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Abstract: The patient had a red rash on the left scrotum and thigh root, accompanied by intense pain and fluid exudation, due to repeated rubbing of the thigh root by underwear. After treatment at an outside hospital due to inadequate care, which resulted in poor outcome, the patient visited our outpatient clinic and was considered to have secondary eczema after examination. The patient was given oral antihistamine with topical ointment treatment, and the pruritus was significantly relieved and the skin damage basically subsided.
Basic information】Male, 28 years old
Disease Type】Secondary eczema
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】August 2021
Treatment plan】Oral medication (loratadine capsules) + topical medication (urea ointment, zinc oxide ointment)
[Treatment period] Outpatient review after 30 days of home treatment
Treatment effect】Itching is obviously relieved, and skin damage basically disappears.
I. Initial consultation
The patient said that 30 days ago, he was playing basketball outdoors and his underwear repeatedly rubbed the root of his thighs, resulting in a red rash on the left scrotum and the root of his thighs, accompanied by strong pain and fluid exudation, and was treated accordingly at an outside hospital. As time went by, the flesh-colored plaques gradually expanded in size, became hard to the touch, and the itching became so intense that it affected his quality of life, so he came to our clinic. On examination, we found a keratotic plaque on the left scrotal root above the thigh, about 5×2 cm in size, with a clear border, above which we could see the scratch marks left by repeated scratching. According to the patient’s clinical manifestations and pathogenesis, the probability of secondary eczema was considered to be high. A fungal examination was performed after communication with the patient for differential diagnosis. The fungal examination showed a negative fungus, which ruled out tinea cruris and considered secondary eczema.
II. Treatment history
The patient was advised to be treated by oral medication with topical medication and the patient agreed. Urea ointment has the effect of softening keratinized patches, which is conducive to drug absorption. It can be applied on the surface of eczema to make the skin damage gradually fade in order to achieve the purpose of treatment. The patient took the medication back and went home for treatment, and was instructed to follow up on the discomfort.
III. Treatment effect
After 15 days of medication, a telephone call was made to the patient, who said that the intense itching caused by secondary eczema on the skin surface was significantly relieved after about 2 days of medication and that he was able to sleep smoothly. The keratotic lesions on the scrotal area had softened significantly after about 1 week of medication. By the date of the telephone callback, the secondary eczema skin damage on the scrotal area had basically subsided, but the abnormal skin structure was still visible to the naked eye, and the patient was instructed to continue the medication and to review it in 30 days.
IV. Notes
We are glad that the patient’s eczema symptoms gradually resolved after active treatment. Secondary eczema is usually accompanied by intense itching, so be careful not to scratch frequently, or you run the risk of gradually worsening secondary eczema symptoms due to repeated irritation. The use of oral antihistamine treatment may cause central inhibition, resulting in dizziness, weakness, sleepiness and other phenomena, if the symptoms are not heavy can continue to take, if the symptoms are heavy affect the quality of life, to promptly review the replacement of other drugs alternative treatment. If the application of urea ointment, resulting in local flushing of the skin, burning, pain and other phenomena, to promptly follow up.
V. Personal insight
Secondary eczema itself is an erythematous itchy disease triggered by repeated external stimulation of a certain disease. If it appears in a specific area, it may be confused with ringworm, ringworm of the hands, ringworm of the feet, ringworm of the femur and other diseases, and a fungal examination should be done for differential diagnosis. Before the condition is completely cured, be careful not to consume too much spicy, stimulating, or seafood-based food to avoid causing increased itching and affecting the effectiveness of secondary eczema treatment.