Case report: Why me?

Many patients who come to our walk-in clinic, initiate interaction with a statement (such as “I only have three things to ask about” (shudder) or a question. A very fair-skinned 41-year-old woman presented recently with a most unusual opening remark—“why me?” From the attached picture, the answer would seem to be at least partially obvious: “You spent too long in the sun.” Further history clarified—and muddied—the situation. Knowing she was prone to sunburn due to her fair skin, just like everyone in her family—all of whom had participated in the outing responsible—the patient had applied liberal amounts of a good sunscreen to her entire sun-exposed body (including under undergarments—although the picture raises doubts about that). Read: Dr. Robert Dickson: Case report: Itchy all overOther family members, following the same careful preparation, had not been sun-burned. The woman’s burn was an unusually bright red color and had been so painful that she could not sleep. It was apparently a marked first-degree burn—too early perhaps for blistering or peeling. Nothing had been applied topically—and even Tylenol #3 had not provided pain relief. A more thorough history provided (as usual), the key to the patient’s severe and unusual sunburn. She had been diagnosed recently with cutaneous lupus and placed on Plaquenil (hydroxychloroquine)—her only medication. As I suspected, a quick Google search revealed that both cutaneous lupus and Plaquenil are sun-sensitizers. The patient had not been cautioned. I was reminded (especially now in the summer season) that many medications can cause photosensitivity. I was taught about the phenomenon—but must admit to not often reminding patients who are prescribed thiazides, tetracyclines, NSAIDs, etc. Photosensitivity to these common medications (and others) must be infrequent—or my memory would have been stirred long ago. The treatment consisted of an antihistamine (Rupall) and a short course of Percocet. Oral prednisone was considered (if necessary), but nothing topical but cool compresses was suggested. I believe that the experience is a “topical” reminder of how many of our common remedies could cause photosensitivity.Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: Why me?

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