PakMediNet Discussion Forum : Medicine : Quiz
Hello every one
I have just joined this site.
I would like to discuss an imagenery dermatology patient.
A 33 year female patient presented with rash on the face, which gets worse in the sun. Patient is also experiencing joint pains. She is most worried about the rash. What investigations at this stage would be useful. What additional information you would like to ask the patient?
Posted by: memon Posts: 28 :: 16-08-2002 :: | Reply to this Message
Your history is pointing towards the rash of SLE. Investigations include ESR, CRP, ANA and anti-DS DNA. Other investigations should be done to look for the complications of SLE.
Questions should be related to joint pains (arthritis), breathing & renal status.
Posted by: docosama Posts: 333 :: 18-08-2002 :: | Reply to this Message
You are absolutely right. SLE should give you this picture. I would do Ro and La antibodies too, and RA Latex factor. To rule out possibility of RA.
The other condition in which you get rash on the face following solar exposure would be Polymorphic Light Eruption, it is fairly common in Anglo saxon population. Patient usually develops rash on the exposed parts of the body few hours, sometimes a day after the exposure to strong sun. In Solar Urticaria, rash appears with in minutes.
Any way, well done and full marks to you
Kind regards
Posted by: memon Posts: 28 :: 18-08-2002 :: | Reply to this Message
yah ,going for systemic lupus erythematous.she be quetioned for her other systemic illnesses ..like joint pains
Posted by: abidrana Posts: 19 :: 19-08-2002 :: | Reply to this Message
Memon:
Can you show us any picture describing solar rash ?
Posted by: docosama Posts: 333 :: 19-08-2002 :: | Reply to this Message
I will try to post some pictures of solar rashes.
Now since you have made the diagnosis of SLE - how would you manage her. Lets have step by step treatment regimen.
What would you prescribe at first?
[Edited by memon on 08-19-2002 at 04:54 PM GMT]
Posted by: memon Posts: 28 :: 19-08-2002 :: | Reply to this Message
short course of steroid may be the ideal choice?
Posted by: abidrana Posts: 19 :: 20-08-2002 :: | Reply to this Message
quote:
abidrana wrote:
short course of steroid may be the ideal choice?
Posted by: memon Posts: 28 :: 20-08-2002 :: | Reply to this Message
treatment steps
1- no involvement of major systems
nsaids
2-skin in volvement
NSAIDS PLUS HYDROXYCHLOROQUINE OR LONG ACTIONG INTRADERMAL STEROIDS
RETINOIDS VIT A
3-PLUS JOINT INVOLVEMENT
STEROID PREDNISOLONE 1-2MG/KG BODY WT UNTIL SYMPTOMS SUBSIDE
4-STILL NOT IMPROVING
METHYPREDNISOLONE 1G I/V DAILY FOR 3 DAYS THEN WEEKLY.
5-STILL NOT IMROVING
STEROIDS PLUS IMMUNOSUPPRESSIVE CYCLOPHOSPHAMIDE
6 STILL NOT
PLUS PLASMAPHORESIS
OR GAMMAGLOBULIN TRANSFUSION
Posted by: cardinal s Posts: 6 :: 24-05-2003 :: | Reply to this Message