62 years old, female. She has a depressive disorder and is u | Figure 1

ReginaldoCastro

Internal Medicine

62 years old, female. She has a depressive disorder and is using Sertraline 50 mg/day. 10 days ago, the patient had problems with her family members and her depressive condition worsened. 5 days ago it started pruritus in the palmar region and wrist evolving with fissures. What is the probable diagnosis in this case?

Note: this case will be updated soon.

Update 1

We see desquamative, dry lesions, with cracks and crusts, erythematous (reddish) areas, abrasions (probably by the act of scratching), location in hands and fist, bilateral.

By appearance and pruritus (itching), the most likely diagnoses are:

• Contact dermatitis or chronic eczema - common in people who wash their hands a lot, use chemicals or have sensitive skin.
• Atopic dermatitis - can manifest itself in crises, usually associated with stress or emotional factors (such as depression)
• Palmar psoriasis - when there are well-defined plaques, peeling and fissures,
• Prurigo or self-induced lesions - in patients with anxiety or depression, abrasion may occur due to repeated scratching.

As a patient has Atopic Dermatitis, and there was a worsening of the disease with Depression, this is the diagnosis. I changed your medicine to Depression. Today she uses Escitalopram 20 mg instead of Sertraline. She also used Prednisone 40 mg/day and Loratadine 20 mg/day, evolving with improvement.

Diagnosis Added

Atopic Dermatitis.