Case from Dr Nameer Al-Sudany
A 15-year old poor female has had bad nutritional history presented with an erythematous scaly and crusted dermatitis reaction involving the face especially the nose and perioral region.The hands and feet were also involved by an acute phototoxic reaction presented as burning erythematous rash associated with painful fissuring and followed by exfoliation. The patient had no signs and/or symptoms of GI or CNS involvement and gave negative history of previous drug intake, GI problem or psychiatric disorder.
7 comments:
Dear Nameer,
This is a superb example of the condition especially the lateral foot image showing just the light exposed dorsal surface involvement. It must be very satisfying to diagnose a case like this when you can treat it very easily. I only see it infrequently in elderly alcoholics with very poor nutrition and after a few days in hospital with good food it magically disappears!
Best wishes
Ian
Dear Ian,
Thanks for comment on this case.
Pure nicotinamide as a drug or supplement is not available in Iraq at the time being. So we gave the patient Stress capsules (twice daily) which contain many vitamins and trace elements including nicotinamide 100 mg per capsule. The patient has improved greatly within a matter of few days. I think depending on a good food alone takes longer time for improvement. So one should go directly and give nicotinamide in an adequate dose plus good diet for fast magic improvement.
Best wishes
Nameer
I am sure your are correct about the vitamin supplements because these patients may well be deficient in other nutrients. The speed with which they improve always astounds me. If you are asked to do a consult on a milder suspected case in hospital you have to get there early before they get better!
Thank you Nameer for sharing this interesting case with us. The image quality is excellent.
Thank you sir for sharing
Sir my close differential was zinc diffeciency.... but in ur case no any prob of GI
Thank you dr.Nameer for sharing.
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