40/y/o/f c/o generalized itching. after which these occur some heal by themselves leaving hyperpigmented areas n some forming crusts..pt is suffering from this on n off since 6months.. she also suffers from seasonal allergic rhinitis n asthma since many yrs ..my dear curofians help me DX n RX this case

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Dx :- Atopic triad. Which consisting of atopic dermatitis progressing to allergic rhinitis and asthma, have numerous pathophysiological characteristics in common. Genetics combined with environmental and lifestyle factors are considered to be the main contributors to the common pathophysiological mechanisms. Rx :- As it is IgE mediated Type 1 hypersensitivity, no such good treatment is available. 1 ) Lifestyle modifications. 2 ) Avoidance of allergens as much possible , as per reports of Total and Specific IgE quality and quantity. 3 ) Use of mast cells stabiliser as an when required , like Cetirizine / Levocetirizine / Levocetirizine + Monteleukast / Phexfenadine / Phexfenadine + Monteleukast combinations of choice. 4 ) In severe form , short term steroid with dose tapering. eg, Deflazecort , Prednisolone etc 5 ) Treatment is based on an enhanced awareness of atopic dermatitis, with a focus on the potential for the progression of future IgE-mediated airway disease and food allergy. 6 ) The recognition and treatment of atopic dermatitis at an early age could theoretically reduce the incidence or severity of the 'triad march'. 7 ) Improvement of personal hygiene and awerness about the prognosis of the disease.

Nicely explained Dr Saha thanks
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Dermatologists are in a better position to help in this case. To me D/D is 1.Papular Urticaria. 2.Henoch Schonlien purpura. 3 . Erythema Multiforme. 4.Drug eruptions -look for h/o drug intake like eptoin .Treatment is 1 . eliminating the cause. 2 . Reassurance. 3 . Symptomatic treatment like antihistaminics and if required steroids like deflazacort in extreme cases

Thanks Dr
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Allergic Rhinitis with Asthma and Atopic dermatitis is a new triad called Atopic triad.... I think its eczema/Atopic dermatitis.. Rx Monteleucast sodium plus levocetrizine 1od Hs for 1month... Tab.Deflazecort 6mg bid for 5 days od for 5 days and tapper off... Some Ayurved and homeopathy medicines have dramatic results... u can surely go for it... Life style changes must be done to avoid allergies... Time has come to go for Holistic approach as steroids are getting villainous... They are good but we are using them like bred and butter...

Agree with u Dr ...keeping in mind Atopic triad I mentioned about allergic rhinitis n asthma ..thanks fr the feedback
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Exposed sites involvment insect bite hypersensitivity Give Antihistamines Topical momate cream once daily application Topical Calasoft lotion twice a day Lesion behind ear looks like seborrheic dermatitis Apply topical momate cream

Atopic dermatitis

Hi mam , good morning, I agree with above opinions, but , diabetes mellitus,liver, renal dysfunction must be ruled out .. how about eosinophils count in this patient mam? Thanks...

Thanks fr the valuable feedback Dr
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Xeroderma with sec infection. Avoid soap. Apply Moisturizers. Tab Araratx 10 MG. B. d for one month. Tab Health ok.od. Rule out diabetes.

I thik one has to find out her allergen, try admitting the pt. In hospital put on a starvation's diet, start introducing her normal diet One by one or you may find straight some new addition. If not successful px. Long term anti allrgic,. Change her area of residence for some time clothes.or try low dose Steroid.of course i am against it. But some times You can't avoide.

Acnitic hyperpigmentation dd lichen simplex

Dermorespiratory Syndrome....Atopic Triad....

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