ASK THE DOC
Dr. R. Murlidhar, Consultant Dermatologist, Apollo Hospitals, Chennai, replies to this week’s queries.
I am a 76-year-old diabetic. I have been insulin-dependent for two years. I have dark odd-shaped patches on my thighs since January 2005. These are light in colour in the morning and become dark by night. I have light itching sometimes but no pain. A
light pricking sensation occurs while taking in the afternoon and again at night. I consulted a skin specialist. My case was diagnosed as L. Amylosel. I took L. Cetrizet and applied Lobate (S) ointment for a month and there was some relief. I stopped taking the medicines as advised by the Doctor. The pricking sensation has reappeared and the patches are still there. Is it a harmful disorder? T.M. Selvanarayan
Answer: I think you mean lichen amyloid, you probably got the spelling wrong. This condition does produce dark itchy patches. It can occur practically anywhere, but the legs and thighs are common sites. Friction worsens it, as the oute
r layers of skin, when damaged, contribute to the worsening of the pigment and itching. Do not scrub or scratch the patch. Drugs like cetrizine, which are antihistamines, help by reducing the itching and therefore the progress of the disease. I would advise emollients or moisturisers and sparing use of steroids. You can use the steroid you have been prescribed, but sparingly, may be on alternate days. The condition is harmless and has not been linked to any internal problem. If there is a doubt about the diagnosis, get a biopsy done.
I have been suffering from psoriasis of both legs for four years. It started with two small patches on the lower legs and in the beginning was cured with gentamycine. Subsequently it reappeared and was suppressed with Elicon cream used for four month
s but thereafter it continues to be a problem. I have tried several allopathic, homeopathic and ayurvedic remedies but to no avail. It is causing lot of inconvenience with peeling of epidermis, itching, swelling of ankles etc. Is a complete cure possible? D. Swain
Answer: Psoriasis is a common skin problem, caused by excessive multiplication of the outer layers of the skin thus producing thick patches. If the extent of involvement is less, it can be controlled with external medications, not ster
oids alone. Gentamycin is an antibiotic and as such may not help psoriasis. Depending on steroids alone is not safe as the disease tends to recur. There are other medicines like vitamin d3 analogues, dithranol and so on. Sometimes we use systemic drugs to give more long-lasting relief, especially if the disease is extensive or interferes with your quality of life. In many of these circumstances, we use drugs that target the immune cells, which actually attack the skin and produce the psoriatic patches. These medicines should be used under expert medical care and can work wonders in able hands. Of late we have lifestyle modifications to prevent relapse. The future is not so bleak.
I am 80. Three years ago I was affected by herpes. Since then I have had the problem of dry skin and dandruff on the left side of my head and body. I have used Candid TV shampoo for head and application of oil for the body. But the problem continues.
Is there a solution? Venkataswamy
Answer: You have raised a very important issue here. From your question, I assume that the herpes affected the left side of the body, especially the scalp. Herpes, i.e. herpes zoster, is a viral infection that affects a nerve root, whi
ch supplies one half of the body. Dandruff and dry skin are representative of a mild inflammation of the skin. The inflammation in dandruff — if it is indeed dandruff -— is stimulated by a fungus. So you should use a pure antifungal shampoo three days a week and a mild steroid shampoo once a week or so to keep the inflammation down. However, if it is psoriasis, which many people mistake for dandruff, see the answer above. On the scalp, psoriasis responds to a tar-based shampoo quite well. As for the dry skin, using an oil or a moisturiser regularly will certainly help you. If it does not, see a dermatologist for expert help.
I am 18 years. For three years I have been suffering from cracks on my tongue and lips. I was given some medication by a doctor but it did not help. Now the problem appears regularly due to which I am not able to eat well. What is this problem? Ganesh Kumar
Answer: Cracks on the tongue and lips can be quite painful. I think you should see a good dermatologist, as this complaint is not very common at your age. We could be dealing with a form of cheilitis here. You may require a biopsy of t
he lip to find out the cause of the inflammation and then you can be put on specific treatment. At present the details you give are too sketchy. Some patients develop cracks on the tongue due to a condition called geographic tongue, which is completely benign and requires no treatment, but this is not accompanied by cracks and inflammation on the lips. A biopsy is a simple test that gives us more information, so don’t panic at the use of the word.
I am 51. I have diabetes for three years but it is under control. My problem is thin patches appear on the skin often. Doctor prescribed Allday but this gives only temporary relief. Once I discontinue it, the problem recurs. Please suggest something
to relieve this. Prabhakar Rao
Answer: Allday is an antihistamine. It relieves itching when the cause is usually urticaria or hives. Though your description is inadequate, I wonder if that is what you have. Urticaria presents as reddish weals, which itch and disappe
ar soon, only to reappear elsewhere. Since you are diabetic, it is possible that you may have an infection, which is stimulating your system to produce urticaria. This is common but should not be assumed always. Having said this, there are other skin manifestations of diabetes, which need to be looked into. Talk to your diabetologist and a dermatologist. If it is urticaria, continuous antihistamine therapy may be needed, there may be no end point at this stage. Hence the need for a definitive diagnosis.
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