Case Spotlight

The Addis Clinic connects physicians to frontline health workers, allowing for specialty care in the most remote and underserved areas.

This month we introduce you to a patient in Haiti who has experienced an ongoing rash on her hands and wrists “for a long time” that is very itchy and painful and has not responded well to initial treatment.  In the past, she applied topical hydrocortisone with no results, and at one point was given an oral antifungal medication, which only resulted in a small improvement.  She came to her local community health worker seeking help because she is “absolutely miserable” with the painful itching.

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The community health worker believed all available local resources had been utilized and submitted the patient’s detailed medical history and pictures of the rash to The Addis Clinic for allocation to a dermatology volunteer.  The Addis Clinic is grateful to have four active dermatologists in our volunteer network and one of them graciously and immediately took the case. The patient’s history as reported by the health worker included the fact that she did not present with rashes in any other areas of her body, she did not report any fever or other complaints, and that no one in her family or village reported a similar complaint.  The woman lives in extreme poverty, and water is not easily accessible in her neighborhood, making it difficult to maintain good hygiene.  The health worker knew that a U.S. medical team was set to visit the town the following week and hoped to contact them to bring medication for the patient if she required something that was not available locally.

After utilizing The Addis Clinic’s asynchronous telemedicine platform to discuss the patient with the community health worker, the dermatology volunteer believed that the patient suffered from a combination of Dyshidrotic Eczema and Lichen Simplex Chronicus (LSC).  According to the physician, “More than likely something in her environment is irritating the skin.  After scratching for long periods of time, the skin becomes thickened, which leads to the LSC.”  His recommendations included the application of a more potent topical steroid like betamethasone dipropionate 0.05% or clobetasol propionate 0.05% to the affected areas on the hands and wrists. Following application of the steroid, the dermatologist recommended the application of a moisturizer with 10-20% urea. Urea is part of the natural moisturizing factor of the skin, and when a patient has eczema, the amount of urea is greatly decreased and needs to be replenished. He instructed the health worker to have the patient complete this regimen three times a day for up to four weeks.  The health worker will follow-up with the patient after this time and was given further instructions if the rash remained resistant to treatment.

The Addis Clinic looks forward to following the progress of this patient and we are hopeful that the advice from our dermatology volunteer results in improved quality of life for this young woman.