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: memonPosts: 28 :: 16-08-2002 :: | Reply to this Message

Re: Quiz

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: docosamaPosts: 333 :: 18-08-2002 :: | Reply to this Message

Re: Re: Quiz

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: memonPosts: 28 :: 18-08-2002 :: | Reply to this Message

Re: Quiz

yah ,going for systemic lupus erythematous.she be quetioned for her other systemic illnesses ..like joint pains

Posted by: abidranaPosts: 19 :: 19-08-2002 :: | Reply to this Message

Re: Quiz

Memon:

Can you show us any picture describing solar rash ?

Posted by: docosamaPosts: 333 :: 19-08-2002 :: | Reply to this Message

Re: Re: Quiz

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: memonPosts: 28 :: 19-08-2002 :: | Reply to this Message

Re: Quiz

short course of steroid may be the ideal choice?

Posted by: abidranaPosts: 19 :: 20-08-2002 :: | Reply to this Message

Re: Re: Quiz

quote:

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abidrana wrote:
short course of steroid may be the ideal choice?

---

What would you achieve with short course of steroids say prednisolone for 2-3 weeks? What will happen when you stop the steroids. What are we trying to treat with steroids - rash? or arthritis?

For the rash topical steroids and sun avoidane/sun block creams might be adequate.

SO you gave steroids - lady got better, stoppped - both rash and arthritis flared up, so what next?

Think about it!!

Posted by: memonPosts: 28 :: 20-08-2002 :: | Reply to this Message

Re: Quiz

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 sPosts: 6 :: 24-05-2003 :: | Reply to this Message