Dr. Dilip Kumar Meena
Dermatology
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
Hello doctor,
My grandfather is 74 years old, 5' 8" feet tall, and weighs 149 pounds. He developed deep cracks and dry skin on his feet eight months back. He initially had small cracks, which started spreading. We consulted a dermatologist, who said it was dry skin and asked to apply moisturizer, but it did not help and kept getting aggravated. Another dermatologist diagnosed it as a fungal infection and prescribed tablets, antifungals, and steroid creams. My grandfather is still using those creams, and the skin looks a little better now. He is unable to walk properly. He washes his feet properly after getting exposed to mud, which happens very often. He also goes swimming in non-chlorinated water every day, which he stopped a few months back due to this skin issue. I have attached the reports of blood tests done, prescribed medications, and photos. Apart from the topical creams, he is currently taking Tablet Metformin (which he started a month back), Tablet Ramitorva, Tablet Nebicard-SM (since 12 years after heart stent placement). He never had such skin problems previously. Please help.
Hello,
Welcome to icliniq.com.
I understand your concern. Looking at the photographs (attachments removed to protect the patient's identity), I suspect palmoplantar psoriasis (type of psoriasis that affects the palms and soles) or hyperkeratotic palmoplantar eczema (fissured lesions in the middle of both the palms), as both have a similar appearance to this. Both the conditions are difficult to differentiate even on clinical examination, sometimes. But both the states, if limited to palms and soles, require the same treatment. He needs medicines that can reduce the thickness of the plaques and aid in healing the fissures. Dryness due to too much exposure to water, soaps, and detergents can worsen the condition. It is best to use the following medicines for three weeks and follow up. Use Topisal-6% (Clobetasol and Salicylic acid) ointment. Use Moisturex (Urea, Lactic acid, Propylene glycol, and light liquid Paraffin) or Xerina (Glycolic acid, Urea, and Cetylated Fatty Ester complex) cream or U lac (Urea and Lactic acid) cream. At the time of application, mix both (two parts of Topisal-6 % and one part Moisturex or Xerina or U lac cream) and apply twice a day. Also, Moisturex should be applied without adding Topisal-6 % two to three times, besides morning and evening. Take Tablet Fexofenadine hydrochloride 180 mg once a day for three weeks. Review after three weeks.
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Dermatology
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