Developed Elevated Papules On Bilateral Lower Extremities. Using Hydrocortisone Cream. Suggestion

Posted on Mon, 6 May 2013

Question: My brother in law has developed elevated papules on his billateral lower extremities. They are flesh tones, and itch. He scratches at them until they bleed. He is putting hydrocortisone cream on them, but it doesn't help. These nodules will fall off and regrow. They are solid, not fluid filled. Circulation is intact but he has decreased tactile sensation ( but he can feel that they itch). He has +2-+3 pitting edema and can't walk 10 steps without getting sob. Suggestions?

Answered by Dr. Sudarshan (3 hours later)

Hi XXXXXXX

Thanks for writing in.

The condition can be insect bite,prurigo,lichen amyloidosis,venous prominences etc.

I would also know-

Does it increase in size/number?Any such lesions over arms?

Is there reduction in size on pressure over it?Does it blanch?
Since when he has this?
Is he on any medication?
Are the lesions persistent?

Can you upload images of the area?
Photos can help a lot in predicting the condition.
Upload the photos and answer the questions and we can continue the discussion here.
Till the time he can take tab Zyrtec twice daily for few days continue hydrocortisone cream for application.
Hope this helps.

I will be available for follow up.

Regards.
Dr. Sudarshan
MD
Dermatologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudarshan (1 hour later)

I'm not sure how to post a pic. He's had these for abt 3-6 mo. He isn't on any other medications besides the hydrocortisone cream. He has no papules on his arms. They are flesh colored, so I don't believe they blanch. When they fall off, they leave an indentation that is a light pink in color. Almost looks like the color of a mostly healed scar. The nodules on the edematous leg grow in a patch of dry skin. They itch really bad, and XXXXXXX scratches them until he bleeds. They are more prominent to posterior leg then anterior. These nodules r hard to the touch and fall off leaving indentations that don't bleed.

Answered by Dr. Sudarshan (23 hours later)

Hi again XXXXXXX
Photos can be uploaded by using UPLOAD YOUR REPORTS section on right side of this box.
From the description provided by you it can be lichen amyloidosis or prurigo nodularis.
These can be treated by oral +topical potent steroids, intralesional steroids,oral immunosuppresant s.Few procedures like dermabrasion /phenol application can be helpful.

Upload the images and we can narrow down the possibilities.

Awaiting your response.
DrSudarshan
MD
Dermatology

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar