Female patient, 35 years old.
History of hypothyroidism treated with levothyroxine.
It presents a one-year history characterized by painful papule-pustules, some confluent, erythematous plaques with scaly margins in large folds, pubis and abdomen.
Consultation in primary health care (PHC) receiving multiple treatments, topical and systemic antifungals, cefadroxile and ketoprofen without response.
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Evaluated by an internist physician, the patient was urgently referred to a dermatologist, given the disabling pain the patient experienced.
Pemphigus was suspected Hailey-type ileum, indicating hospitalization and biopsy.
Histopathological study of the lesions identified subcorneal pustules with abundant neutrophilic polymorphonuclear inflammatory infiltrate and epidermis with mild spongiosis compatible with subcorneal pustulosis.
Treatment was initiated with intravenous corticosteroids and analgesia, with subsequent change to oral corticosteroids (Prednisone 0.8 mg/Kg/weight).
One month after treatment, the patient presented partial reduction of erythema, desquamation and pain; however, new lesions continued to appear and the dose was maintained for another month.
At the new control, erythematous papules and few pustules persisted, associated with mild burning and pruritus.
It was decided to start strong cotrimoxazole (160/800 mg) one tablet every 12 hrs for 10 days and then one tablet per day for 20 days.
After completing treatment, the patient had an excellent response, only residual hyperpigmentation and reported being completely asymptomatic.
Glucose-6-phosphate dehydrogenase was requested to start dapsone, however, the last antibiotic response to this therapy continued for two months, was lower than that observed with the use of cotrimoxazole.
