Dermatology Case Study 6

CHART NOTE

Was seen for 3 visits because of recurrent episodes of urticaria.  He was started on treatment with ephedrine, Periactin, and Sinequan, and his hives are almost but not completely gone.

It is my feeling that acute urticaria (in our definition, an urticaria that has been present for less than 3 months) should not be evaluated for cause unless that cause is apparent, but rather should be treated only with drug therapy since at least 70% of patients with acute urticaria will have the urticaria clear spontaneously and because the possibility of finding the cause is so small.  His urticaria has not been present for longer than 3 months, and therefore I have elected to treat him only with drug therapy.  His hives seem to have almost cleared, and I think that we should continue his drug therapy for a period of time before pursuing with any further evaluation.  He is on the same 3 medicines noted above and is to call me in a week for followup.

CHART NOTE

This is a followup.  It was my impression that she had the skin reaction on her buttocks due to a drug hypersensitivity, the most likely drug being Pronestyl and the secondary drug being either Aldactone or hydrochlorothiazide or both.  She was treated both with penicillin and with prednisone, and I have now followed her for a period of 2 months.  Her symptoms have completely cleared and there has been no recurrence, and this is an alteration of the previous pattern in which she had episodes every 2 to
3 weeks.

It is impossible to skin test for any of these drugs, and the reaction indeed may not be an IgE-mediated reaction, in which case skin testing would be negative at any rate.  We therefore need to draw some conclusions which perhaps may be incorrect but which are at least reasonable.  I would recommend that she be given no more Pronestyl or Aldactazide and would be very hesitant at giving her any of the sulfonamide-based diuretics or at using sulfa-type drugs in the future.  If she does not have a recurrence, I am not planning to see her again.

FOOTNOTE

Line 7 (Page 1).  Clipped sentences, which often omit subjects and articles, are common in chart notes, and the transcriptionist may transcribe as dictated or, with the approval of the physician, expand to complete sentences.

Line 21 (Page 1).  Pursuing with any was edited to pursuing any.

Line 31 (Page 1).  The physician changed his mind.  The dictation.  It is my rec. ... was deleted.