Dermatology | Figure 1

MustafaHamdi

Pharmacist

Dermatology

A 27 yo married girl came to my pharmacy, after she got married those squama & patches started to appear as shown in old pics 1,2&3. It felt itchy at that time, this patch on her shoulder keeps appearing even after it falls, and the new pic shows that this squama appear again on her upper thigh. She applied fucidic acid with corticosteroids and took itraconazole, fluconazole caps, topical antifungal, and whitening cream with no effect at all. She tried to take immune enhancement as if it was an autoimmune disease but no effect. She has been raising cats for 7 years. She mentioned that at the beginning of marriage, her husband ejaculated on the same area on her abdomen several times. Her RH blood group is O negative and her husband is B+, no kids till now. Her mother had breast cancer. She mentioned that she took diclofenac frequently on her period. What could this be and what's the proper treatment?

Similar cases:

1. Case: A 24 yo married girl came with this squama on her shoulder and those patches on her body as described in photos and they appeared two years ago after she got married, as she describes. This patch on her shoulder keeps appearing even after it falls, and those patches never go despite she applied corticosteroids, antibiotics, antifungals and whitening creams, without any healing. She mentioned that she takes diclofenac frequently especially in her period. No chronic disease or any other diseases, her mother has breast cancer, what could those patches be and what's the proper treatment?

2. Case: 64-year-old female with DM and HTN notices a growing itchy rash on her arm that shows on her opposite leg as well. She recalls a similar attack 2 years ago. Has a history of eczema that improved in adulthood. She takes antiallergics (not steroids) but it appears on her back 32 days later. This time a 5-day course of I/m Dex 4mg per cc is taken, but later she develops the rash on her arm again. At the time, she had stopped taking antiallergy tablets which made her groggy and blamed reflux. What is the prognosis if she stops fexo and clemastine abruptly? What is the diagnosis?

3. Case: A 23 yo married female came to me with these rough reticulated pimples appeared in her both hands, leg and elbow, it feels itchy. No history of any disease except mild anemia. She had 3 cats and she mentioned that she walked under the hot sun for a while and she was applying calcipotriol with betamethasone (daivobet) on her abdomen for something else. She applied fucidic acid with corticosteroid with no effect. Could this be an allergic reaction to daivobet? Or what could this be and what’s the proper treatment?

4. Case: A 35-year-old female patient presents to the Pharmacy with patchy lesions on both feet appearing around the ankle on the left foot and top part of her right foot. She complained of occasionally itching. She mentioned the lesions started very small about a year ago but have grown wider with time. She's been prescribed a couple of antifungals in the past including Griseofulvin, terbinafine, and some azoles both oral and topical all to no avail. Please what's your take on the diagnosis and treatment?

Additional Information

• A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. History includes hypertension, long-term smoking, and a sedentary lifestyle.
• A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back, having no recent travel or exposure to new environments, and caring for a small kennel with approximately eight dogs rescued from the streets.
• A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days, revealing multiple small pustules with surrounding inflammatory signs on the chin.
• Patient in late teens presenting after a collapse, with no previous cardiac history and no family history of sudden death.