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Case 407


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Female patient, 20 years old, comes to the Health Center complaining of recurrent skin lesions (images 1 to 3) since she was 4 years old. Initially, the lesions affected regions of folds of the arms and legs, but, 5 years ago, they started to occur in a disseminated way throughout the body, concentrating on the back. The lesions are itchy, appear about twice a month and get worse in times of stress or with the use of woolen clothes. There is partial improvement with the use of topical corticosteroids.

Considering the images presented and the case described, what is the most likely diagnosis for this patient?

a) Seborrheic dermatitis.

25%

b) Irritant contact dermatitis.

25%

c) Atopic dermatitis.

25%

d) Psoriasis

25%
   

Image analysis:

Image 1Photograph of the patient's cervical and dorsal regions showing chronic eczema (red outline), with the presence of erythema (reddish macula that occurs due to vasodilation), skin thickening and lichenified areas (thickening areas with accentuation of the furrows and skin color).

Image 2Photograph of the medial region of the right thigh. Diffuse chronic eczema (red outline) is visible, with the presence of erythema, skin thickening and dry skin.

Image 3Photograph of lower limbs. Diffuse eczema is noted on both legs and thighs (red outline). In the region of the left knee, it is possible to observe an edematous and erythematous area (yellow ellipse), without a central orifice, painful and without elimination of secretions, suggestive of secondary bacterial infection.

Highlights:

- Atopic dermatitis is a chronic and multifactorial skin inflammatory disease;

  • - AD is often associated with other atopies, such as asthma and allergic rhinitis;

  • - The diagnosis of atopic dermatitis is clinical, and Hanifin and Rajka's criteria is the most used;

  • - The eczema pattern of atopic dermatitis varies according to the age range of the affected patient;

  • - The treatment of atopic dermatitis is individualized and involves general care, topic and systemic treatment.

References:

  • - Leite RMS, Leite AAC, Costa IMC. Dermatite atópica: uma doença cutânea ou uma doença sistêmica? A procura de respostas na história da dermatologia. An Bras Dermatol. 2007;82(1):71-8.

  • - Carvalho VO, Sole D, Antunes AA, Bau AEK, Kuschnir FC, Mallozzi MC, et al. Guia Prático de atualizaçao em dermatite atópica Parte II: abordagem terapêutica. Arq Asma Alerg Imunol. 2017;1:157-82.

  • - Castro APM, Sole D, Filho NAR et al (2006) Guia prático para manejo da dermatite atópica. Opinião conjunta de especialistas em alergologia da Associação Brasileira de Alergia e Imunopatologia e da Sociedade Brasileira de Pediatria. Rev Bras Alerg Imunopatol 6:267–282

  • - Wollenberg A et al. “Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I.” Journal of the European Academy of Dermatology and Venereology : JEADV vol. 32,5 (2018): 657-682.

Author:

Rafaela de Souza Furtado, 5th year medical student at UFMG.

Mail: rafaelasouza.furtado@gmail.com

Supervisor:

Raquel Ferreira Queiroz, Dermatology resident at Hospital das Clínicas da UFMG.

E-mail: raquelq21[at]gmail.com 

Reviewers:

André Luís Drumond, Leandra Diniz, Rafael Arantes, Melina Araújo, Larissa Rezende e Prof. Júlio Guerra Domingues.

Translated by:

Rafaela de Souza Furtado, 5th year medical student at UFMG.

Mail: rafaelasouza.furtado[at]gmail.com

Test question

a)

25%

b)

25%

c)

25%

d)

25%

e)

25%
   

Commentics

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