Case Report


Uses of Antidepressant as Adjunct Treatment of Very Severe Atopic Dermatitis

Authors: Shamail Zia , Fazail Zia , Shraddha Panchal , Adeel Ahmad , Syeda Rabab Jaffer
DOI: https://doi.org/10.37184/lnjpc.2707-3521.3.12
Year: 2021
Volume: 3
Received: Jul 12, 2021
Revised: Nov 24, 2021
Accepted: Dec 02, 2021
Corresponding Auhtor: Shamail Zia (drshamailzia@gmail.com)



Abstract

This is a case of severe atopic dermatitis in a young married male age 37 years. This patient was very anxious and frustrated. The patient was using all the standard treatments for severe atopic dermatitis (A.D) but he was not getting better. The use of antidepressants is not common practice in treating atopic dermatitis. Most general practitioners and dermatologists don’t pay attention to how much a patient is suffering not only physically but also mentally and because of this, they don’t suggest antidepressants. The role of antidepressants as an anti-inflammatory is still needed to be educated among physicians. This is a vicious cycle. The stress causes the exacerbation of this disease in which patients start itching all over the body and because of itching, lesions all over the body start getting infected as during itching staphylococcus aureus which resides under the nail enter in the lesion and cause infection and because of infection patients have a fever, lethargy, and weakness. The use of antidepressants is a game-changer in the management of atopic eczema.

Keywords: atopic dermatitis, antidepressants, itching, perivascular infiltrate, spongiotic vesicles, stress, superficial perivascular inflammation.

INTRODUCTION

The use of antidepressant medication usually not being advised as a treatment of atopic dermatitis as in some studies it has been suggested that antidepressant has the anti-inflammatory role and because of this reason we are reporting this case as this might be useful for other physicians to manage severe atopic dermatitis easily [1, 2]. Usually A.D managed by topical steroids, topical use of the immunomodulators, topical antibacterial in case of infection but after all these maneuvers, patients of severe A.D usually don’t get relief.

CASE PRESENTATION

A 37-year-old married male came to us for a second opinion regarding his diagnosed disease atopic dermatitis associated with severe itching and pustular thick crusted plaques i.e. erythroderma ( Figs. 1A-1C).

The patient was having severe anxiety and the patient’s family informed us about the suicidal thoughts the patient is talking about [3]. The patient was taking all the standard treatments of atopic dermatitis already i.e. azathioprine, tacrolimus, topical application (LPC 3% and clobetasol propionate 70%), antihistamine, and multivitamins.

The patient was very restless with itching rigorously in front of us. Because of severe itching, the patient’s lesions were infected and having fever (100F) [4]. His whole body was erythematous and most lesions are infected lesions. He quit his corporate job as he said “I itch all the time and it’s really embarrassing for me to hold the social pressure and all of my peers asking about my itch and no one wants to sit and shake hands with me as they thought this disease is communicable” and the patient was became socially isolated in his own office and company didn’t want him to be in the office [5]. After quitting his job, the patient was more anxious and living his life miserably. The patient’s skin biopsy microscopic picture of the lesion (Figs. 2A-2D).

We advised the patient and guide him to continue his former medication as this was the standard treatment he was taking. On the next visit after a month patient came in a very relaxed state and all the lesions have been miraculously subsided and left only the post- inflammatory hyperpigmentation scars (Figs. 3A&3B) and we were really surprised about the improvement of this patient as we were not expecting this much improvement and after taking detail history from the patient, he informed us about the addition of one more medicine that is venlafaxine that has been started by a local psychiatrist the day after he visited us one month back as his family took him to the psychiatrist because of his suicidal thoughts and continuously weeping and not getting enough sleep.

Fig. (1): (A): Edematous and crusted papular lesions on upper back and lower back thick discrete hyperkeratotic papules and plaques. : Erythema with non-discrete plaques. (C): Yellow arrows show the ruptured vesicles with infected dry crust on them.

(B)