A 50-year-old male patient . with dog bite on his only right leg. no systemic symptoms with ampicillin sulbactam treated Eczema-like itchy discharge lesions on hands and other leg. only crp high albumin low. What is the diagnosis and treatment recommendation?



There is no reason why ichthyosis (?) Should present acutely in a 50 yr old pt. The h/o oozing eczema like description of lesions stated cannot be underscored. Eczema like lesions are never seen in icthyosis. The scale which should be thick and hyperkeratotic is not there. In short it can no be called icthyosis. Two other findings reported - the raised CRP and hypoalbuminemia needs to be examined if they can be fit into overall diagnosis. Attention is drawn to the papular lesions, topped with a central black dot (dried up vesicle) suggestive of " papular urticaria" such lesions are seen on the forearms and dog bitten teg. Now why eczematisation in papular urticaria ? Both are allergic manifestations and here I hazard the guess that the pt might be atopic. Papular urticaria is cosier ed a marker of atopy. So h/o asthma, food and drug allergies as well as nasal and ocular allergies should be sought, which strengthens atopic background. Raised CRP, and hypoalbuminemia are both reported in atopic dermatitis. Test for esonophil count and serum ig E levels for more colloboration of atopic diathesis. In my view dog bite is as the cause is pt's misconceived conjecture and the ampicillin salbactum are not the culprits. Now why eczematisation (subacute ) ? Probably the pt might have applied a topical ointment or even a musquito repallent causing contact eczema. Or it could be a dessiminated secondery eczema. Cases on Curofy are difficult to solve because of lack of comprehensive presentation of the facts and followup feedback, often. If h/o allergy/ atopy and h/o applying some external medication go a long way to confrm the above suspected diagnosis. Queries are welcome. No better alternative linking up all data given.

Icthyosis Rx moisturisers and astringents Oral tab Levocetrizine5mg 1bd for 5to7days than 1od If response is poor Clop-s nano lotion can be applied along with

Thanx dr Basuki Nath Pathak

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Ichthyosis vulgaris the inherited ichthyosis include ichthyosis vulgaris, recessive X-linked ichthyosis, autosomal recessive congenital (ARCI) Congenital bullous ichthyosiform erythroderma (CBIE) ichthyosis ,spastic paralysis, development delay nd degenerative retinitis are some I.e of syndrome ichthyosis

Icthyosis Rehydrate skin by applying moisturizer Cream or astringents. Levocet 5 mg BD Clean area with diluted betadine lotion apply calamine lotion and than lobate s oint+ muprocine onit in 3:1 ratio BD locally. Multivitamins and antioxidants orally. Improve general health and personal hygiene.

Thanks Dr Sanjoy Sarkar

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See papular urticaria lesions more clearly in the last picture which , I think holds the key to the proposed diagnosis above.


Tnx Dr Amitabha Dasgupta

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Thanks a lot Dr .Sanjoy sir

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Ichthyosis:A group of skin disorders characterised by dry, scaly or thickened skin



Thanks Dr. Ashok Leel

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