(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: An 18-year-old girl developed insect bite dermatitis on her right lower outer calf due to mosquito bites when she went out for fun, followed by repeated scratching and irritation, resulting in local skin damage changes, formation of flushing, blistering, crusting, and intense itching, which seriously affected her quality of life. After coming to our hospital, she was clearly diagnosed with secondary eczema, and after active treatment with topical medication and oral medication, the itching sensation on her legs completely disappeared and the local skin returned to a healthy state.
Basic information】Female, 18 years old
Disease Type】Secondary eczema
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】August 2021
Treatment Plan】Medication (loratadine capsules + human-like collagen scar repair silicone gel + clobetasol propionate ointment)
Treatment Period】Come back for follow-up after 15 days of home treatment
Effectiveness】Localized erythema papulosum blisters, eczema-like changes gradually subsided, itching disappeared
I. Initial consultation
Hot summer days are often accompanied by nasty mosquito bites that affect human health. An 18-year-old girl came to our hospital accompanied by her family. The patient reported that she went out for a picnic 6 days ago and found some kind of unknown mosquito bite on her outer calf after she returned home, but she did not take it seriously at that time, so she did not do the corresponding treatment. However, due to the strong itching of the bite, the patient frequently scratched the area, and the original local mosquito bite marks gradually expanded 3 days ago, and local erythema, papules and blisters were formed, accompanied by strong itching, which seriously affected the quality of life. We examined the patient and found that there was a skin lesion of about 5×4 cm in diameter on the skin surface of the right lateral calf, with residual blisters visible above the lesion and a vesicular surface formed after breaking the blisters, with light crusting visible in individual areas and residual scratching marks around the area. Based solely on the clinical presentation and the patient’s self-report, the patient was initially considered to have secondary eczema caused by insect bite dermatitis following a mosquito bite. After communication with the patient, the patient agreed to undergo routine blood tests and serum total IgE testing to clarify the diagnosis. The results of the routine blood test showed an increase in eosinophils and the serum total IgE test showed an increase in the patient’s IgE level, which was consistent with the diagnosis of secondary eczema.
II. Treatment history
The damage to the skin on the outer side of the patient’s legs lasted for 3 days and seriously affected his quality of life, so the patient was treated immediately. After integrating the overall situation, the treatment plan was chosen to use oral medication with topical medication. The patient was given oral loratadine capsules with topical human-like collagen scar repair silicone gel and clobetasol propionate ointment. The capsules are antihistamines that can reduce the level of histamine in the body after ingestion and effectively relieve the itching caused by eczema. The topical application of human-like collagen scar repair silicone gel can form a protective film on the skin surface that is invisible to the naked eye, while promoting tissue regeneration. The accompanying clobetasol propionate ointment is a hormonal medication that gradually resolves the clinical manifestations of local secondary eczema through its own anti-inflammatory, anti-allergic and immunosuppressive effects. After the patient went to the pharmacy to pick up the medication, the patient was explained the specific dosing instructions, and the patient’s family was instructed to supervise the regular use of the medication and to come back for a follow-up visit after 15 days of administration.
III. Treatment effect
After 15 days of medication, the patient came back for a follow-up consultation and reported that his symptoms gradually decreased after medication, and at 3 days of medication, the pruritus was significantly relieved, the local skin surface blisters gradually dried up and the vesicular surface disappeared, and although there was mild drowsiness, it was tolerable. At 7 days of medication, the dry crust on the patient’s skin surface subsided, the blisters disappeared completely, and the exuding surface healed. As of the day of follow-up, 15 days of medication had elapsed and the itching had completely disappeared. On examination, the original skin damage on the right lateral calf disappeared and no subcutaneous nodule-like changes were observed. The patient was instructed to continue to apply human-like collagen scar repair silicone gel to increase skin hydration.
IV. Notes
We are glad that the patient’s pruritus completely disappeared after active treatment and the degree of skin recovery reached a more satisfactory result, but the patient still needs to pay attention to the following conditions in daily life.
1, secondary eczema is often accompanied by intense itching, so patients should pay attention to avoid eating spicy, stimulating, seafood, fishy hair type of food before the condition is completely controlled and the symptoms have not completely disappeared, otherwise it may lead to aggravation of the original itching symptoms, which is not conducive to the treatment of the disease.
2, because the patient application of loratadine capsules belong to the antihistamine drugs, and this kind of drugs often lead to drowsiness, so patients should focus on their own sleep when the daily medication, if drowsiness, but the degree of light, usually belong to the normal drug reaction, you can continue to take, after stopping the symptoms of drowsiness will gradually disappear, if the degree of drowsiness is heavy, affecting life and learning, should immediately go to the hospital. should immediately go to the hospital for medical consultation.
3. Clobetasol propionate ointment is a glucocorticoid ointment, so when using it at home, you should strictly follow the doctor’s instructions and not apply too much to prevent local pigmentation or hormone dependence.
V. Personal Insights
Secondary eczema is an allergic disease caused by a foreign stimulus that occurs on top of a pre-existing skin disease. Secondary eczema itself is related to allergies, so when blood tests are performed, most patients are often accompanied by an increase in eosinophils. The patient’s secondary eczema was caused by insect bites and constant scratching, and the patient’s blood test results also showed an increase in eosinophils, which is typical of secondary eczema.
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