, Jillian W. Wong2 and John Koo3
(1)
Department of Dermatology, University of New Mexico, Albuquerque, NM, USA
(2)
Department of Dermatology, University of California, Davis Sacramento, CA, USA
(3)
Department of Dermatology, University of California, San Francisco, CA, USA
Abstract
Mr. Dickens is a principal at a local high school, who has been seeing you for the past 2 years about his chronic urticaria. He is typically a very pleasant and compliant patient. As an educator, Mr. Dickens values the patient education component of his visits with you, and is generally eager to share his experiences of living with a chronic skin condition. When he started with you, each urticarial episode lasted up to 12 h and occurred approximately every other day. Once aggressive therapy was instituted, his condition gradually improved to the point where he now experiences an episode every other week, with each one lasting no more than 1 h. Today is his regular 3-month follow-up, and the receptionist noted that he appeared quite unhappy.
Mr. Dickens is a principal at a local high school, who has been seeing you for the past 2 years about his chronic urticaria. He is typically a very pleasant and compliant patient. As an educator, Mr. Dickens values the patient education component of his visits with you, and is generally eager to share his experiences of living with a chronic skin condition. When he started with you, each urticarial episode lasted up to 12 h and occurred approximately every other day. Once aggressive therapy was instituted, his condition gradually improved to the point where he now experiences an episode every other week, with each one lasting no more than 1 h. Today is his regular 3-month follow-up, and the receptionist noted that he appeared quite unhappy.
Pt: Doctor, I had a bad flare yesterday. It took nearly 10 h to clear up.
Dr: I’m really sorry to hear that, Mr. Dickens. Did you do all of the things we had discussed to control this episode?
Pt: Yes, I did. I even took an extra anti-histamine pill just to see if that would help, but it didn’t. I have been under a lot of stress lately, and I notice that each episode has lasted longer. Other than that, everything else in my life has been the same, including my treatment plan.
Dr: Stress can play a big role. Have you tried relaxation techniques such as yoga or meditation? In terms of therapy, would it be okay to add another anti-itch pill to your current regimen for better control of the current breakthrough episodes?
Pt: I’m tired, Doctor. It has been about 3 years; yet, these breakthrough episodes have not completely gone away. My positive spirit can only carry me so far. When will they find a cure to help me get rid of my disease?
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
