35 yrs age male pt c/o burning sensation in the affected area. pls suggest diagnosis and management.


Dr Sumit Let me discuss few DDs 1. It's Not Contact dermatitis- notice the sparing of skin which appears normal where the rubber of the slippers rests. So it can be contact due to slippers. In fact that's the area protected from sun. 2. It's not irritant because spring of the skin on the sides, if you lift the shirt, there will be a sharp demarcation meaning skin affected only in the sun exposed areas. 3. Pellagra is closest diagnosis, check for the skin in the V area of the neck. Rule out other features described by Dr. K. S. Gayathri Dinesh . 4. Porphyria Cutanea Tarda by Dr. Sandeep Gupta should be considered ask for change in urine color. IN which activity of the heme synthetic enzyme uroporphyrinogen decarboxylase (UROD) is deficient. The most common presenting sign of porphyria cutanea tarda is fragility of sun-exposed skin after mechanical trauma, leading to erosions and bullae, typically on hands and forearms and occasionally on face or feet. Healing of crusted erosions and blisters leaves milia, hyperpigmented patches, and hypopigmented atrophic scars. Hypertrichosis is often observed over temporal and malar facial areas and may also involve arms and legs. Indurated, waxy, yellowish plaques that resemble lesions of scleroderma can develop over the chest and the back but are most prominent in the preauricular and nuchal areas check for it if you feel it could be PCT. Plus it's sometimes mutilate the face. In this case I would go with Pellagra once PCT is ruled out. Treatment Niacin Vit B3 Sunscreen in morning Emollient or moisturizer Venusia Max cream in night Information from dietary manage from dermnet: The primary prevention of pellagra involves an adequate diet. Food sources of niacin and/or tryptophan include nutritional yeast, eggs, bran, peanuts, meat, poultry, fish with red meat, cereals (especially fortified cereals), legumes, and seeds. The recommended daily allowance of niacin for infants is 5-6 mg; for children, 9-13 mg; for adults, 13-20 mg; for pregnant women, 17 mg; and for breastfeeding women, 20 mg. Optimal supplementation is 20-30 mg daily. Secondary prevention is as follows: Patients should avoid sun exposure during the active phase of the disease. Patients should follow a convenient dietary regimen. Close dietary follow-up after the patient's recovery helps prevent the recurrence of pellagra.
I agree Dr.avitus john

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Pellagra .. Lesions over the sunexposed part and typically sparing the areas of the slipper strap (suncovered) .. Do check for any neck /face lesions and alcoholism or other probable causes of pellagra ... Dietary & lifestyle modification... Niacinamide 100mg thrice daily
Classical case of pellegra with exfoliative dermatitis. See for face and neck area for casal's necklace. Ask for history of Alcoholism. Give emollient with niacin injection/tab.
Pellegra ., dementia,diarrhoea,dermatitis Niacin deficiency presents as this 3 ds
porphyria cutanea tarda ,a photo sensetive skin disorder.
Irritant contact dermatitis
Irritant contact dermatitis
Dry Eczema
Without proper history it can't b diagnosed only DD's can b made...pallagra...icd...ple...porphyria cutanea trada...
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