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.
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.
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
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.
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 - 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.
PA - Today's status.
Latest Blood reports
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 - 👍
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