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22
Jun

A 21 years old boy with erythema plaques scaling and crusting on whole body

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Case Presentation

A 21-year-old boy presented in March 2009 at our clinic with symptoms and signs of crusting erythema plaques all over his face and body (Fig.1-A). He had suffered from eczema since he was 10 months old, when he developed a scaly red rash over his cheeks and over his knees and elbows. His elder brother and father suffer from hay fever. In the past 20 years, he had been treated with antihistamines, antibiotics and topical corticosteroids alternatively and concurrently, during which time no improvement occurred: new eczematous lesions continued to develop and spread on his trunk, hands, feet and face.

case_9

case_9_b

During the physical examination, he was evidently uncomfortable and scratched his arms continuously. He felt cold but his body temperature was 37C; his skin was very red with large crusted scales covering his two elbows (Fig.1-A), and with scratched and infected lesions on his two popliteal fossa area (Fig.1-A). Other body areas were all reddish. The skin scratch test was positive. The patient was advised to avoid immunosuppressant therapy (topical or systemic steroid) and was give Tangs Derma-zema 1440mg thrice daily. After 4 weeks of therapy, the patient experienced the corticosteroid withdrawal syndrome with fissures and oozing on his elbow area (Fig.1-B,C) and was ever more reddish at his popliteal fossa area (Fig.1-B,C).

Eczema can be provoked by the withdrawal of steroids, hence the body will experience the rebound phenomenon. On examination, the patient’s temperature was 37C, yet he continued to feel chilly and itchy. The symptom seemed to worsen initially, but over the next two months, the dead crusts and scaling skin was exfoliated from the eczema lesions (Fig.1-D,E). Henceforth, he did not feel chilly anymore, and the severity of itchiness had stopped during daytime, only occurring during bedtime. Since then, his eczema lesions had shown marked clinical improvement, and he is continuing TANGS treatment and is currently under monthly observation. He is looking forward to a full recovery in the near future. We will continue to monitor and update his recovery process with monthly photographs.

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