gradually returned to normal and did not recur.
Basic information】Female, 33 years old
Disease Type】Induced Urticaria
Hospital】Tianjin Haihe Hospital
Date of consultation】August 2019
Treatment plan】Western medicine treatment (Ebastine tablets, compound glycyrrhetinic acid tablets, vitamin C tablets) + Chinese medicine identification (Jing Fang Si Wu Tang, Ginseng and Bai Zhu San, Ba Zhen Tang)
Treatment period】3 months of outpatient treatment, regular follow-ups
Treatment effect] Skin sensitivity gradually returned to normal, no recurrence
I. Initial consultation
The patient did not have any skin abnormality at the time of consultation, but her medical history was nearly half a year. Further understanding revealed that the patient became a mother one year ago and had been taking care of her child by herself, her life and rest were disrupted, and her rest and diet were irregular. Six months ago, it was found that the skin scratched by the baby would itch unbearably, and the scratched area appeared a light red bulge, further scratching to stop the itching, the bulge will be more, even in a row, the itching can not be relieved. If you hold back and do not deal with it, the bulge will subside on its own after ten minutes, and the itching will gradually be relieved. This situation occurs repeatedly and more and more frequently, and now even a tight belt or sock tube can cause rash and itching, which has affected daily life. A skin scratch test was then performed on the patient, and the results showed positive. Related blood tests suggested slightly high eosinophils, normal CRP, no significant biochemical abnormalities, and allergen testing suggested high IgE. Combined with clinical symptoms, the diagnosis of induced urticaria was clear.
(Skin manifestation)
II. Treatment history
Induced urticaria is a kind of chronic urticaria, suggesting that the skin is in a state of hypersensitivity, and can generally be left untreated in mild cases. However, this patient has affected her daily life and her skin is hypersensitive, so she needs to be treated systematically. It is good that the patient has stopped breastfeeding and can receive medication. The first choice is a second-generation antihistamine, ebastine tablets for anti-allergy, and vitamin C tablets to improve vascular permeability and assist in reducing skin reactivity. Because induced urticaria is associated with disorders of the autoimmune system, a relatively safe and moderately acting immunomodulator, compound glycyrrhetinic acid tablets, was added. At the same time, according to the patient’s medical history, the patient’s past work and diet disorder was the root cause of the disease, so he was advised to adjust his work and rest, ensure sleep, eat regularly, exercise appropriately, avoid allergenic food and environment according to the allergen test results, eat a light diet, and regulate qi and blood with traditional Chinese medicine, such as Jing Fang Si Wu Tang, Ginseng and Bai Zhu San, and Ba Zhen Tang.
Treatment effect
After one month of comprehensive treatment of anti-allergy, immune regulation, Chinese herbal medicine and lifestyle adjustment and regular follow-up, the patient’s incidence was significantly reduced. After discontinuing the drug, the patient was advised to continue to maintain a good lifestyle and relaxation, and after six months of follow-up, no recurrence was observed, skin sensitivity returned to normal, and the skin scratch test was negative.
IV. Precautions
I am glad that after treatment the patient’s skin sensitivity gradually returned to normal, the wind mass is not easily triggered, the patient should follow up with the following points.
1, the occurrence of induced urticaria is related to the hypersensitivity of the skin, avoid external stimulation is the main preventive measure to reduce the triggering of the rash, try to wear loose natural material clothes in daily life, avoid tight and non-breathable dress code. When a rash occurs, scratching is strictly forbidden, and cold compresses or topical application of glyburide lotion should be applied to promote capillary constriction and reduce the release of allergic mediators, thus relieving itching and accelerating rash fading. If the itching and rash cannot be relieved, oral anti-allergy medication or topical glucocorticoid ointment should be used, and scratching is strictly forbidden.
2. Induced urticaria is related to autoimmunity, and the daily lifestyle and mood state have a great impact on the function of the autoimmune system. In addition to medication, patients need to adjust their lifestyle, maintain a healthy diet and rest, eat a light diet, avoid spicy stimulating and allergenic foods, avoid staying up late and overdraft, exercise appropriately, especially aerobic exercise, and ensure a relaxed mood.
3, induced urticaria treatment period is long, easy to repeat, patients need to follow the doctor’s instructions, not to suddenly reduce or stop the medication on their own, resulting in the abandonment of treatment before. Of course, do not self-medication, so as not to long-term improper use of drugs lead to the occurrence of adverse reactions.
V. Personal insight
1, induced urticaria patients basically belong to the allergic body, the management of their daily life is as important as drug treatment. The effect of drug treatment alone is often poor, but with good health and life management, long-term adherence, can gradually change the physical state, thus ensuring the long-term effectiveness of treatment, as in this case, the patient, after lifestyle adjustment, the treatment effect is more obvious.
2, induced urticaria in the adjustment of drug treatment plan need to adhere to the sequential treatment, according to the symptoms slowly reduce the drug, gradually discontinue, not to see the effect of stop, in order to ensure the stability of the curative effect.
3, special groups of people suffering from induced urticaria, such as children, pregnant women, breastfeeding, the elderly, special diseases, the need to choose a treatment plan according to the physical condition and characteristics of special groups of people, to avoid the contraindications of special groups of people medication, to avoid the impact of long-term medication on the body and life, such groups of people, in particular, should not self-medication, must go to the regular hospital dermatology to seek professional treatment services.