{"text":"THE ALAN LYELL CENTRE FOR DERMATOLOGY \nStobhill Hospital \n133 Balornock Road \nGlasgow G21 3UW \nSecretaries: 0141201 3141 \nOutpatient Appointments: 0141 201 34593378 \n* \u2018 Fax: 0141201 3144 \nManagement Office - QueensPark House, Victoria Infimasy, \n- \/' 014] 201 5807, Fax: 0141201 5825 \nSouth - Professor Colin Munro, Dr David Bilsland, Dr Angela Drunmond; Dt Felicity Gamptell \nWest - Dr Robert Herd, Dx David Tillman, DrDavid Burden, Dr Paula Beattie, Dr Joyce Leman \nNorth Eagt - Dr Susan Holmes, Dr Colin Clark, Dr Catherine Jury \n- Dr Lisa Nay smith, Dr e ather Graham \nCLINIC: 0\/2008 \nDICT: 20\/ 1 0\/2008 \nTYPED: 23\/10\/2008 \nHG\/AMD \nDR. GRAHAM - TUESDAY MORNING \n. GENERAL DERMATOLOGY CLINIC \nDr Marjory Stephens \nKilsyth Health Centre . \nBurngreen Park, Kilsyth, Stirlingshire \nG65 OHU ' \nDear Dr Stephens \nAgnes Clelland - 08\/09\/1955 - CHI: 0809555328 - CRN: 10338654X \n39 Rennie Road, Kilsyth, Glasgow, G65 9PQ - \nDiagnosis: ) -Possible erythema multiforme \nManage ment: Aciclovir 20 mgs five per day for five days \nFollow-up: Open appointment \n\/ \nThank you for referring the above lady. She was reviewed originally by Dr. Kerr in 1999 with a \nvery atypical eruption. She was investigated extensively at that point including multiple biopsies \nwhich favoured a 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 to ignore them. This episode \nstarted in September and was a severe reaction. It tended to affect her trunk and buttocks to mid \nthigh and to just below the submammary region. She describes it as being bright red and itchy \nand it has resolved leaving some staining and some peeling. She did have a cold sore and she \nalso developed further cold sores currently. She has also had dental infections and at times has \nhad urinary infections. She is diabetic and currently on Ramipril, Fluoxetine, Metformin, \nSimvastatin and occasional Celebrex. All of these drugs have been started since the reaction. \nMrs. Clelland was also urticarial patch tested and was shown to be allergic to peppermint, \nmenthol and benzoates which she tries her best toavoid. She 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 erythematous papules on her left elbow and she had a cold sore \nat the corner of the left side of her mouth. I have given Mrs Clelland an open-appointment so that \nI cansee her if the rash recurs. I have also given her Aciclovir to 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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