SUBJECTIVE: The patient is a (XX)-year-old woman who returns 4 weeks after beginning narrowband UVB for chronic eczema.
The patient’s regular dermatologist saw her last week, she tells me, because her eczema worsened significantly as she was tapering prednisone. She is now back to 20 mg prednisone daily; he had tapered it down to 7.5 mg.
She is using clobetasol ointment on her skin. She does note that the itchiness has lessened, but she does not think the eczema has improved since she started phototherapy.
MEDICATIONS: Prednisone 20 mg daily, clobetasol ointment daily, hydroxyzine 10 mg q.6 h, betamethasone valerate lotion to the scalp and desonide cream to the face p.r.n.
OBJECTIVE: The patient is alert and oriented x3. Normal mood. Normal body habitus. There are erythematous, slightly lichenified coalescing papules into larger plaques on the upper mid back, abdomen, proximal thighs and arms. The patient’s face is clear.
ASSESSMENT: Chronic eczema.
PLAN: The patient will continue with the narrowband UVB for an additional 4 weeks. We discussed with the patient if at that point she really has not had any improvement in her eczema as evidenced either by her skin clearing or by a lower dose of systemic steroids, then it is unlikely continuing phototherapy is going to be beneficial.
We discussed with the patient again today that the phototherapy, if not curative, can have an additive benefit through other medications in managing the eczema.
The patient voiced understanding of this, and she will continue with the narrowband UVB 3 times weekly. The patient has had 11 treatments to date in present dosage of 321 millijoules. Followup will be in 4 weeks.
