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Simple cases
Case 6
46-year-old man with painful erythema on back
History
How long have you had this?
Since the weekend - that is, two days.
Reasonable question. This skin disorder is acute and self-limited, so the time sequence is important.
Does it itch or hurt?
Yes, it is painful and burns.
Good question. This is a painful disorder.
Do you take any medicines?
No, none.
Good question, important in differential diagnostic considerations.
Were you in the sun on the weekend?
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.
How do you feel otherwise? Do you feel sick or have fever?
No, I really feel fine.
Good question. In more severe cases, the patient may have fever, chills or cardiovascular problems.
Have you have sunburns in the past?
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.
Lesion
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.
Diagnosis
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.
Therapy
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.
