One of the very few things I trust in my country is Medicine. When it boils down to simple things, such as subacute spongiotic dermatitis/psoriasiform eczema, it really seems that the world is conspiring against the proper diagnosis. HX - female, 53 yr old, hard smoker, no alcohol or drug abuse. Profession translator, hence sedentary and past overweight. Early March - started diet w/ endocrinologist (Fluoxetine/Sibutramine/Alprazolam). After ten days had ocular discomfort and headaches and stopped (medic) on my own. Two or three days thereafter noticed a flare of plaque, pruritic and scaly lesions on elbows. Dermatologist 1, at the endocrinologist's clinic said it was psoriasis, but only through biopsy could it be ascertained 100%. Dermatologist 2 (my own), a Uni professor/chair holder, after a scraping, said it would be a psoriasiform lesion, but not psoriasis. Attempted to moisten skin (neutral soap/hydroxyurea cream). After one month, lesions on elbows had resolved, but barely could celebrate and they had spread to the entire body - back and lower back, above pubic bone, internal thighs, and only one front tibial surface (had a rupture of the ACL/meniscus early March - same leg), neck, face (eyelids mainly) and back of knees. On the return to my dermatologist, he prescribed Doxepin, which I did not take when I found out that it was an antidepressive drug (was afraid of another drug reaction - my association). Late June, when I returned to the endocrinologist, he requested a series of blood tests, all of which were in the normal range. He referred me to a general practitioner for further investigation of the skin lesions + smoking cessation program. General practitioner said that he would not do anything before having the opinion of a dermatologist he trusted. Dermatologist 3: said it was not psoriasis at all, but probably allergic dermatitis. Prescribed change of soap, Fisiogel (Stiefel - hypoallergenic lotion for the cutaneous barrier), Hixizine (hydroxyzine 2 x 25mg/day) and Topison (mometasone furoate - Libbs) for topical use on the lesions 2x day on the body and 1x day on the face. First day OK, second day I woke up in the middle of the night with something I reckon could be the so called Bell's palsy - burning and stinging sensation on the left cheek and nose, with uncontrollable lacrimation from the left eye. Could neither feel nor move the mouth or nose. This sensation was gone after five minutes (I imagine, as I panicked, but kept trying to move the mouth). I tried to find the directions for use of Topison, just to discover, to my perplexity, that its adverse reactions include paresthesia (very infrequent), cutaneous atrophy, contact dermatitis (infrequent), etc. This dermatitis has been going on for four months now and the lesions are not resolving (although there seems to be some central clearing in the oldest ones, they seem to wax and wane). My skin around the eyes feels like paper. Pruritus before Hixidine was unbearable, but now is better. I have reduced 25 pounds of my weight since then. I asked a friend who is a plastic surgeon to have it biopsed (nobody asked for a biopsy). This was done mid June and the result was subacute spongiotic eczema / psoriasiform dermatitis. My questions: 1) Is it normal that a dermatitis (contact, allergic, atopic or whatever) will take so long to be controlled? 2) How can I be sure that it is not early stage mycosis fungoides, only through additional biopsies? 3) Let us suppose that it is really a effect of stress (as seems to be consensus among the doctors I've seen), how long will it take for resolution of the lesions, as the stressful events (ACL rupture) and others are now long gone? Sorry for the lengthy e-mail.
Skin conditions like Eczema/Psoriasis are extremely difficult to trret, mainly because the exact cause is not known.
Also they have periods of remission when the skin will be totally normal and then there are flare-ups which have some trigger factors like stree and hormonal changes etc. which trigger off the lesions again.
Treatment is usually Corticosteroid ointments which help in reducing the inflammation but does nothing to cure it.
For psoriasis medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques. Ointment and creams containing coal tar, dithranol (anthralin), corticosteroids like desoximetasone (Topicort), vitamin D3 analogues (for example, calcipotriol), and retinoids are routinely used. Argan oil has also been used with some promising results.
Hi, Dr Aparna
Thank you so much for having taken the time to read that huge post. I feel reassured to hear an outsider (re the specific medical community of my region) opinion, the more so because it confirms that I am not being underdiagnosed and/or undertreated.
Once again, thank you for your time.
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