Case report: Red face concerns

A long-standing patient, previously in my family practice, just came to our walk-in clinic for help with a severe facial rash. Having known the patient and family for many years, I was aware that she—and the rest of the family—suffer from an extensive variety of recurrent allergic (and related) conditions. They have asthma, eczema, seasonal allergies etc., which keep flaring at various times through the year. Most issues are handled by the patients with antihistamines, inhalers and creams when required. Two weeks before being seen, the 45-year-old, very fair-skinned woman had been strolling with family, fully clothed, in a grassy, unkempt and windy parkland, out of town. Read: Case report: A hand rash and more When she developed an itchy facial rash a few hours later, she attributed the rash to an allergy to Rupall, an antihistamine she had been taking for years. This struck me as a bit unusual, but she reported having almost an identical facial rash long ago when taking Blexten, which she immediately discontinued with gradual resolution of the rash. She had been switched to Rupall having found that 20 mg Reactine “did nothing.” With recurrence of her facial rash, she had stopped Rupall and just applied moisturizers, which made it worse. She is in good health, allergic to penicillin, and taking no medications other than the Rupall (now discontinued). In general, she is apprehensive of prescribed medications. Read: Case report: A troubling red toe Examination revealed a pruritic, erythematous dermatitis, covering her entire face (see picture, reproduced with permission of the patient). It was mostly eczematous in appearance, macular, with a few excoriations due to scratching. Considering the history and distribution of the rash, I theorized that the patient had been exposed to a wind-blown allergen on the only part of her body not covered. I recommended cautiously resuming the Rupall and added a five-day course of oral prednisone. Topical therapy consisted of cool water compresses and no other topical treatment until the rash cleared. In retrospect, I wondered if the “reaction” to Blexten in the past, had been a similar occurrence. I have found that in highly atopic individuals, a variety of interesting allergic phenomena can occur. Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: Red face concerns

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