Managing Acute Allergic Reactions and Corticosteroid Withdrawal: A Case Study of Contact Dermatitis and Eczema Treatment 急性过敏反应与皮质激素戒断管理：接触性皮炎与湿疹治疗案例分析

A 65-year-old healthy male developed widespread itching, erythema, and papules a day after visiting a newly painted house. Two days later, his face became exudative and swollen. He sought medical attention, with a history of mild eczema that did not require treatment. Apart from the rash, the physical examination was normal, with no fever or drug history. He had recently been taking a health supplement containing Sickle Senna Seed (Cassia obtusifolia).

Upon physical examination, 40% of the body surface area showed erythematous lesions, and an acute allergic reaction to chemical paint was suspected. The patient was referred to the hospital’s A&E department for further investigation. Two days later, after treatment with corticosteroid prednisolone and antibiotic cephalexin, the facial and body rashes significantly improved, but the lower limb rash persisted. He was given topical corticosteroid treatment. However, unexpectedly, five days later, the rash increased and spread after applying the corticosteroid, and both lower limbs became red and swollen. Blood tests and other physical examination parameters were normal. The patient suspected himself an allergy to corticosteroids and stopped using them, but the rash did not resolve, and his skin became red, itchy, and his lower limbs swollen. Analysis suggested that the exposure to paint triggered contact dermatitis or eczema, combined with a rebound effect after discontinuation of steroids. The patient was treated with customised TCM oral and topical herbal medicine. Two weeks later, the rash began to flatten, the swelling in the lower limbs reduced, and itching significantly decreased. After continuing the medication for 14 weeks, the rash completely resolved.

This case highlights the complexity of diagnosing and managing allergic reactions, particularly when combined with pre-existing conditions such as mild eczema. The patient’s acute allergic response to chemical paint triggered contact dermatitis, which was exacerbated by the use of corticosteroids. A rebound effect following corticosteroid withdrawal further complicated the clinical course. Traditional Chinese Medicine (TCM), including both oral and topical herbal treatments, proved effective in managing the patient’s symptoms, leading to gradual resolution of the rash, reduced swelling, and relief from itching over a 14-week period. This case demonstrates the importance of comprehensive treatment strategies that address both the immediate allergic reaction and the potential rebound effects of corticosteroid therapy.

You can find the full recovery footage for this case on our video channel.

Discussion

Allergic reactions to environmental factors such as chemical paints are common and can vary widely in severity. In this case, the patient’s reaction was severe enough to involve a significant portion of his body, suggesting a strong immune response to the chemical irritants. The patient’s history of mild eczema may have predisposed him to an exacerbated reaction, as individuals with pre-existing skin conditions are more likely to experience intense responses to allergens or irritants.

The use of corticosteroids is common in managing acute allergic reactions and inflammatory conditions, but their withdrawal can lead to a rebound effect, as seen in this case. This phenomenon, often referred to as “steroid-induced flare,” occurs when the body experiences a worsening of symptoms after the discontinuation of steroids, as the skin’s natural defenses are temporarily suppressed. The patient’s experience underscores the need for careful monitoring when tapering or discontinuing steroid treatments, particularly in sensitive individuals or those with complex underlying conditions.

Incorporating Traditional Chinese Medicine (TCM) into treatment regimens may offer an effective complementary approach, particularly for patients who experience adverse effects from conventional therapies. The use of herbal treatments and external topical applications in this case provided a holistic treatment that helped reduce inflammation, alleviate itching, and promote healing. TCM’s role in managing dermatological conditions, particularly those with an allergic or inflammatory origin, deserves further exploration in clinical practice. This case emphasizes the importance of a multidisciplinary approach to managing allergic reactions and related conditions, particularly in patients with complex medical histories or those who may experience adverse effects from steroid therapy.

For more details on steroid withdrawal, please refer here:

  1. Topical Steroid Withdrawal in Atopic Dermatitis: Report from Sweden 特应性皮炎中的外用类固醇戒断：来自瑞典的报告
  2. Glucocorticoid Induced Adrenal Insufficiency GI-AI 糖皮质激素引起的肾上腺功能不全
  3. A Systematic Review of Corticosteroid Withdrawal Syndrome 激素戒断综合征

Privacy

In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.

一位65岁身体健康的男性，在参观刚刚油漆过的新住宅后一天，出现全身发痒、红斑和丘疹。两天后，脸部出现渗出和红肿，前来求诊。患者有湿疹病史，但湿疹非常轻微，未曾治疗。除皮疹外，其他体检全部正常，没有发热和药物史。患者近期口服了含有决明子的保健品。

体检发现，40%体表面积出现红斑，疑似急性过敏反应。患者被转诊至医院急诊部进一步检查。两天后，在糖皮质激素泼尼松龙和抗生素头孢氨苄的治疗下，面部和身体的红疹明显减退，但下肢的红疹未有好转。患者开始使用外用皮质激素药膏。然而，出乎意料的是，五天后，涂抹皮质激素后，皮疹面积扩大，下肢红肿加重。血液检测和体检指标均在正常范围内。患者认为是皮质激素药膏过敏，停止使用激素药膏，但皮疹仍未消退，皮肤仍然发红、瘙痒，下肢肿胀加重。经过分析，认为是油漆接触引发了接触性皮炎或湿疹，并伴随皮质激素撤药后的反弹现象。患者开始接受中药治疗，包括口服和外用植物药膏。两周后，皮疹开始变薄，下肢红肿逐渐消退，瘙痒明显减轻。继续服药14周后，皮疹完全消退。您可以在我们的视频频道找到此案例的完整恢复影像。

讨论

由于环境因素如化学油漆引起的过敏反应较为常见，并且其严重程度因人而异。在本案例中，患者的反应严重到涉及身体大部分区域，表明他对化学刺激物的免疫反应较强。患者有轻微湿疹的病史，可能使他更易于对过敏原或刺激物产生更剧烈的反应，因为有基础性皮肤问题的个体更容易受到过敏或刺激物的影响。

皮质激素在处理急性过敏反应和炎症性疾病中广泛应用，但其撤药可能会引发反弹效应，正如本病例所示。此现象通常被称为“类固醇诱导的加重”，当皮质激素治疗停止后，症状会加重，因为皮肤的自然防御暂时被抑制。患者的经历突显了在减少或停用类固醇治疗时需要谨慎监控，尤其是在敏感个体或有复杂基础病史的患者中。

将中医纳入治疗方案可能为那些对常规疗法产生不良反应的患者提供有效的补充疗法。本案例中使用草药治疗和外用涂抹为患者提供了整体治疗，有助于减少炎症、缓解瘙痒并促进愈合。本病例强调了多学科方法在处理过敏反应及相关疾病中的重要性，特别是在有复杂病史的患者或可能因类固醇治疗出现不良反应的患者中。