Case 1 42 yr old male presented with a maculopapular rash interscapular region gor 3 mths scaly erythematous rash above both eyebrows Minimal rash in front of the chest presternal area Clinically diagnosed as Seborrheic Dermatitis Patient a Jeweller, in Diamond buissness by profession. Buissness slack since 3 mths sitting idle In a mental conflict to innitiate a income generating buissnees A CA his Yoga teacher`s son willing devote full time in his buissness if he was interested in investing and starting the new buisines. He never had rash before. Case 2 40 yr old married lady came with intense itching on her forearms beyond the folded shirt sleeve since 3 days. She had fever, probably a viral infection for which she recieved an antibiotic from her Family Physician. She also searched, on a search engine and found a homeopath, received homeopathy medicines by courrier for her cough and cold of last 3 days. She attributed her itching to the medicines given by her family physician, as she felt the itching had worsened after she took the antibiotic. She also gave history of itching on exposed areas on exposure to sunlight before. She had received anihistaminic, cortisone injection before presenting to me. For her uncotrolled itching gave her one antihistamine, 3 tabs of oral cortisone, topically cortisone with a moisturiser and escitalopram 10 mg tablet ,all she took under my observation in the clinic. Her itching subsided within 20 mins. She had admitted she was hyper all the time and regretted it.
45 yr old lady developed lichen planus since few months, on the right forearm,upper arm,shoulder in a zosteriform distribution. On direct questioning,denied any stress. But when asked about how many children she had, she said,a son and a daughter. The daughter was married in a court with the spouse of her choice,a year back. Now the mother rues the fact that she could not celebrate the wedding,the way she wanted,which is in hosting a reception with an official ceremony. At this point she started crying and could not stop crying. Her grouse was, it was a family friend, who had influenced her and the boy`s side by a biased derogatory information about both to each other`s parents. Later she came to know that actually there was no truth in that and in that case,she would have officially accepted the daughter`s choice and given her consent. She was angry with that family friend for inciting disapproval consequently hurting the sentiments of her daughter and the groom. She probably was not recognising the anger towards herself for being so gullible. She was overreacting,not overcoming the unhappy event. Case 4 A marketing manager developed lichen planus on the penis, of the nails and a single papule on his thumb. His wife`s parents were staying with him, wife`s mother developed cancer, for which besides the physical efforts, he ended up spending three and half lacs, for which he had to sell his property. There was a legal case going on on some property matter of his inlaws. Case 5 A 30 plus male developed lichenplanopilaris resulting in hair loss,on the scalp upper lip.On the scalp he was developing scarring alopecia. He had an ongoing home loan , over and above he was borrowing money from his employer. Case 6 Case 7 Case 8 75 yr old man c/o itching on the back,arm and legs.Itching for last 10 yrs,managing by application of coconut oil and camphor. Case 9 A 40 yr old healthy man c/o intense itching on the dorsa of both forearms. Case 10 A YOUNG GIRL COMPLAINED OF ITCHING ON ARMS AND LEGS. O/E NO SKIN SIGNS When asked if she had `any reason in her mind` she imagined could be responsible. She said there were issues in her personal life. Case 11 A young 24 year old boy came with excoriation or prurigo like lesions few in number. He had it for few years. He had an elder brother who was underprivileged. The mother narrated that when he was 3 yrs old he would say he is being neglected. She said that he had gone to the extent of saying that may be it would have been better if he was `also` underprivileged. Now he was 24 both parents were bank employees. Mother is still working, Father is retired. Son is working in a bank, away from where parent`s stay. He had some exceptional qualities, like was writing poems when was very small, was in the habit of being a voracious reader. The mother said he was an introvert. About which he agreed. He said he was making An special effort to get out of it, now that he was on his own away from home, employed In a reputed bank . He had a good physique,was slim and spoke well. Father was a more reticent mother. Mother was articulate and was eager to communicate. Both parents said the boy was aggressive and did have uncontrollable anger. The boy too agreed that he was having a bad temper. Now is it likely that he was digging out his skin because he had a dominating mother And his uncontrollable anger was responsible and was displayed by internalizing And digging out his skin. Case 12 History of a patient of Atopic Dermatitis Case 13 Lichen Planus, Rosacea in the same patient Case 14 Lichen Amyloidosis (LA) is considered to be a self inflicted condition A 45 year old man had LA on both lower legs for the last few months. He was a teacher giving tuitions to school children. As he became popular,he employed many other teachers and started an institute of tution classes. His wife was also helping him in the administration. As part of his natural temperament he would feel the pressure of his responsibilities. His wife also had a somewhat similiar temperament. At times one of the teachers would remain absent which would derail the schedules and leave children remaining idle and also that would leave the curriculum incompletely finished. Thus the stress of such a scenario on an already vulnerable personality, probably led to the development of LA Case 15 A small child of 6 yrs age presented with umbilicated skin coloured eruptions(papules).A clinical diagnosis of `Lichen nitidus` made. On detailed history,it was found that the child had been passing urine in bed (nocturnal enuresis) few times a week. Later it was also found that the child would pass stools(defaecate) uncontrollably At times three times a day. Now Lichen nitidus is a dermatoses of unknown etiology. It is very obvious that there were chunks of not very normal behaviour. The psychosexual behaviour deals with oral,anal sexual phases in the development of a child and the conflicts resulting in fixations leading to abnormal Behaviour. Case 16 A 67 yr old suffering from Parkinsonism accompanied by his wife had pigmented violaceus itchy papules on the trunk, legs now for few months. Lichen planus, once again, etiology not known. Considered as psycho somatic dermatoses by many. Possibly mental depression, which instead of being experienced as emotional suffering probably by denial or flight resulting in a physical symptom in the form of `Lichen Planus` Case 17 A cricket coach age 40 yrs,developed itchy bumps(hives),which were evanescent (temporary/evanescent/transient). He subsequently developed Herpes Zoster, a viral Infection, a consequence of having suffered from Chicken pox(Varicell Herpes Zoster virus) when small. On detailed history it was found,that the nuclear family of the patient, was staying In a rented house.They had dreamt or were planning to buy a house.The house price Beyond them,which would force them to take a loan,a loan, which would not be Easy to repay.It would mean one salary between the married couple to be sacrificed Towards the loan per month.The anxiety of the scenario, enough for the innate Immunity to take a nose dive for Herpes zoster to emerge with falling natural defenses. Case 18 30 yr old married woman presented with itching. Case 19 A small child of 3 yrs age, had developed a patch of alopecia on the scalp,since last 3 months,his parents had separated 3 months back.He had become rowdy. Since then.He was hyperactive as such even before. The mother felt he was unmanageable since the separation.The child was aggressive,the stress too much for him to handle. |