Hyperkeratosis, Parakeratosis Needed help and suggestion

[bmac1610]

Hi

My father is having a skin problem from last 2-3 years. The treatment he was taking in the starting was DCP pulse therapy, in the first month everything was normal but from next month after the DCP he got diarrhea, we thought it was due to food poisoning but next month after getting DCP few days later he got accute diarreha and need to be admitted in ICU and doctors said it's due to the DCP.

After that we consult to another Dermatologist and he start with new medication Betnosol Forte-1 mg and Azoran 50mg, Cifron OD 1g and the ointment Zincoderm-G in the starting but later changed to Topisal-3%, the skin shows improvement but some on the lesion are still visible. One month ago he used the Topisal ointment on a boil on his leg and it made a mess, he got a infection on that leg and a large blister with pus all around the lower leg and swelling, it looks like that leg got severe burn. We consult the doctor again and he prescribed with some antiboitics sefdin, metrogyl and vibact and flutibact ointment but now it's been one month but still their is some swelling and the some lesion are still their.
Now today we consult the Doc. again and he prescribed with Cifrom-D 1g and Topisal 3%, now i'm confused what to do because the problem still exist even after 2 year of continous treatment and he put a lot of weight because of steriod like Betnosol Forte and DCP. Below is the Biopsy Report summary:

Skin Biopsy shows mild Hyperkeratosis, Parakeratosis with collection of plasma in stratum corneum. There is patchy hypogranulosis, irregular acnathosis, mild elongation of rete ridges, lymphctic exocytosis and spongisosis. Papillary and superficial dermis show proliferating capillaries with perivascular mononueclear cell infiltrate. Dermis also shows thick collagen bundels. Possibility of nodular prurigo canonot be ruled out in this biopsy.
This biopsy was done last year

Please suggest should i continue with the antiboitics now or switch back to the betnesol forte again and which ointment is better Topisal 3% or Flutibact?

[Bhupinder Kaur, MD]

Hello,
According to this biopsy report it can be due to nodular prurigo characterised by pruritic (itchy) nodules which usually appear on the arms or legs. Treatment includes steroids, vitamins, cryosurgery, thalidomide and UVB light. In the event that staphylococcus or other infection is present, antibiotics have proven effective. Your father needs to take the antibiotics but for the other treatment options you need to discuss them with his dermatologist.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[bmac1610]

Thanks for reply and suggestion Mr. Maatson.

[maatson]

'Hypertrophic lichen planus' is a likely diagnosis. External application of potent steroids, antibiotics,if there is associated infection  either externally or internally, foot elevation to combat edema, would be the treatment normally recommended.Systemic steroids are reserved for extensive lesions.
Do follow your Doc.