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Hep C and skin disorder called T.M.E.P.?

Hi there. I got my skin biopsy results back today. The pathology report said that I have something called. T.M.E.P. which stands for Telengiectasia Macularis Eruptiva Perstans, what a mouthful! The dermatologist told me that what it's basically saying is that I have increased amount of mast cells in my skin biopsy. I asked her if the interferon could have caused this. She said that she had not heard of it, but that she'd not seen this disorder that often in her adult patients. She ordered further labwork to rule out a systemic cause. Supposedly, there's not a whole lot I can do about it other than treating the itchiness with antihistamines and something like Zantac. Depending on what comes up with my lab work will depend on whether or not she'd refer me to a hematologist. Anybody else familiar with this?

Susan
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408795 tn?1324935675
Interesting stuff on Pubmed, there have been quite a few studies on this subject.  I wonder if this response happens and possibly prevents a cytokine storm?  Just thinking out loud.  Terrible situation to run into, I hope you're doing alright.  What does it mean of future tx for you?  Oh maybe I should read prior posts on this thread.  good luck

Proinflammatory cytokine-induced cellular senescence of biliary epithelial cells is mediated via oxidative stress and activation of ATM pathway:
a culture study.
Sasaki M, Ikeda H, Sato Y, Nakanuma Y.

Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.

Cellular senescence is reportedly involved in cholangiopathy in primary biliary cirrhosis and oxidative stress is proposed as a pathogenetic factor in biliary epithelial cells (BECs). This study investigated the involvement of proinflammatory cytokines (IFN-beta, IFN-gamma and TNF-alpha) and ataxia telangiectasia-mutated (ATM)/p53/ p21(WAF1/Cip1) pathway with respect to oxidative stress in cellular senescence of BECs. H(2)O(2) treatment (oxidative stress) induced phosphorylation (activation) of ATM and p53 and also p21(WAF1/Cip1) expression in BECs. Treatment with inflammatory cytokines generated reactive oxygen species (ROS) in cultured BECs followed by activation of the ATM/p53/p21(WAF1/Cip1) pathway and the induction of cellular senescence. Pre-treatment with ATM inhibitor (2-aminopurine) and antioxidant (N-acetylcysteine) significantly blocked the cellular senescence of BECs induced by oxidative stress or inflammatory cytokines. In conclusion, proinflammatory cytokines induce ROS generation and activate the ATM/p53/p21(WAF1/Cip1) pathway, followed by biliary epithelial senescence. This senescent process may be involved in the development of destructive cholangiopathy in humans.

PMID: 18608517 [PubMed - indexed for MEDLINE
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Avatar universal
I was also diagnosed with TMEP in 08. All over the inside of my arms, on the tops of the legs only ..and not much elsewhere. I itch occasionally but before, I started itching on my arms and legs and a rash broke out so bad with little bumps and I couldn't stop scratching. I was miserable. I take antihistamines only! The itching only occurs here and there anymore. I think it depends on what I eat. So careful what ya eat... no tomatoes, no aspirin, or codine pills at all!!!! Hope this helps...Oh and DO NOT get in hot bathes...take warm showers. mild temp. Avoid the direct sunlight for any amount of time and cold cold weather, all the above made me itch sooo bad. God Bless
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Avatar universal
I have granuloma annulare, white blood cells pooling to the surface of the skin, red pooling blotches mostly.  Some look like measles on my back and other parts of my body. I am absolutely covered with this mass of red , all under the skin.  It too in the past has been terribly prickly/itchy. Dr prescribed 2 things:  1.  Hydroxyzine hcl 10 mg up to 3 every night before bed.  Also a mild sleep aid.  I got so bad for awhile that I couldn't wait to get home from work to start popping pills so I could get some relief.  I have switched my lotion/moisturing treatment from lavendar and olive oil to Eucherin Intensive Cream, I have not itched for several days now.  Could be from all of the prayers.  I firmly believe I am getting divine help with this issue by offering up my suffering for someone else that needs it most.  By the way, I am not in treatment yet, still waiting to hear if I have been selected to enter the clinicals in Seattle.  Good luck to your husband; I work with the public every day and this is terribly unslightly,but you have to adopt the attitude that there is nothing you can do about and be thankful  you have the strength to get up out of bed every morning and get to work.  God bless all!
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Avatar universal
Google T.M.E.P.  there is some information there.
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Avatar universal
hello....i have TMEP with Systemic Mastocytosis for several years now.....I feel bad for your husband because it is a true problem. I have to take many precautions/medications.  you might want to visit the Mast Cell Forum    http://mastcelldisorders.lefora.com/headlines/
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Avatar universal
My husband was diagnosed with TMEP last year.  He has it really bad on his chest, neck, shoulders and back.  It has gotten so bad that he hates to get dressed.  The dr prescribed doxepin 25 mg and 10 mg.  That seemed to help for awhile but it has gotten worse this week.  My husband has to wear 100% cotton, light color shirts and even that does not always help.  He did have a biopsy last year.  Any advice would be great.  It is starting to affect his way of living.  He avoids everything but 100% cotton.
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Avatar universal
I hope it gets better Susan.  I have had itching before with sun, but what was really weird to me was I began to have it, too, with exercising.  I'd take off walking fast or just working in the yard, and after about 15 / 20 min I'd be itching all over (especially upper thighs and my back - but everywhere, actually). If I got sweaty, the sides of my face would itch terribly.  It definitely kept me out of the sun this summer (the heat is the pits lately)  and it's also slowed me down in the yard some  (even in the cooler weather because the itching gets intense no matter if it's cool outside or not, everytime I do strenuous yard work.)  There was no rash, though.  Strange what this virus / or treatment can do, huh?  Best of luck!  Happy New Year :)  

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Avatar universal
Maybe you are just allergic to work :)
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Avatar universal
I tried to tell everyone that- that I was just allergic to work lol.  

I briefly googled mast cells after I read Susan's note and reflected on my own itching, and I read the first sentence of what mast cells do, and I said "that's it - close it - stop reading now, or you'll convince yourself within the next 10 minutes you have a goiter being invaded by mast cells.

I'm such a hypochondriac, but for reason! :)
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91778 tn?1252555170
Thanks for going into detail. I have noticed I have allergies now. And never had before. I guess it is a weak immune system. I wish you luck. God bless.... Debi
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Avatar universal
Hi Susan, oh no -- I didn't mean to say at all that I thought yours was from anything BUT the treatment, or (in my case) I was wondering if all my itching (when I exercise) was perhaps HepC related.  In no way do I think it's due to lack of exercise.  I knew mine was not due to soaps or change in detergent  (just wasn't that kind of itching), and mine wasn't due to lack of exercise, either.   After reading your note more carefully and saw you had this kind of itching and no rash, it was just interesting to me that I had this same thing going on at times.  When I googled mast cells and read something about anaphylactic reaction with the mast cells,  that's when I decided I didn't need to read anymore because... well - I tend to overly scare myself lately worrying or wondering about all these "things" popping up on me over the past few years, like this thyroid cr** and this kind of itching I never had before and the hypersensitivity to sun (I've been in the sun all my life,  but now I can't take it).  I've never been on treatment, either and so in my case I was wondering if mine could be related to just the Hep C or maybe my body's interferon.
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Avatar universal
Susan, I sure hope you don't think the comment I made was regarding your situation. I was "jokingly" asking chcnme if she was allergic to work because she only experiences this doing work or working out. In no way was I referring to your situation.
Happy New Year!
Imagine
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Avatar universal
I have just re-read your note again with even more interest because I see you have no rash with this.  And this condition is due to increased mast cells?  I wonder what causes that (the increased mast cells). WHen this started happening to me with the exercise, I felt like there was some kind of reaction occurring in me, like right under the skin -- like certain cells were rushing to the surface to .... do an "attack" to an allergen. lol.  (I know that's a crude description, but that is exactly what I wondered). Almsot like my body was responding to ... something foreign.  Now I'm wondering if I could have this TMEP.  (That is a mouth-full.)  Da** mast cells :)  I can't remember what function mast cells have.  hmmm.... very interesting.
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Avatar universal
The way I found out was that the dermatologist did a skin biopsy.  In my case, since my arms were itching the most, she chose the crook of my arm(elbow side) to do it.  My itching it mostly in the arms and legs and it drives me nuts when it occurs.  Anyway, it doesn't have a thing to do with lack of work.  I know, that 'lack of work' thing has to be a joke, right?  You don't get a change to a skin biopsy with increased mast cells, by a lack of work.  Nice try.  I could be a darn work-a-holic and still have this condition.  I'm thinking with all the interferon I've had, as well as this last go around I have double dose of the Ribavirin AND also was on the Procrit and Neupogen, that maybe this caused some changes in my chemical makeup.  I've been off of treatment for 6 mon., so this is a post treatment issue.  I did not have this prior to any treatments.  I've not had any changes to the type of soap or shampoo that I've used.  I asked the dermatologist if that was what could be causing this and she said absolutely not. She said that you can't get changes to a skin biopsy by your soaps anyway and she said that if I was having that sort of reaction that I'd have a rash and have the itching all over me and not just associated with the heat.

Susan
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Avatar universal
Htownwife:  I don't know if it's related at all to all that Riba I used to take, or not.  I've been off of treatment for 6 to 6-1/2 mon.  

Tulsatime:  I don't have any rash, just the itching.  It mostly occurs whenever I get hot for any reason.  Like: any exposure to the sun, showers, exercise, you know what I mean?  Drinking a hot beverage sometimes makes me have it, too.  I notice it most on my arms and legs, but sometimes it also itches on my back or face.  I totally didn't think that ANYTHING would come back on this skin biopsy.  In fact, I was 99.9% sure when I went in there today, that she was going to tell me that it was negative.  Anyway, the first thing is to see if this Allegra and Zantac combination help it any and then, to see if the labwork gives her any clues.  I think this surprised her, too and she had to do some research on this pathology finding because she said she wasn't all that familiar with it.  I mean, 'leave it to me' to get something odd ball.  Can't be the regular easy to treat stuff...

Susan
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91778 tn?1252555170
Hi susan, were is your rash? I have a little one on my face and my doctor gave me some rosacea cream, it didn't get better. And it itches too. Let us know what you find out cause I do not have a clue what mine is and it is driving me nuts. My dr is on leave till feb so I won't see her till then. hope you get some relief, take care, Debi
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161341 tn?1189755824
I've never heard of it. My husband has a rash and periodic itchiness, but we assumed it was from the Riba. Is your rash worse than the "normal" Riba rash?
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Avatar universal
I have never heard of it either. At least you found out about it.  Now you will be the educator here.  Gosh you sure have been through the ringer.0.
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