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Abstract: The patient, a 42-year-old male, presented to the clinic with “itching and peeling of the palms of both hands for several years, recently aggravated by palm cracking with pain”. The pruritic symptoms were significantly relieved and the lesions subsided without any adverse effects.
Basic information】Male, 42 years old
Disease Type】Lipidemic eczema
Hospital】Nanning Second People’s Hospital
Date of consultation】April 2022
Treatment plan】Medication (Desloratadine dispersible tablets, compound glycopyrrolate tablets, trimethoprim econazole cream, vincristine cream)
Treatment period】4 weeks of treatment, outpatient follow-up
Treatment effect】The disease has been controlled, itching and skin lesions have been significantly improved, no discomfort in 1 month follow-up
I. Initial consultation
When the patient Mr. Zhou first saw me, he couldn’t resist saying, “Doctor, please take a look at it, it’s killing me, I can’t sleep well these days. I have a layer of dead skin on the palm of my hand, which itches from time to time, and after tearing off the dead skin, I feel that the itchiness is reduced, but after a while the itchiness comes back. This condition appeared the year before last and recurred, especially in cold weather when the itching was severe. In the past few days, several cracks (cracking) appeared on the palm of the hand, and the pain was unbearable, so I came to the hospital”. After communicating with the patient, we improved the relevant examinations, including blood routine, blood lipids, liver and kidney function, and sex hormones, which were all abnormal. The tests were negative for mixed food allergens, milk, total immunoglobulin E and mixed inhalant allergens, and negative for ANA and other related immunological indicators.
II. Treatment history
From the patient’s self-report and symptoms, it is known that the patient is engaged in agricultural work and may be exposed to irritants such as pesticides for a long time, and the condition is aggravated in winter time, the specific triggering cause is not known. The patient has no family history of genetic predisposition or drug allergy, and has a history of smoking and alcohol consumption. The patient was willing to cooperate with our treatment. The following medication regimen was made: first, oral medication intervention, including dexloratadine dispersible tablets and compound glycopyrrolate tablets; combined with topical medications, such as trimethoprim econazole cream and vincristine cream, both of which can be used at the same time, trimethoprim econazole cream can be applied first, and after its complete absorption (about 20-30 minutes), then vincristine cream can be applied. Since the causative agent is not known, that is, the allergen is not found, the patient needs to pay attention to some daily life matters. According to the self-report, it is suspected that the contact between pesticides and other irritants and skin, it is recommended to wear an extra layer of gloves when farming or fertilizing, in order to reduce the contact with irritants, and to avoid bacterial infection in the cracked area, which may cause new symptoms such as inflammation. It takes at least 4 weeks to administer the medication, and the patient’s family was informed of the whole process and all expressed their understanding.
III. Treatment effect
After 4 weeks of active and effective treatment, the patient’s online follow-up revealed that the patient’s keratinized hyperplasia decreased, the cracking cracks healed during the period, the self-perceived itching sensation decreased, no pain and other irritation occurred, and the self-perceived quality of life improved compared to that before the treatment, and most obviously, the patient’s sleep quality improved. However, there are still symptoms such as keratinization hyperplasia and flaking on the palms of the hands, and it is recommended to continue using medication as well as maintaining good and healthy habits. In summary, the patient’s condition has been significantly controlled.
IV. Notes
I was very relieved to see the patient’s symptoms gradually reduced. In daily life, patients need to pay attention to the following aspects.
1, daily attention to hand hygiene, available warm water (clear water soak), do not go to contact with strong alkaline objects, such as soap, detergents, cleaning agents, etc., and irritating substances, such as paint.
2, pay attention to the care of the hands, usually you can apply some external oil skin care products, try to avoid scratching.
3, in the environment prone to aggravation of the disease, to strengthen the application of ointments and moisturizers to reduce the progress and aggravation of the disease.
4, diet, pay attention to the light diet, less spicy, stimulating food, less seafood, more fruits, vegetables and other vitamin-rich food.
V. Personal insight
Lack of lipid eczema is a common skin disease, most patients have symptoms in the colder winter or winter-spring change of season, manifested as chapped palms (palmoplantar), but also a chronic disease, the specific causes or triggers are complex and difficult to confirm. The onset of the disease is not only related to one’s intrinsic allergies, but also to one’s usual habits, in addition to the stress during the illness may also cause the disease to worsen. The actual fact is that you will be able to get a lot more than just a few of the most popular and popular items in the marketplace.