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Abstract: The patient, Ms. Li, 35 years old, had a wound of ulcerative nature in the arm area due to a break, and chose to disinfect the area without significant healing, and the wound had symptoms of significant enlargement. The corresponding examination was performed at the hospital and it was judged to be sporotrichosis. The local symptoms disappeared after choosing drug treatment, and the broken plaque on the skin surface gradually shrank, crusted and fell off, and the patient was satisfied with the treatment effect.
Basic information】Female, 35 years old
Disease Type】Sporotrichosis
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】May 2022
Treatment plan】Medication (potassium iodide cream, potassium iodide tablets)
Treatment period】30 days of home treatment
Effectiveness】The broken plaques on the skin surface gradually shrank, crusted and peeled off
I. Initial consultation
Patient Ms. Li came to our hospital in May 2022 and reported that after her right arm was previously stimulated by trauma and broken by a wooden thorn, the local skin surface showed obvious redness, swelling and pain within 1 month, and the plaque was gradually changed and proliferated. The wound did not heal and had a tendency to gradually spread to the surrounding area. On examination, the patient was seen to have formed red ruptured changes raised above the skin on the lateral side of the right upper arm with clear borders and mucus-like hyperplasia at the rupture site, while there was red infiltrative erythema around it and adhesions to the skin above, which was considered to be sporotrichosis based on the patient’s medical history and local morphology. A fungal culture was performed on the patient and sporotrichous fungi were seen. Combined with the patient’s clinical manifestations and laboratory test results, the diagnosis of sporotrichosis was met.
II. Treatment history
The skin damage on the patient’s skin surface had lasted for 1 month and gradually expanded to the surrounding area, and the disease progressed relatively rapidly. After communicating with the patient, the patient understood the occurrence and development of the disease and clarified the treatment plan with the patient, choosing to use potassium iodide cream with oral potassium iodide tablets. Potassium iodide intake in the body coupled with topical comprehensive treatment can inhibit the metabolism and reproduction of local sporotrichous bacteria, thus causing the gradual death of local sporotrichous bacteria in order to achieve the purpose of treatment. Patients were instructed to pick up the medication and learn how to use it before going home for home treatment, and were instructed to follow up with the patient whenever there were problems.
III. Treatment effect
After 30 days of medication, the patient returned by phone and said that after 3 days of medication, the state of local adhesions and exudation had significantly improved, and the skin surface had lightly crusted. After 7 days of medication, the symptoms of outward expansion of the lesions had stabilized and did not expand further. After 15 days of medication, the local crusts gradually softened and the red faint color around the skin gradually turned brown. As of the date of the telephone call, the local skin damage had been significantly relieved, the broken skin surface changes had basically healed, and although there was still mild local crusting, the degree of itching had subsided. The patient was instructed to continue the medication and to follow up at any time.
IV. Notes
I am glad that the patient’s symptoms have improved after treatment, but the patient needs to pay attention not to choose to use vinegar, saline, alcohol and other irritating liquids for stimulation, so as not to lead to local combined bacterial infection, so that the original part of the formation of ulceration, which is not good for health. The medication should be used for a full course of treatment and should not be stopped just after the symptoms have been significantly relieved, otherwise it will not be conducive to the treatment of the disease. Potassium iodide tablets may cause discomfort in the throat, such as nausea, vomiting and burning sensation, so if the symptoms are severe, it is recommended to stop using the medication immediately and follow up at any time.
V. Personal insight
Potassium iodide tablets for internal use and potassium iodide cream for external use are the preferred treatment options for sporotrichosis, as in this case. If potassium iodide is ineffective or resistant, itraconazole capsules may also be used. Sporotrichosis has a low positive fungal microscopy rate and requires the option of fungal culture for a clear diagnosis, and if pathology is done, typical fenestrated granulomatous dermatitis is seen.