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Abstract: A 20-year-old male hairdresser came to our hospital with erythema, flushing and itching on his hands for more than 1 year due to long-term exposure to chemicals, and was diagnosed with eczema secondary to chemicals.
Basic information】Male, 20 years old
Disease Type】Secondary eczema
Hospital】Nanning Second People’s Hospital
Date of consultation】May 2022
Treatment plan】Topical medications (Halomethasone cream, skin disease lotion) + internal medications (Desloratadine dispersible tablets, Levocetirizine hydrochloride tablets, Compound glycyrrhizin tablets, Vitamin C tablets)
Treatment period】Outpatient consultation, 4 weeks of drug treatment
Treatment effect】The disease was controlled, itching and skin lesions have been significantly improved, no discomfort was seen in 1 month follow-up.
I. Initial consultation
The patient is a young hairdresser who often travels around the country for work. When I first saw him, the first thing he said to me was “doctor, it’s itchy”, which had been going on for 1 year and recurring frequently in the past 1 month. The specific cause of the trigger is unknown, the skin manifested with red spots, papules of different sizes, and always itchy feeling, at first he could not resist scratching, but led to more redness and swelling of the arm, now he is holding back from scratching. He reported that his condition had been aggravated for 3 days, and such papules and erythema of different sizes appeared on the back of his hands and legs, especially on the back of his hands, with many and dense papules and papules, and a distinct itching sensation, and the cause of aggravation was unknown. The patient had no significant abnormalities except for a slight increase in leukocytes, and was initially diagnosed with secondary eczema.
II. Treatment history
According to the patient’s condition, routine blood tests, liver function, sex hormones and other routine tests were performed. In addition, the patient reported that he had been examined for allergens and none were found. Based on the patient’s clinical symptoms and the results of various tests, the patient was diagnosed with secondary eczema, which was considered to be in the acute stage because of its rapid onset and intense itching.
The treatment was based on symptom relief, using an internal plus topical treatment. The topical medication was halometasone cream, and considering that the patient did not have blisters, vesicles, or exudation, skin disease lotion was added. For internal medication, dexloratadine dispersible tablets, levocetirizine hydrochloride tablets and compound glycopyrrolate tablets were used, and vitamin C tablets were added as an adjunct to the medication for 4 weeks. I emphasize to the patient that medications only relieve the symptoms of secondary eczema and are difficult to treat, as the triggers are complex and numerous and often vary depending on the individual’s constitution and the different stages of the disease, so it is difficult to determine. If you don’t pay attention to your life, it is easy to recur, so I emphasized this point to the patient and advised him to develop a good lifestyle, and the patient and his family expressed their understanding and cooperation.
III. Treatment effect
After 4 weeks, the patient reported that the papules and erythema on the back of the hand basically improved after 1 week of medication, and then the medication was suspended, but the other day the patient relapsed (the cause is not known) and insisted on the medication. In summary, the patient’s condition is now under control, and the pruritus and lesions have improved significantly, and no discomfort has been observed in the follow-up period of 1 month.
IV. Notes
I was very happy to see the patient’s symptoms gradually reduced. I told the patient to continue to pay attention to the following matters.
1, diet, maintain a light diet, do not ingest chili, seafood, strong tea, coffee and other stimulating or cold spicy food, and do not drink too much, pay more attention to rest, do not be too much mental stress.
2, try not to scratch the itch with your hands when you have an attack, and do not bathe in water that is too hot, just warm water.
3. Pay more attention to personal hygiene, and do not wear too tight gloves on your hands for a long time.
V. Personal Insights
Secondary eczema acute phase attacks quickly, often erythema, more and dense papules, etc., the patient’s situation is relatively light, serious will also appear systemic symptoms, or by scratching will also appear blisters, vesicles, oozing, etc.
There are three main purposes of treatment, one is to relieve symptoms, like the treatment plan I use for patients, is to relieve symptoms; second is to eliminate the cause of the disease, this is more difficult, because the causes or triggers of secondary eczema will be different because of personal factors, that is, the stage of onset, it is difficult to determine; third is to reduce recurrence, improve the quality of life of patients, if you know the cause of the trigger, it is necessary to live more Pay attention and try to develop a good lifestyle.