Suggest Treatment For Bumps And Scars On Upper Arm

Brief Answer:
Flat hyperpigmented and depigmented scars; hypertrophic scars.

Detailed Answer:
Hello. Thank you for writing to us

I have taken note of your query and I have also reviewed the Images.

There are flat hyperpigmented and depigmented scars on posterior aspect of upper arm.
In addition I can also see there are a few pinkish red, raised bumps on outer, upper arm which are probably hypertrophic scars.
Both of these could be a sequelae of previously healed severe acne Or they could be a sequelae of Prurigo.

Where else do you have them? Do you have any symptoms like itching?

Regards

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Brief Answer:
Neurotic Excoriations; Selective Serotonin reuptake inhibitors

Detailed Answer:
Hi. Thank you.

I have reviewed your other discussions with different doctors on healthcareMagic and I have to say that you have got quite a few but different possibilities like dermatitis herpetiformis and bacterial infection etc etc.

I have also reviewed the Images and I can see there are a lot of excoriated/ ulcerated lesions distributed widely on skin. There are also depressed atrophic scars from previously healed lesions.

Because that there is no associated itching and therefore there is no reason to scratch at your skin hence I rule out dermatitis herpetiformis (DH) as a possibility because DH is a severely itchy condition. I also rule out bacterial infection as this seems a chronic problem with your skin (new lesions as well as scaring from previously healed lesions) and does'nt seem like a simple bacterial infection.

I will keep a different possibility i.e of compulsive skin picking Or Neurotic excoriations considering that you have a history of anxiety neurosis and panic attacks. Your skin problem seems very much related to psychiatric symptoms.

Because you are aware that you have these underlying neuropsychiatric problems of anxiety neurosis therefore it is easier to manage this condition in your case.

In my view you should be started to once of the selective serotonin reuptake inhibitors (SSRIs) e.g fluoxetine, sertraline, fluvoxamine etc

Topically you may use an antibacterial ointment for open lesions just as a measure to prevent secondary bacterial infection. Nothing else.

Steroid creams won't help either since this is not primarily a skin problem rather it is a psychiatric problem and seems skin is just an Innocent bystander.

Regards

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Brief Answer:
Paroxetine(paxil)can be scheduled for day; Fluoxetine is better alternative

Detailed Answer:
Hi.

I can understand that your job as a nurse is demanding and requires you to be awake and alert at night.
Paroxetine (paxil) has a side effect of drowsiness. This drug can be scheduled for daytime after you finish your night duty. However, if sedation is still bothersome and interferes with your work you can be shifted to a different Selective Serotonin Reuptake Inhibitor i.e fluoxetine (prozac), which would suit you better.
Other options like tricyclic antidepressants e.g amytriptyline can also be considered for your condition. Though sedation can be a problem with these but scheduling the drug for daytime in case you have night duties can achieve the desired results without inerfering with your duties.
I suggest that you talk to your doctor regarding the same.
I would also suggest you to use a topical antibiotic e.g 2% mupirocin ointment, twice daily for open lesions. Topical steroids are not indicated in your case.

Regards

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