Simple cases

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Case 6

46-year-old man with painful erythema on back

Since the weekend - that is, two days.

Reasonable question. This skin disorder is acute and self-limited, so the time sequence is important.

Yes, it is painful and burns.

Good question. This is a painful disorder.

No, none.

Good question, important in differential diagnostic considerations.

I was at a health club and did get out in the sun, but I used a sunscreen.

Good question, as the answer is in the history.

No, I really feel fine.

Good question. In more severe cases, the patient may have fever, chills or cardiovascular problems.

Yes, as a child and then often at the beginning of the summer.

Good question. Sunburns in childhood may be associated with an increased risk of melanoma. One can warn the patient.

Choose the right efflorescences:

False. No hives are seen.

Correct. The patient has a widespread erythema, technically known as a patch, but in essence a large macule.

False. No papules are seen.

False. No scales are seen, although they will soon appear.

Choose the right diagnosis:

False. A phototoxic reaction requires contact with or ingestion of a phototoxic substance. This history is lacking.

False. Once again, the history doesn't fit.

Correct. This is sunburn. This UV-induced reaction begins acutely a few hours after exposure and peaks at 24-36 hours.

False. The patient is not taking any medications.

Choose the right therapy(ies):

Correct. These antiinflammatory agents often provide some relief in acute phase.

False. In such a case, systemic corticosteroids are not indicated. They might be worthwhile in a more severe case with blistering.

Correct. This simple measure provides good pain relief.

Yes. Avoiding sunburns will reduce the degree of skin aging and the risk of skin cancers.

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