简单病例
Case 2
Redness of the entire skin for one week in a 70-year-old patient with chronic nicotine abuse.
History
Do you have any known skin problems?
I used to have numerous small tumours caused by sunlight. But that was not bad.
This question allows you to learn something about your patient's "skin past". Do the current skin changes have anything to do with a pre-existing skin disease?
Do you experience itching?
Sometimes. But mostly I feel chilly.
At this point, the patient describes an important symptom that points to general a problem.
Have you exposed yourself to sun recently?
Since I have a garden, I am regularly exposed to it, but I behave carefully.
You can rule out a sunburn with this question.
Are you taking any drugs? If yes, which ones and since when?
I have been taking a beta blocker for several years.
With this question you are trying to find out if there is a possibility of a drug reaction.
Do you feel healthy? How have you been feeling lately?
I have to tell you that during night I have been sweating a lot lately.
There are certain symptoms that should make you think of possible differential diagnoses, even if there is no direct connection with the skin. (Skin changes often reveal other diseases).
Are there any family members with skin problems?
I think one grandmother had psoriasis, but I am not completely sure.
This information is not very important , but it should be kept in mind. Dermatoses can be hereditary or there can be a familiar predisposition to them.
Lesion
Choose the right efflorescences:
The characteristic feature is a reddish-purple erythema of almost the entire body.
Sometimes skin oedema results in skin detachment, forming a palpable vesicles.
They may be thin or thick, early or late.
This depends on the intensity of the itching and the thickening of the skin due to the oedema.
诊断
Choose the right diagnosis:
Urticaria causes solitary lesions that may confluence. However, it never causes vesicles and scales.
It is a paraneoplastic erythroderma (=generalised redness): The present case is a Hodgkin's lymphoma.
Psoriasis can develop into diffuse redness, making the diagnosis difficult. In these cases, a biopsy will help.
The lesions in this disease cause petechial purpura rather than erythroderma.
Therapy
Choose the right therapy(ies):
Hospitalisation is inevitable in patients with erythroderma, since severe vasodilation leads to water-, electrolyte- and protein- loss, which must be treated.
According to the patient's complaints. In general, this treatment calms the inflammatory reaction as well as the scaling.
This depends on the clinical symptoms. s Severe pruritus and multiple excoriations are possible entry sites for pathogens, which can lead to superinfection.
In the present case, it is clear that the cause of the erythroderma (Hodgkin's lymphoma in this case) must be treated.
Test
The following questions are related to the current case. Try to solve them.
