{"text":"~ THE ALAN LYELL CENTRE FOR DERMATOLOGY \nManagement Office \nSouth \nWest \nNorth East \nh \nDr Marjory Stephens \nKilsyth Health Centre . \nBurngreen Park, Kilsyth, Stirlingshire - \nG65 OHU \nDear Dr Stephens \nStobhill Hospital \n133 Balomock Road \nGlasgow G21 3UW \nSecretaries: - 0141201 3141 \nQutpatient Appointments: 0141 20! 3459\/3378 \nTFax: 014} 201 3144 \n- Queens Pask House, Victorit Tnfirmarys \n.52 0141 201 5807, Fax:0141 201 5825 . . ' \n_ professor Colin Muaro, DY David Bilsland, Dr Angela Drummond, DT Felicity Campbel! \n- Dr Robert Herd, Dr David Tillmas, Dr David Burden, Dr Paula Beattie, OF Joyce Leman \n-Dr Susan Holmes, Dr Colin Clark, Dr Catherine Jury \n-Dr Lisa Naysmith, Dr Heather Graham \nCL : 20\/ \n10\/2008 \nDICT: 20\/10\/2008 \nTYPED: 23\/10\/2008 \nHG\/AMD \nDR. GRAHAM ~ TUESDAY MORNING \nGENERAL\u2019DERMATOLOGY CLINIC \nAgnes Clelland - 08\/09\/1955 - CHI: 0809555328 - CRN: 10338654X \n39 Rennie Road, Kilsyth, Glasgow, G635 9PQ \nDiagnosis: Possible erythema multiforme \nManagement: Aciclovir 200mgs five per day for five days \nFollow-up: Open appointment \n2 \nS \nvery atypical eruption. \nThank you for referring the above lady. She was reviewed originatly by Dr- Kerr in 1999 witha \nShe was investigated extensively at that point including multiple biopsies \nwhich favoured 2 diagnosis of either erythema multiforme or urticarial vasculitis but there were \ncertainly some atypical features-. At the time it was wondered if a cold sore may be a trigger \nSince 1999 she has had much milder episodes and has tended t0 ignore them. This episode \nstarted in September and was a severe reaction. It tended to affect her trunk and buttocks 10 mid \n_ She describes it as being bright red and itcby \nand it has resolved leaving some staining and some peeling. She did have a cold sore and she \nalso developed farther cold sores currently. Shehas also bad dental infections and at times has \nhad urinary infections. She is diabetic and currently onl Ramipril, Fluoxetine, Metformin, \nSimvastatin and occasional Celebrex. \nAll of these drugs have been started since the reaction. \nMrs. Clelland was also urticarial patch tested and was ShowD to be allergic t0 peppermint, \n: menthol and benzoates which she tries her best to avoid. \nShe tells me that when she touches fresh \nmint in the garden she gets an itch but not the same type of reaction. \nOn examination there were a few erythematdus papules on her left elbow and she had 2 cold sore \nat the corner of the left side of her mouth. \n1 can see her if the rash recurs. \nI have given Mrs Clelland an open apP ointment SO that \n1 have also given her Aciclovir 10 treat the cold sore and to see if \nwe can possibly prevent the reaction from happening although I do think this may be unlikely- \nYours sincerely \nHEATHER GRAHAM \nAssociate 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