This is regarding my cousin, who is 28 years old and has itching on the back of the hands and also on the face. She often has small water-filled pimples for one year, which burst out and are painless (flaccid and tense). There is no involvement of lips, inside the mouth, or any other part. Doctor did a few costly tests. I have attached the reports, along with the photo of pimples after bursting out. Rest everything is normal with her, normal motion, no fever, and no other disease. It is not related to any particular diet or season as well. Kindly tell us what this disease is and what the treatment is. Please help us doctor, and please answer the question in a single attempt as I cannot afford to pay once again.
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It is pemphigus foliaceus.
In the attached picture (attachments removed to protect the patient's identity), crusted papules and plaques with occasional flaccid bullae are seen.
Any mucosal involvement?
Any systemic disorder?
Any dermatological disorder in the past or previous doctor's diagnosis?
Excessive use of sanitizer?
Contact with irritant?
Any chemical contact?
Tzank smear is needed to rule out the possible diagnosis as there are many variants like herpetiformis, erythematous, endemic pemphigus.
Pemphigus foliaceous is usually a benign disease of long duration.
Local skincare of the lesions is of utmost importance.
Bland emollients like Emoderm or Moisturex soft cream thrice daily for 15 days can be used.
Hand hygiene plays a very important role. Mild soap water to clean hands will suffice.
FM Derma cream (Fluticasone Propionate and Mupirocin) plus mild steroid (Mometasone) at night for ten days.
Maintain proper skin hydration.
Clean the area with povidone-iodine before application of ointment/cream with clean hands.
Keep a proper check on blood sugar levels.
Evaluation of reports needs to be done.
Avoid scratching or rubbing lesions so that there is no secondary bacterial infection.
Maintain proper electrolyte balance.
Not to worry much as it is localized non-life-threatening pemphigus foliaceus, it will heal in 4 to 5 weeks.
Follow-up after five weeks.
Any history of trauma?
Any history of atopy or allergies?
Any drug history or drug allergies?
Thank you for your response. Let me answer all your questions.
There is no mucosal involvement.
No systemic disorder.
No exposure to sanitizer or chemical or irritant (except mild detergent).
No history of trauma or allergies.
The previous doctor got a few costly investigations done like:
Transglutaminase antibody TTG IgA 1.32 (< 20 negatives).
Desmoglein 1 antibody 2.20 (< 20 negative)
Desmoglein 3 antibody 3 ( < 20 negative) CBC, RBS, RFT normal range.
I read on the internet that pemphigus foliaceous usually has Dsg1 positive (which is negative here). Just a brief description of the symptoms, she has small fluid blisters on the hands, legs, few areas on the face, which are very itchy, painless, flaccid, and then they burst out as the lesions shown in the pic. Her itching is not responding to Allegra 180 also. Does she even need other medicines like Dapsone, steroids, or Azathioprine, as I read on the internet?
Please guide us further as we are really worried about her. What do you think is the diagnosis?
Welcome back to icliniq.com.
It is contact irritant dermatitis.
Avoid excess use of detergents.
Use hand gloves or kitchen gloves while working in the kitchen.
Apply Fucidin (Fusidic acid) cream twice daily for two weeks.
Apply 1% Hydrocortisone cream at night for 15 days.
Tablet Roxid (Roxithromycin) 150 mg twice daily after food for five days.
Tablet Pan D (Pantoprazole and Domperidone) before food for five days.
Follow-up for any doubts.
Any history of fever?
Are you diabetic?
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