Case #82: The man with itchy skin
This 35-year-old man presents with fever of 3 days duration associated with itchy lesions appearing on his body. Below is the photo of his back.
Questions:
1. Describe the lesions
2. What is the most likely etiology?
3. How would you treat this condition?
Mon, 220609 @ 0700
Categories: Patient of the Week
Answers:
1. there are multiple lesions of various sizes, various shapes and of various ages. Some are vesicles with blisters, while others have crusted, and some have pustule forming on them.
2. Varicella zoster virus
3. Since it is already the 3rd day, antiviral would not be helpful and therefore the treatment would be merely symptomatic ~ antihistamine for itch, PCM for itch and antibiotics for secondary bacterial infection.
Kudos for everyone here, including MissyC who is of non-medical background but gave an admirable answer!
Well done.
1. Multiple pustular, vesicular lesions ranging from 5mm to 20mm to seen on the patient’s back. Some are crusted.
(just curious is this patient immunocompromised?)
2. Secondary bacterial infection in Chicken pox (VZV)
3. Symptomatic-
a) Fever-Tab. paracetamol
b) Itchiness- calamine lotion, anti-histamine
c) hygiene, avoid scratching, shorten finger nails
d) Pharmaco- Aciclovir is not indicated if fever more than 24 hours. Intravenous acyclovir therapy is recommended if this patient is immunocompromised as to prevent life threatening complications- pneumonia,encephalitis, hepatitis, and hemorrhagic complications .
1. There are multiple vesicles and pustules on patient’s back. Some of the lesions are crusted.
2. Varicella-zoster virus with secondary bacteria infection (staphylococcus or streptococcus)
3. Mostly symptomatic treatment. Paracetamol for the fever. Calamine lotion for the itchyness. Acyclovir is effective within the 1st 24 hours of onset of rash, so probably not in this case. Avoid scratching of the lesions.
1. Multiple vesicular, pustular lesions seen at the back with blackish crusted lesions & scab formation, surrounded by reddish margins.
2. Most likely etiology: varicella-zoster virus (Herpes infection)
3. Acyclovir 200mg 5 times daily for 1 week is most likely to be useful during the 1st 3 days of infection. Calamine lotion & antihistamines for itchiness, hygiene, antipyretics for fever. Hygiene & quarantine would be useful.
My differential diagnosis would be pustular psoriasis as it can also present similarly.
1.There are multiple vesicles of varying sizes with surrounding erythematous skin on the patient’s back. there are also some pustules and hyperpigmented crusted lesions seen.
2.Varicella with secondary bacterial infection most probably caused by Staphylococcus.
3. Paracetamol for fever ;
Calamine lotion and antihistamines (eg Loratidine) for the itch ;
Topical Fusidic acid on pustules ;
Acyclovir to shorten length of illness and decrease rate of complications.
1. multiple erythematous maculopapular lesion on normal skin, with multiple pustules. err.. the darker n bigger lesions look like crusts i think..
2. varicella zoster aka chicken pox. it tends to b worst (uglier n more complications) if get it in adult age
3. symptomatic treatment
- fever: antipyretic; PCM
- itchiness: antihistamine, calamine lotion
- proper hygiene, quarantine from other ppl too!
antiviral acyclovir (eg: Zovirax) works if started in early stage (within 24 hours of rash onset). if more than that, does not helps. so for this pt, acyclovir would not help..
Is it full blown chicken pox, ugly lesions are crust forming pus, culprit Varicella zoster virus? this patient got other underlying medical condition to have skin eruptions like that?
From non medical eyes, after close encounter with hubby having mild chicken pox years ago,only treatment antibiotics + cream. Last year, he develop shingles, lucky caught early. Thus, doc recommended Conventional expensive treatment ie Zovirax (Acyclovir)+Declovir Cream+Arcoxia (for pain) plus self traditional treatment tried tested drink,bathe,sleep NEEM
tks drjimbo, layman get 2C & learn about diseases happening here…
I think your knowledge can upstage some medical students.
really
those days we grew up with chicken pox unlike now everything must be under control body no chance to fight disease naturally
so what is the answer ?
1. Maculopapular lesions with some pustules seen
2. Varicella zoster ? measles ?
3. calamine lotion, antipyretics – PCM, acyclovir to be given early
Dr. Jimbo, i’m gonna start work at seremban hosp. this week!
congrats on passing liang. stop me and say ‘hi’ if u meet me in the hospital.
Liang, good luck. my sister is a HO there also.
1.multiple vesicular lesions of varying sizes, with scabs overlying some of the lesions.
2.varicella zoster infection.
3.antipyretics (paracetamol 1g qid/prn)
acyclovir for severe attacks and immunocompromised patients.
calamine lotion
hello,it 1st time i’m here. nice to meet u.
it quite an interesting blog, especially the cases. learn alot.thanks.
kambate. keep up the good job.
thanks for visiting the blog, ang. Come by often.
1.vesicle(small, clear fluid-filled blisters < 10 mm in diameter) and pustules(elevated lesions with pus).
2.herpes/ chickenpox
3.symptomatical treatment.
(a)itch- antihistamine and colloidal oatmeal bath.
(b)prevent secondary infection- keep hygiene,keep clean.
unless patient immunocompromised problem then need antiviral (acyclovir)