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PHOTOS UPLOADED: BACK, RIGHT SHOULDER, ABDOMEN, RIGHT FLANK: MEDICAL ISSUE:
Question: PHOTOS UPLOADED: BACK, RIGHT SHOULDER, ABDOMEN, RIGHT FLANK:
MEDICAL ISSUE: SKIN LESIONS (Flat, red, smaller than 1/8 inch, no itching, no pain, no oozing, no bleeding)
RULE OUT POSSIBLE LIVER DISEASE INCLUDING CIRRHOSIS (COMPENSATED OR DECOMPENSATED)
FEMALE/87 YR. OLD W. MILD DEMENTIA & COGNITIVE DECLINE/MEDICATIONS TAKING: SYNTHROID 5 mg daily
MEDICAL QUESTION: Looking at provided photos, could these be cutaneous skin lesions due to liver disease? She has other symptoms: protruding belly/abdomen but rest of body is extremely thin, muscle wasting, no appetite. No imaging tests have been done yet. Last blood test cannot be accessed at this time.
MEDICAL ISSUE: SKIN LESIONS (Flat, red, smaller than 1/8 inch, no itching, no pain, no oozing, no bleeding)
RULE OUT POSSIBLE LIVER DISEASE INCLUDING CIRRHOSIS (COMPENSATED OR DECOMPENSATED)
FEMALE/87 YR. OLD W. MILD DEMENTIA & COGNITIVE DECLINE/MEDICATIONS TAKING: SYNTHROID 5 mg daily
MEDICAL QUESTION: Looking at provided photos, could these be cutaneous skin lesions due to liver disease? She has other symptoms: protruding belly/abdomen but rest of body is extremely thin, muscle wasting, no appetite. No imaging tests have been done yet. Last blood test cannot be accessed at this time.
Patient has a history of alcohol consumption for last 10 years/daily/approx. 8 ounces strictly & only with dinner. No social drinking. No private binge drinking no drunkness, etc.
Brief Answer:
Regarding skin lesions
Detailed Answer:
Hello and welcome to ask a doctor service. I have gone through your query and viewed the image.
I can see spots with most of them having excoriations and others which are post inflammatory hyperpigmentation from previously healed/ healing spots. For a liver pathology to induce such lesions they need to be itchy which would explain excoriations but as you said they are NOT itchy so it is unlikely that underlying liver disease is a cause for them. They are most likely neurotic excoriations due to irresistible urge or compulsive picking at the skin. Do you ever see her picking at the skin?or fiddling with her skin?or does she ever complain of crawling or weird sensation in skin?
Hope I have answered your query. Let me know if you need any more assistance
Regarding skin lesions
Detailed Answer:
Hello and welcome to ask a doctor service. I have gone through your query and viewed the image.
I can see spots with most of them having excoriations and others which are post inflammatory hyperpigmentation from previously healed/ healing spots. For a liver pathology to induce such lesions they need to be itchy which would explain excoriations but as you said they are NOT itchy so it is unlikely that underlying liver disease is a cause for them. They are most likely neurotic excoriations due to irresistible urge or compulsive picking at the skin. Do you ever see her picking at the skin?or fiddling with her skin?or does she ever complain of crawling or weird sensation in skin?
Hope I have answered your query. Let me know if you need any more assistance
Above answer was peer-reviewed by :
Dr. Raju A.T
QUESTION #1: Is it possible that there might be enough brain dysfunction due to cognitive decline & dementia (possibly Alzheimers) for patient to not notice various sensory input like itching? Patient is constantly supervised 24/7 by another adult & has never been seen itching or picking any skin whatsoever. QUESTION #2: In addition, the lesions are also on her back in areas that cannot be reached by her own hands so can psychiatric neurotic/repeated picking be ruled out? Short & Long Term memory are also severely affected, executive functioning is minimal & getting worse; motor skills are still good.
Brief Answer:
Lymphomatoid papulosis or Pityriasis lichenoides chronica are possibilities
Detailed Answer:
Hi.
I don't think that dementia or cognitive decline would make any difference to the itch perception if the person is conscious and oriented. Considering that she has these lesions on inaccessible sites as well I would like to consider other possibilities of lymphomatoid papulosis and pityriasis lichenoides chronica (PLC). I would suggest a skin biopsy from one of these lesions in view of the above possibilities. Kindly contact a physician in your region for the needful.
Take care.
Lymphomatoid papulosis or Pityriasis lichenoides chronica are possibilities
Detailed Answer:
Hi.
I don't think that dementia or cognitive decline would make any difference to the itch perception if the person is conscious and oriented. Considering that she has these lesions on inaccessible sites as well I would like to consider other possibilities of lymphomatoid papulosis and pityriasis lichenoides chronica (PLC). I would suggest a skin biopsy from one of these lesions in view of the above possibilities. Kindly contact a physician in your region for the needful.
Take care.
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. Prasad
Answered by
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