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Abstract: This case refers to an 8-month-old female child who presented with symmetrically distributed erythema and papules on the surface of the extremities, and could see some obvious bumps. The child came to the clinic because she unconsciously scratched the papules on the skin surface and formed some crusts and had recurrent episodes. After the consultation, the child was diagnosed with atopic eczema based on her symptoms and ancillary tests, and she was given medication to help her symptoms subside and recover.
Basic information】Female, 8 months old
Disease Type】Atopic eczema
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】April 2022
Treatment plan】Anti-allergic (Desloratadine suspension) + anti-eczema treatment (Chlorcyclizine Hydrochloride cream)
Treatment period】10 days of home treatment
Effectiveness】Erythema, papules and crusts on the skin surface gradually disappeared.
I. Initial consultation
In April 2022, a woman entered the clinic with a swaddled child in her arms. The parents described that the child had symmetrical erythema and papules on the skin surface since 2 months of age, and they appeared intermittently and could see some obvious small bumps. They were mainly located in the elbow fossa, popliteal fossa, ankle and extensor side of the extremities. As the child grew up, he or she began to scratch the papules unconsciously, resulting in the formation of crusts on the skin surface. As the child was young, the parents did not give the child any medication and brought the child to the clinic just after the epidemic had stabilized. When I saw the skin damage on the skin surface and the distribution of the skin damage, my first impression was that atopic dermatitis is also called atopic eczema. Since the child was too young to undergo dermatopathological examination and the parents refused to draw blood for routine blood tests, the child was examined for fungi based on the differential diagnosis of the disease, which showed a negative fungal test, and the clinical symptoms supported the diagnosis of atopic eczema.
II. Treatment history
The symptoms on the skin surface of the child had been recurring for about 5 months. When I saw the erythema and papules on the skin surface of the child and the crusting caused by unconscious scratching, I could feel the pain of the child and the concern of the parents for the child. After coordinating with the parents, they gave up some tests and only agreed to do a fungal examination, and then a clinical diagnosis could only be made based on clinical symptoms. Since the child was more than 6 months old, the child was chosen to be given oral dexloratadine suspension, a drug that when ingested into the body reduces the release of histamine within the body, relieves the allergic symptoms within the body, brings the erythema and papules on the skin surface of the child under control, and relieves the itching of the child. The skin surface is treated with non-hormonal clofentezine hydrochloride cream, a topical antihistamine, which is used on the skin surface to reduce the symptoms of local skin allergy and to gradually subside the skin damage formed by atopic eczema. The parents were then instructed on the use of the medication and told to use it regularly.
Third, the effect of treatment
Although atopic eczema may be related to a certain extent to genetic constitution, it is possible to subside the skin surface symptoms after the symptoms appear by following a full course of treatment as directed by the doctor. With the above mentioned medication, the family members reported that the child’s symptoms gradually began to subside in about 5 days and the skin surface had basically returned to a healthy state in 10 days.
IV. Notes
We are glad to see that the child’s symptoms have improved significantly with the medication. However, since the child is relatively young, it is recommended to follow the doctor’s instruction when choosing the dosage of medication in the later stage, and not to use too much medication to avoid excessive suppression of the child’s central nervous system. As for the topical medication, it is not easy to apply it too thickly to avoid irritation to the skin.
When bathing the child in daily life, avoid using too hot water to avoid stimulating the local area, leading to increased itching, which is not conducive to the recovery of the disease. In terms of diet, when adding supplementary food, do not add fish, shrimp, crab and other high-protein foods to the child until the disease has fully recovered to a healthy state, and caution is recommended for egg-based foods. The temperature of the child’s living environment should not be too high, and it is recommended that the temperature should be below 26°C to prevent itching from increasing.
The probability of recurrence of atopic eczema is relatively high. If the symptoms of eczema reappear after healing, it is recommended to seek medical attention promptly. Do not blindly use drugs at will to avoid causing symptoms to become more complicated.
V. Personal insight
Atopic eczema is a chronic inflammatory skin disease characterized by pruritus as well as acute attacks and chronic course. This disease may be related to genetic constitution, and the intake of certain new foods triggering allergic symptoms may lead to the recurrence of the disease. Later, even if such drugs are no longer taken, the skin surface symptoms will not be quickly relieved by stopping the intake of food. When skin symptoms appear, erythema, papules and itching on the skin surface are more obvious, and treatment should be carried out in a timely manner according to the doctor’s instruction, as in the case of the child, who was treated correctly and got good results. Remember not to blindly use acid, alkali, salt, vinegar, alcohol and other liquids for external application on the skin surface to prevent the original symptoms from becoming more complicated. The antihistamines may be centrally inhibited after taking the medication and cause drowsiness in the child, which is generally not a cause for excessive concern. However, if the child’s drowsiness is very serious, he or she should seek medical attention and treatment in a timely manner.