Case 1

Eczema & Diabetes

Patient Demographics
Name : Mrs. L
Gender : Female
Race : Chinese
Age : 45 years old
Weight : 60 kg
Height : 160 cm
Body Mass Index (BMI) : 23.44 (pre-obese)
Chief Complaint/Presenting Complaint
I have rashes on my leg, around my thigh areas and at my feet.
History of Presenting Complaint
She says that it is very itchy. She scratches until there are minor wounds.
There are patches of redness on the itchy areas. The redness and itchiness
subside after a few days but a relapse occurs.
Past Medical History
Rhinitis
Past Medications
Rhinocort aqua (budenoside) 64mcg
Dosage : 2 puffs into each nostril in the morning
OR 1 puff into each nostril twice daily
Family History & Social History
Family History :
Mother has eczema.
Social History :
Married with two children.
Physical Examinations & Other Relevant
Findings
Weight : 60 kg
Non-fasting blood glucose level : 8.0mmol/L
(Target control : 4.4-8.0mmol/L)

Present Medical Conditions
Eczema based on the factors and symptoms below :
- rashes on the leg, thigh areas and at the feet
- history of rhinitis
Present Medications
Glucophage 850mg (metformin hydrochloride)
Dosage : 1 tablet (850mg) twice daily
Current Problems & Medications
Problems Medications
Eczema
Diabetes Glucophage 850mg
List of Drug Related Problems
Needs additional drug therapy : No medication is taken for eczema
Inappropriate compliance : Lack of compliance to lifestyle
modification + oral anti-diabetic agent (OAD) therapy
Need for monitoring
Desired Therapeutic Outcomes
Medical Condition Desired Therapeutic Outcomes
Eczema To treat eczema by controlling
itching, reduce skin inflammation
(redness and swelling) and reduce new
lesions from forming.
Diabetes To arrest disease progression of
diabetes.
To reduce risk of diabetes
complications such as retinopathy,
nephropathy, neuropathy, coronary
heard disease (CHD), diabetic foot,
erectile dysfunction (ED).
Pharmaceutical Issues & Plans
Medical condition : Eczema
Medications : Corticosteroid (Elomet cream 0.1%) + Antihistamine (Zyrtec 10mg)

Indication
Relief of the
inflammatory
& pruritic
manifestations
How to
use
Apply twice daily
Preferrably after
morning shower &
before sleep
Keynotes

Continue to apply
for 48 hours after
symptoms subside
Indication
Symptomatic
treatment
Of allergic origin
How to
take
1 tablet (10mg)
Twice daily
Keynotes
Non-sedating
Can be taken in
combination with
Rhinocort aqua
mometasone
furoate
cetirizine
dihydrochloride

Possible dietary supplements :
Probiotics boost the immune system and control allergies
Borage oil anti-inflammatory and reduce eczema symptoms
Evening primrose oil reduce itching of eczema
Patient Counselling Points
Identify trigger factors for eczema and avoid these triggers. Possible trigger factors :
Possible
trigger
factors
Soap &
detergents
Inhaled/
contact
allergens
Food
allergy
Stress
Non-
pharmacological
intervention
Mild soap &
moisturizer
Short, warm
showers
Avoid/reduce
food causes
allergy
Exercise
Current Problems & Medications
Problems Medications
Eczema
Diabetes Glucophage 850mg
List of Drug Related Problems
Needs additional drug therapy : No medication is taken for eczema
Inappropriate compliance : Lack of compliance to lifestyle
modification + oral anti-diabetic agent (OAD) therapy
Need for monitoring
Desired Therapeutic Outcomes
Medical Condition Desired Therapeutic Outcomes
Eczema To treat eczema by controlling
itching, reduce skin inflammation
(redness and swelling) and reduce new
lesions from forming.
Diabetes To arrest disease progression of
diabetes.
To reduce risk of diabetes
complications such as retinopathy,
nephropathy, neuropathy, coronary
heard disease (CHD), diabetic foot,
erectile dysfunction (ED).
Pharmaceutical Issues & Plan
Medical condition : Diabetes
Medication : Continue on
with Glucophage 850mg.
Patients value : 8.0mmol/L
Exercise at
least
150mins/week

High fibre diet
Balanced diet : 50-
60% carbohydrate,
15-20% protein,
25-30% fats
Total carbohydrate
intake
Regular meal
timings
Medication : 15-30
min after food



Lifestyle Modification
Pharmaceutical Issues & Plan
- Pre-obese
Patients value : 23.44 (pre-obese)
In obese patients with diabetes, a
weight loss of 5 10% of initial body
weight improves insulin sensitivity,
reduces blood pressure and
improves dyslipidaemia.
The optimal rate of weight loss : 1 2
kg/month.

Monitoring Plan
SBGM = Self Blood Glucose Monitoring
Self-care : Blood glucose monitoring
Keeping a log of your test results is vital. It will give a good picture of your body's response to your diabetes care plan.
Hence, changes can be done by you and your doctor to achieve effective treatment.
The warning signs of trouble:
Vision problems (blurriness, spots).
Tiredness or pale skin colour.
Obesity (more than 20 pounds overweight).
Numbness or tingling feelings in hands or feet.
Repeated infections or slow healing of wounds.
Chest pain.
Vaginal itching.
Constant headaches (This may be a symptom of
high blood pressure.)
References
American Academy of Dermatology. How Is Eczema Diagnosed and Treated? [Online]. Available at :
http://www.webmd.com/skin-problems-and-treatments/eczema/understanding-eczema-treatment [Accessed :
21 April 2014].
American Academy of Dermatology. Atopic dermatitis: Diagnosis, treatment, and outcome [Online]. Available at :
http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/atopic-dermatitis/diagnosis-treatment
[Accessed : 21 April 2014].
Astrazeneca. Rhinocort Aqua [Online]. Available at : http://www1.astrazeneca-us.com/pi/Rhinocort_Aqua.pdf
[Accessed : 21 April 2014]
Drugs.com. Mometasone cream [Online]. Available at : http://www.drugs.com/pro/mometasone-cream.html
[Accessed : 21 April 2014].
Datapharm Communications Ltd. Cetirizine 10mg Film-coated Tablets [Online]. Available at :
https://www.medicines.org.uk/EMC/medicine/26858/PIL/Cetirizine+10+mg+Film-Coated+Tablets/
[Accessed : 21 April 2014].
National Jewish Health. Atopic Dermatitis or Eczema [Online]. Available at :
http://health.usnews.com/health-conditions/allergy-asthma-respiratory/atopic-
dermatitis-or-eczema/treatment [Accessed : 21 April 2014]
NHS choices. Rhinitis, allergic-Treatment [Online]. Available at :
http://www.nhs.uk/Conditions/Rhinitis---allergic/Pages/Treatment.aspx [Accessed :
21 April 2014].
NHS choices. Side effects of corticosteroids [Online]. Available at :
http://www.nhs.uk/Conditions/Corticosteroid-%28drugs%29/Pages/Sideeffects.aspx
[Accessed : 21 April 2014]
Univeristy of Maryland Medical Center. Eczema [Online]. Available at :
http://umm.edu/health/medical/altmed/condition/eczema [Accessed : 21 April 2014]





Drugs in use : clinical case studies for pharmacists / edited by Linda J. Dodds.
London : Pharmaceutical Press, c2010.
Mims
Malaysia Clinical Practice Guidelines www.acamed.org.my