Dr. Dhepe Snehal Madhav
Venereology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have had severe dermatitis for more than two years, and my dermatologist is unsure of the diagnosis as all my blood work was normal. I suffer from Hashimoto's thyroiditis for more than 30 years, and I take Tirosint for it. I tried many steroid creams for my skin condition, but nothing helped, and they seem to worsen my skin condition. I took Ilumy for two months and then took Skyrizi for four weeks, but nothing helped. I was tested negative for ANA and lupus as well. I attached pictures of it. Kindly give your opinion.
Hi,
Welcome to icliniq.com.
I saw the pictures (attachments removed to protect the patient’s identity). It is an atopic rash with a fungal infection. I suggest you take tablet Teczine M (Levocetirizine and Montelukast) once at night after dinner for ten days and tablet Loratadine 10 mg once at daytime after breakfast for ten days. Apply Miconazole ointment twice daily in the morning and night for three weeks. Kindly answer the following to help you better. Do you have a fever? Are you allergic to any drug? Do you have an itching or burning sensation? Are you diabetic? Do you have a history of atopy? Had any fungal infections before? Have you notices any aggravating factors? Answer the questions to rule out possible causes. Regards.
Patient's Query
Hi doctor,
Thank you very much for your quick reply. I do not have a fever. I am not diabetic and have no history of drug allergies. On and off itching is present for the whole day, and it is very intense with burning and irritation. And I do not have any excess sweating. Friction seems to bother it in certain areas. I have a history of atopic dermatitis. The only aggravating factor is steroid cream. Do you think this could be atopic dermatitis without the fungal aspect? Would something like Dupixent work? Thanks.
Hello,
Welcome back to icliniq.com.
Yes, it is an atopic rash with fungal infection with high margins. Avoid triggers like spicy food, heat, sweating, sun exposure, prolonged shower, hot shower bath, harsh soaps, and scratching or rubbing the lesions. I would recommend using a monoclonal antibody as it is a good option for allergic reactions and urticarial rash. Take care.
Patient's Query
Hi doctor,
Thanks for the reply. High humidity helps temporarily. I did not notice any food allergies and no animals in my house. I am off gluten, dairy, and nuts. I cannot have jewelry, and also some clothes bother me. What do you recommend for treatment? Do you think the antifungal regimen would cure atopic dermatitis, or do you think treatment for both atopic dermatitis and fungal is necessary? Thanks.
Hello,
Welcome back to icliniq.com.
Kindly avoid foods like chicken, mutton, fish, prawns, cheese, paneer, egg, milk, carrot, beetroot, potato, sweet potato, groundwater, chocolate, sauce, pickles, drumsticks, etc. Try to identify the trigger and avoid it. Avoid triggers like woolen and synthetic clothes. Use mild soap or liquid cleansers like Cetaphil cleanser (water, Cetyl Alcohol, Propylene Glycol, Sodium lauryl sulfate, Stearyl Alcohol, Methylparaben, Propylparaben, Butylparaben), avoid conditions that cause sweating. I suggest you use Mometasone cream twice daily. If there is no response to steroid, then start with the following; Topical Tacrolimus ointment at night for three weeks, Teczine M (Levocetirizine and Montelukast) once daily at night for ten days, tablet Lorinol 10 mg (Loratadine) once daily for ten days after breakfast, and apply Acrofy moisturizer (Coleus oil) after bath for ten days. If no response is seen after this, you can think of a monoclonal antibody. Regards.
Patient's Query
Hi doctor,
Thank you for your reply. I have photosensitivity, dry skin, and burning on exposure to the sun as well. My IgE levels were never tested. The only thing that I do not avoid on that list is chicken and sweet potatoes. Mometasone seems to help in some areas, but not all areas. Do you think that the biological injections (monoclonal antibody) given for psoriasis can worsen my condition? Thanks.
Hi,
Welcome back to icliniq.com.
A monoclonal antibody is also the treatment of choice in allergic cases and atopic dermatosis. Avoid direct sun exposure and use sun protection measures like wearing long sleeves, cotton clothes, use an umbrella while in the sun, wearing a sun coat and sunscreen, have broad-brimmed hats, and wearing sunglasses. Kindly apply Photostable sunscreen (Ethylhexyl Methoxycinnamate, Methylene Bis-Benzotriazolyl, Tetramethylbutylphenol, Ethylhexyl Triazone, Bis-Ethylhexyloxyphenol, Methoxyphenyl Triazine, Diethylamino hydroxy benzoyl, Hexyl Benzoate) thrice daily for two months and apply even when indoors. Cetaphil Moisturizing lotion after a bath can be used in dry areas. Regards.
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