AMUSING,AMAZING DERMA CASES
Iencounter thought-provoking cases every once in a while in my clinic. Sometimes, it could be amusing, making me wonder if the doctor who handled the case before me is a real doctor or not. Interesting because of the way people respond to me when I ask them about their habits and preferences. Hilarious because of the excuses patients give every time they make a mistake on the instruction and try to cover it up to avoid being berated. And lastly, unusual because some of these patients seem to have a medical degree of their own, acquired from Google or Yahoo, that by the time they consult me, they have bizarre-looking rashes modified by their own manipulation.
• Case No. 1: The parent of a 14-year-old brought their daughter recently to my clinic. Their doctor has been treating their daughter since age five due to discoloration on her body. This rash was persistent for nine years and the doctor was treating the girl with an antifungal regimen all those years, telling her parents that it was really difficult to get rid of a fungal infection and it usually took months to years to treat it. At first glance, I told the mother right away that her daughter’s rash was not fungal but a drug reaction that kept on appearing at the exact same site every time she took a certain medicine. She just confirmed my diagnosis with my interview. According to her, every time her daughter had fever, she would give paracetamol of different brand names and that she would notice the rash flare-up. But so compelling was her faith in her doctor. Half-irritated and half-smiling, I suggested that a piece of skin be sent to the lab for assessment. She agreed and the result came out as I predicted.
• Case No. 2: A patient of mine was being treated for alopecia and part of her treatment included injecting a medicine. She already had two sessions and I expected her hair to be coming out. Before the second session, she confided to my secretary that she had pulled a lot of white hair because it was really very itchy and told my secretary not to tell me about it. Luckily, my secretary told me about it and told her to stop pulling her hair as the treatment would be useless.
• Case No. 3: This patient had been to five dermatologists before she was referred to me. She had a red rash on both her cheeks, a red thickened rash on her nasal bridge, and another two pinkish elevated rashes on both sides of the mouth. At first, I thought I was dealing with lupus, then similar elevated red rashes (plaques) where seen on her torso. I was also thinking of the possibility of Hansen’s Disease (leprosy) but her history was negative for these two diseases. I delved further and decided to do a skin biopsy so as to have a fallback in case my first treatment was ineffective. But even before I got the results of her biopsy, she was back at my clinic after one week with a big smile. I was amazed at the change after only one week but was happy that she was so much better. She told me I was heaven-sent. Her biopsy results just came in, confirming my diagnosis. I am just so happy I gave her the appropriate treatment.
• Case No. 4: I have this charming lady in her late 30s and quite diabetic. I said quite because she has a strong family history and her fasting blood sugar was three points higher than normal. She had red, large but flat rashes over her hip areas, under her breasts and over her armpits. She was prescribed with topical creams that seemed to be working really well at first. However, the rash would reappear with a vengeance until it covered almost her entire body. She suffered so much because of the unbearable itching. The lotions and creams which her two dermatologists gave did not really get rid of her problem. The rash and itch persisted, interfering with her work and sleep. What this lady had was skin asthma and candida infection which I treated at the same time. Since then, the patient has not complained.
• Case No. 5: A young lady, AJ, and her mom came to me for treatment of skin hypopigmentation. As per assessment, almost 75 percent of AJ’s body was covered with it. She was diagnosed with vitiligo and was treated with several anti-vitiligo regimens, but the white spots continued to expand. In desperation, she ended up searching on the Internet for an answer and tried all sorts of creams being sold on the web, only to be frustrated. I told her that it would be much easier to make her skin white than restore its original color due to the extent and instability of her vitiligo. I also did laboratory tests on her to rule out what was causing her vitiligo, then started her on a skin-whitening treatment. I also explained to her that the treatment would not be a miracle and would take months before changes would set in and that she needed to be patient.
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