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Abstract: This article mentions a 58-year-old male patient who reported pruritus on both lower extremities for 10 days, aggravated for 2 days, with densely arranged red spots and patches on the skin surface, accompanied by intense itching, with dark, brownish erythema on the feet; the erythema on the legs was distributed in bright red patches, which did not fade after pressure. According to the patient’s symptoms and auxiliary examination, he was diagnosed as allergic purpura and given medication. After treatment, the patient’s symptoms subsided and he recovered well.
Basic information】Male, 58 years old
Disease Type】Allergic purpura
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】May 2022
Treatment plan】Anti-allergic (cetirizine hydrochloride tablets), increase capillary resistance (compound rutin tablets) + immunosuppressive drugs (topical mometasone furoate cream)
Treatment period】15 days of home treatment
Treatment effect】Red and brown patch-like changes on the skin surface gradually faded, and itching symptoms completely disappeared.
I. Initial consultation
After the May Day holiday, I came to the clinic as usual, having been at work. Today’s patient No. 1 is a grandfather who is nearly 60 years old. The grandfather came to the clinic and reported that the pruritus of both lower extremities had been itching for 10 days and had been aggravated for 2 days, and some red spots could be seen on the lower extremities. Upon examination, densely arranged red patches were seen on the skin surface of both lower limbs; the red patches on the feet were dark and brown in color; the red patches on the legs were distributed in bright red patches and did not fade after pressure. According to the patient’s description and clinical manifestation, the patient was considered to be allergic purpura. After briefly introducing the disease to the patient, we agreed to perform routine blood tests after communication with the patient. The result of the examination showed that the eosinophil value was increased and the platelet value was normal, the examination result was consistent with the diagnosis of allergic purpura.
II. Treatment history
The patient’s leg symptoms had been present for 10 days, and scattered red patches were seen on the skin surface, accompanied by intense itching, which seriously affected the patient’s life. My suggestion was to carry out medication, and the patient could go home and follow the doctor’s prescription on his own. The main treatment includes oral cetirizine tablets, compound rutin tablets and topical mometasone furoate cream. Cetirizine tablet is an antihistamine, which can reduce the release of histamine inside the body, thus improving the allergy symptoms and avoiding the aggravation of leg purpura; compound rutin tablet can increase the capillary resistance in the body, avoiding the frequent appearance of purpura due to the increased fragility of capillaries caused by allergic factors. Topical mometasone furoate ointment is a medium-acting glucocorticoid, which can control the allergy symptoms through immunosuppressive, anti-inflammatory and anti-allergic effects. After a period of medication, the patient’s skin rash and itchy symptoms gradually subsided.
III. Treatment effect
After 10 days of medication, the patient returned to the patient by telephone. The patient said that the itching symptoms on the legs were significantly relieved after 2 days of medication, the bright red patches on the legs gradually turned into dark red and brown, and the brown patches on the feet gradually turned black and appeared mildly peeling. After 5 days of medication, the skin of the feet peeled off and became normal after peeling. And the brown patches on the legs gradually peeled off and the itching level completely disappeared. As of the call-back date, the patient had no new rash appearing and the surface skin symptoms were effectively controlled. As the disease is prone to recurrence, even if the symptoms are relieved, it is necessary to continue the medication and a full course of treatment to consolidate the efficacy.
IV. Notes
After treatment, the patient’s symptoms were effectively controlled, greatly reducing the impact of itching symptoms on work life, and I am glad to solve the patient’s problems. Patients should avoid excessive scratching of itchy areas. You should pay attention to the diet, not to eat too much spicy stimulating food, do not eat seafood fishy hair food, to avoid triggering the body internal allergy symptoms aggravated leading to purpura symptoms intensified. The actual fact is that you will be able to get a lot more than just a couple of hours to get a lot more than just a couple of hours. When you take a bath, don’t use too much hot water, mainly lukewarm water, to prevent the impact on the skin damage of the legs. This disease after a full course of treatment lesions, itching symptoms will gradually improve, but in accordance with medical advice to the full amount of medication, do not stop too early to avoid recurrent attacks. Once the recurrence occurs, promptly go to the hospital for a review and follow-up to control the symptoms as soon as possible.
V. Personal insight
There are many kinds of purpura diseases, including thrombocytopenic purpura, allergic purpura, simple purpura, traumatic purpura, etc. When similar skin damage occurs, differential diagnosis should be made according to clinical examination results. Allergic purpura is mainly caused by allergic factors, so it is more important to find allergic substances. During the treatment period, in addition to the medication prescribed by the doctor, patients are advised to use other drugs carefully to prevent the aggravation of allergic purpura caused by drug allergy. The bruising change on the skin surface during the treatment of allergic purpura, from bright red to dark red gradually, and then gradually peel off, this is a normal phenomenon, no need to worry. It is recommended that you pay attention to your mouth before you are completely cured, to prevent spicy and stimulating, seafood and fishy hair food from aggravating the allergic symptoms inside your body.