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How to manage itchy skin in a Parkinson's patient?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

My mother is a Parkinson's patient with gait problems and cannot walk. She has been having skin itching with wounds on both sides of the inner thighs and chest area below the neck for the last month. We give her an Atarax tablet and use T-Bact on the wound and Ritch lotion on the surrounding skin. The wound heals but comes back during sporadic bouts of uncontrollable itching. There are also boil-like eruptions around the wound. I will upload photos and prescriptions.

Kindly help.

Answered by Dr. Priya B. T

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I went through the pictures (attachments removed to protect the patient's identity).

It looks like she is suffering from a rare disease called a bullous disorder, bullous pemphigoid which will cause blisters and ulcerations. It is an autoimmune disease. It needs steroid and immunosuppressive treatment. Is she diabetic? hypertensive? Lesions are infected too.

I suggest you to do the following tests:

  1. Biopsy.

  2. DIF (direct immunofluorescence).

  3. Complete blood count (CBC).

  4. Renal function test.

  5. Liver function tests.

    These tests help to confirm the diagnosis.

    I advise you to do the following:

    1. Tablet Defcort (Deflazocort) (Corticosteroid) 6 mg twice a day for three weeks.

    2. Taxim O (Cefixime) (antibiotic) 200 twice a day for seven days.

    3. Xyzal M (antiallergic) (Levocetirizine + Montelukast) to be given. Half a tablet in the morning and one tablet in the night for three weeks (for itching).

    4. Zensoft Maxx (moisturizing lotion) or Venusia Max (moisturizing lotion) lotion morning on the spots,

    5. Momate F cream (Mometasone and Fusidic acid) mixed with Calosoft AF (antipruritic, and antiseptic) (Aloe vera gel) lotion in the night on the spots.

      Review after three weeks.

      I hope this helps.

      Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

There have been no itching or eruptions for the past 10 days or so. The wound has fully dried. Kindly advise if medicines can be stopped now.

Kindly help.

Answered by Dr. Priya B. T

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

At this present condition, very few places will be doing the biopsy. This condition is associated with intractable itching. After doing the biopsy, please send me the reports.

I hope this helps.

Thank you and take care.

Regards.

Patient's Query

Hello doctor,

Thank you for the reply.

On your advice, we started Predmet (Methylprednisolone) (corticosteroid) 8 mg. Eruptions and rashes come back at a few places from yesterday evening. We used Diprobate plus cream (Corticosteroids and minerals) for two nights so far. Is her body reacting due to a shift from Defcort to Predmet? Also, we stopped Xyzal.

Kindly help.

Answered by Dr. Priya B. T

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

From the pictures, I see the skin lesions are infected (attachments removed to protect the patient's identity). And the bulla is due to the disease process flaring up. This needs a better steroid than Deflart (Glucocorticoid). Most of the areas are healing. She should not scratch the area. Friction between the thighs will aggravate the problem.

I advise her to take the following:

  1. Tablet of Phexin (Cephalexin) (Cephalosporin antibiotic) 500 thrice a day for five days.

  2. Xyzal M (Levocetirizine and Montelukast) half a tablet twice a day for one month.

  3. Predmet (Methylprednisolone) (Glucocorticoid) 8 mg twice a day for 10 days,

  4. Capsule Omez (Omeprazole) 20 mg twice a day, ten minutes before food to prevent gastritis.

  5. Apply moisturizer in the morning. After two weeks, change to Diprobate Plus (Steroid).

Kindly consult a doctor, talk with them, and take medicines with their consent.

I hope this helps.

Thank you and take care.

Patient's Query

Hello doctor,

Thank you for the reply.

I am wondering if it is fine to take an antibiotic tablet again since we took it early this month for a week. She already takes Pan 40 (Pantoprazole) on your last advice. Her legs are generally apart due to immobility, hence no problem. During the morning time, on the rash or eruption area, can we put T-Bact cream instead of moisturizing lotion?

Kindly help.

Answered by Dr. Priya B. T

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I suggest you give her a tablet of Phexin (Cephalosporin antibiotic) for five days. Continue Pan 40 (Pantoprazole) (proton pump inhibitor) and Mupirocin (antibiotic) ointment for one week and then apply moisturizer.

Kindly consult a specialist, talk with them, and take medications with their consent.

I hope this helps.

Thank you and take care.

Regards.

Patient's Query

Hello doctor,

Thank you for the reply.

Answered by Dr. Priya B. T

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I have a few questions. Please provide information.

  1. How are the skin lesions?

  2. Is there any itching?

  3. Are there any new bullae coming up?

  4. Is there any redness?

Kindly update us with your answers.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you for the reply.

There have been no itching or eruptions for the past 10 days or so. The wound has fully dried. Kindly advise if medicines can be stopped now.

Kindly help.

Answered by Dr. Priya B. T

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I suggest you do not stop steroids suddenly. Please take the medications as suggested earlier.

Kindly consult a specialist, talk with them, and take medications with their consent.

I hope this helps.

Thank you and take care.

Regards.

Answered byDr. Priya B. T

Medically reviewed byDr. Vinodhini J.

Published At July 3, 2020
Reviewed AtFebruary 10, 2025

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Priya B. T
Dr. Priya B. T

Dermatology

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