Po zapoznaniu się z tematami Kliniczne aspekty chorób skóry I i II przeczytaj poniższe case studies:
Patient: A.K., 29-year-old female
General History:
A.K. presented to the dermatology clinic with recurring skin symptoms that have persisted since childhood. In the past, similar symptoms surfaced intermittently, often worsening during specific seasons or environmental changes. She notes that the condition becomes particularly bothersome during stressful periods or after exposure to extreme weather, such as cold or dry environments. Although she has tried various over-the-counter moisturizers and avoids irritants, her condition continues to flare periodically, affecting her quality of life.
Current Symptoms:
The patient describes persistent itching and redness, primarily on the inner elbows, behind the knees, and occasionally on the neck and face. The itching intensifies at night, often disturbing her sleep. Physical examination reveals erythematous areas with excoriations due to scratching and visible scaling. Additionally, patches of thickened skin with pronounced lines (lichenification) are present in areas most frequently affected by symptoms.
Medical and Family History:
A.K. has a history of seasonal allergies and asthma, conditions that appear to correlate with the intensity of her skin symptoms. Family history shows similar allergic tendencies, with her mother and sister experiencing mild skin sensitivity and allergies. There is no record of recent infections, fever, or other systemic symptoms.
Lifestyle and Environmental Factors:
The patient works in an office environment where air conditioning is consistently used, leading to dry air, which she suspects aggravates her symptoms. She also reports a tendency to develop symptoms after wearing certain fabrics, particularly wool or synthetics. Stress seems to play a role, with flare-ups becoming more common during high-stress periods. Limited exposure to pets and a skincare routine focused on fragrance-free products have had only minimal success in controlling symptoms. She has avoided potential allergens, such as specific soaps and detergents, with limited results.
Initial Diagnostic Observations:
Physical Examination Findings: Symmetrical distribution of erythematous, scaly patches in flexural areas (e.g., inner elbows, backs of knees).
Skin Characteristics: Chronic lichenification in frequently affected areas; some excoriations from scratching.
Trigger Assessment: Symptoms seem exacerbated by environmental factors (e.g., air conditioning, certain fabrics) and emotional stress.
Based on the above observations, what do you believe is the likely dermatological condition affecting A.K.?
Case Study
Patient: M.L., 67-year-old male
General History:
M.L. presented to the dermatology clinic with a gradually enlarging lesion on his nose that he noticed approximately six months ago. He reports that the lesion initially appeared as a small, pearly bump and has slowly increased in size over time. The patient describes occasional bleeding from the site, especially after minor trauma, but denies any pain or itching. He has a history of significant sun exposure, having worked as a farmer for over 40 years, often without regular use of sunscreen or protective clothing.
Current Symptoms:
The lesion is localized on the left side of the nose and appears as a raised, pearly nodule with visible telangiectasias (small, superficial blood vessels) on its surface. The lesion has a slightly rolled border, and there are central areas with mild ulceration and crusting. Physical examination reveals no other similar lesions on the face, scalp, or other exposed areas. Surrounding skin is relatively unaffected and lacks significant pigmentation abnormalities or signs of inflammation.
Medical and Family History:
The patient has a history of other skin conditions related to sun exposure, including actinic keratoses, but denies any history of malignant melanoma or other skin cancers. He has no family history of skin cancer but recalls that his father and grandfather also had “sun-damaged skin.” M.L. has no history of immune-suppressive conditions and is not currently taking any medications known to increase photosensitivity.
Lifestyle and Environmental Factors:
Due to his long history of outdoor work, M.L. has accumulated substantial sun exposure over his lifetime. He continues to spend time outdoors but now occasionally uses a wide-brimmed hat. However, he admits to rarely applying sunscreen, particularly in colder months, which has led to extensive cumulative sun damage.
Initial Diagnostic Observations:
Physical Examination Findings: Presence of a single pearly nodule on the left nasal area with rolled edges, superficial telangiectasia, and slight central ulceration.
Skin Characteristics: Sun-damaged appearance with scattered actinic keratoses on the forehead, forearms, and dorsal hands. No evidence of systemic disease or other suspicious lesions on the rest of the body.
Trigger Assessment: Prolonged sun exposure is likely the primary contributing factor, given the patient’s history of outdoor work and lack of consistent sun protection.
Based on these clinical findings and the patient’s history, what is your diagnosis for M.L.’s skin lesion?