62M Diabetes 2011,Dermopathy 2018 WB PaJR.

27-09-2024

This is an online E Log book to discuss our patient's de-identified health data shared after taking his signed informed consent. Here we discuss our patient's problems through series of inputs from available global online community experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. 

The patient is a 62yr old male who is a diabetic since 2011 and is suffering with the skin problem  since 2018. According to the patient  Initially the skin rashes appeared in the form of small blisters found on both leg shins, stomach, chest, on both hands and shoulders. The patient felt itching and when scratched blood oozed and black spots were left after drying.  He was advised allopathy treatment but had no relief.  Later the buttocks and groin area was also badly affected and had relief with an allopathy  ointment.  He suffered itching in scrotal sac skin also and with Homeopathy and Ayurvedic  medication  he found relief.  The old spots are causing severe itching.

The patient is under the treatment with the below prescribed medicines. 

28-09-2024 

PA- Doctor,  the patient is having vigorous itching today with new rashes appearing on the skin. From 2018 to 2023 his sugar  levels are

Fasting  200+

PP 300+

Present  sugar levels

Fasting  91 to 149

PP  140 to 175.

PPM- Is the patient applying any moisturizer?

29-09-2024 

PA- The patient is applying  Kushta Rakshasa Tila (Ayurvedic oil) at night 10pm and allopathy  skin ointment  Belamethosone and Salicylic  acid after bath.

30-09-2024 

PPM- Please share the hourly activities of the patient for the whole day yesterday and please mention  at which hour did he feel the symptoms. 

PA-  The rashes appeared  in the early morning and the area became red with burning sensation. Still he is feeling the burning sensation. 

PA - The patient is suffering a lot with itching and no medicine is giving relief,  oral, ointment  or oils. Nothing.

01-10-2024 

PPM- What oral medication  is the patient taking? His sugars need to be checked  4 times daily. 

Fasting 

2 hr post breakfast 

2 hr post lunch 

2 hr post dinner. 

And if required the doses of his anti diabetic  medication needs to be adjusted as per the current results.  Please share the pics of the following. 

1. The current medicines  he is taking for 

    Diabetes.

2. For itching 

3. Any others.

05-10-2024

PA- Fasting sugar as on 04-10-2024 is 

78 mg/ dl. Patient is taking 15 unit insulin one  in the night. 

PPM- Below are the inputs from our dermatologist. 

Hello sir, In this new patient  I just saw the pics and in pics I don't see any blisters....

they appear to be hypertrophic I,  cherified papules.

My dd would be Prurigo Nodularis for him. Seeing these pics but not as per history. 

I would suggest he should be seen by local dermatologist  for correct  diagnosis.

Secondly allopathic  treatment given to him is mainly oral and topical antifungal, antihistamines  and steroids.

Why was he asked to apply steroid over face is not clear again.

4 mm Biopsy  from one of the lesions in arms can be taken to confirm the diagnosis.

Round the clock oral antihistamines should be given to relieve symptoms and good emollient  all over body(oil/cream) and over raised lesions of arms as they look(not blister) Combination of steroid with Salicylic  acid cream (momate s) can be applied twice a day. On legs and trunk I could only see hyperpigmentated macules.

24 -10-2024

PA -  The patient is continuing with Homeopathy and Ayurvedic medication. 

Present situation is that the old spots on stomach, legs and shoulders are becoming active again and  on itching

blood is oozing out. No permanent solution received till date. Request for suggestions.

Skin Biopsy report.

PA - Itching still persists. How to remove the spots? Please help.

PA - Continuing the above medicines. 

PPM 2 - Can you please share your Ayurvedic and Homeopathy medicines photos here?

Homeopathic Medicines 

Ayurvedic Medicines. 

PPM 1 - @ PPM 3 The diagnosis that you made clinically is also supported by pathology. 👏👏.

What would you suggest as further line of management. 

25-10-2024

PPM 3 - He must keep his body well moisturised at all times  with either coconut oil or good moisturizer  that will reduce  his itching to an extent.

Use mild soap (Dove) to wash. Momate S cream to be applied  only over the papules/raised lesions,  twice a day, rub well.

Still if he feels itchy Tab.Xyzal 5mg (Levocetrizine) Once or twice a day depending upon symptoms. 

Since he is taking cocktail of all medications ( allopathic,  homeopathic  and ayurvedic) it's  difficult to assess if there is any drug interaction.  

The more he will itching the more it will increase.

PPM 1 - Thanks. 🙏

PPM 2 - Sir please need not say thanks  

🙏🙏.

PA - Most affected part as on date

PA - No medicine is working.  Please provide prescription as per your analysis.

PA - Small mastered like seed alongwith skin comes out from  the eruptions.  On enlarging the photo you can find the wound on shoulder. 

PPM 1 - PPM 3 has shared her suggestions above. Prescription can only be given by your local Doctor, once you share the above suggestions with your local Doctor. 

28-10-2024

PA - After using Momate ointment small rashes erupted and itching.

29-10-2024

PA - Today's  status.

Latest Blood reports 

30-10-2024

PPM 1 - Thanks for the high resolution images that offers a better view of the skin lesions. @PPM2 Do these postular (inflammatory) vesicles look umblicated?

PP 2 - Sir it's folliculitis....

Someone needs to explain the patient how to apply  medicine properly. 

As of now half mamoteasone, check blood sugar, use topical antibiotic  and if required  oral I care folliculitis lesions  are widespread.

PPM 1 - 👍