Dr. Priya B. T
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.
Answered by
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Patient's Query
Hello doctor,
My mother is Parkinson's patient with gait problems and cannot walk. She is having skin itching with wound on both sides of inner thighs and chest area below the neck for the last one month. We give her 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 advise.
Hello,
Welcome to icliniq.com.
I went through the pictures (attachments removed to protect patient's identity).
It is looking like she is suffering from a rare disease called a bullous disorder, bullous pemphigoid which will be having blisters and ulcerations. It is an autoimmune disease. It needs steroid and immunosuppressive treatment. Is she diabetic? hypertensive? Lesions are infected too. It needs biopsy and DIF (direct immunofluorescence) to confirm. For her age and medical condition considering please start on tablet Defcort (Deflazocort) 6 mg twice a day for three weeks 1-0-1, Taxim O (Cefixime) 200 twice a day for seven days (few areas infected), Xyzal M (Levocetirizine + Montelukast) 1/2-0-1 for three weeks (for itching), Zensoft Max or Venusia max lotion morning on the spots, Momate F cream mix with Calosoft AF lotion in the night on the spots. Review after three weeks. Do all blood investigations, CBC (complete blood count), renal function test, and liver function tests.
Hope it helps.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
She is not diabetic or hypertensive. I will initiate the blood tests. When should we do a biopsy and DIF? Hope the suggested medicines go fine with the existing neuro drugs in the prescription annexed last. How does this medical condition happen? Any linkage to her neuro condition? Will this spread across the body? A year back she occasionally had an uncontrollable itching condition across her body only around midnight time, but no rashes or wounds.
Please help.
Hello,
Welcome back to icliniq.com.
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.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
On your advice, we started Predmet 8 mg. Eruptions and rashes come back at a few places from yesterday evening. We used Diprobate plus cream for two nights so far. Is her body reacting due to a shift from Defcort to Predmet? Also, we stopped Xyzal.
Please help.
Hello,
Welcome back to icliniq.com.
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. Most of the areas are healing. She should not scratch the area. Friction between the thighs will aggravate the problem. I suggest she take a tablet of Phexin (Cephalexin) 500 three times a day for five days, Xyzal M (Levocetirizine and Montelukast) half a tablet twice a day for one month, Predmet (Methylprednisolone) 8 mg twice a day for 10 days, capsule Omez (Omeprazole) 20 twice a day ten minutes before food to prevent gastritis. I also suggest her to apply moisturizer in the morning. After two weeks, change to Diprobate Plus.
Kindly consult a doctor, talk with them, and take medicines with their consent.
Hope it helps.
Thanks and regards.
Patient's Query
Hello doctor,
Thank you for replying.
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/eruption area, can we put T-Bact cream instead of moisturizing lotion?
Kindly advise.
Hello,
Welcome back to icliniq.com.
It is fine. I suggest you give her a tablet of Phexin for five days. Continue Pan 40 (Pantoprazole) and Mupirocin (antibiotic) ointment for one week and then apply moisturizer.
Kindly consult a specialist, talk with them, and take medications with their consent.
Hope it helps.
Thanks and regards.
Patient's Query
Hello doctor,
Thanks for your reply.
Hello,
Welcome back to icliniq.com.
I have a few questions.
1. How are the skin lesions?
2. Is there any itching?
3. Are there any new bulla coming up?
4. Is there any redness?
Kindly update us with your answers.
Thanks and regards.
Patient's Query
Hello doctor,
Thanks for your 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.
Please help.
Hello,
Welcome back to icliniq.com.
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.
Hope it helps.
Thank you.
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