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Suggest Treatment For Lichen Complicatus Simplex

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Posted on Thu, 5 Jun 2014
Question: Hi, I originally was dx with pct because of blisters on top of hands and feet due to biopsy, it has now gotten worse and I go to XXXXXXX hospitals and they say it is Lichen complicatus simplex, it is disfiguring me, and they have me on thalidomide which I hate, they did a biopsy and said that is what is was. The porphria turned out neg in stool, and twenty four hour urine, I don't know what to do next. thank you, XXXXXXX 54 yr old healthy woman. The pct porphyria cutanea tarda was dx 14 years ago. Now spreading up my legs. My feet bleed from wearing shoes, my hands look like I have leprosy. My Dr. at Bostons Brigham and Womens has me use script cortisone cream and wrap in saran wrap and gloves on my hands. I have lived in Florida, the Middle East, Hawaii, and here I am in New England and have this in the winter too. I don't drink or smoke. I used to work with leprosy patients in Hawaii back in 1985. It's not that but I feel like what if something parasitic got into my system. They said it's not parasites from differential, and stool. I am turning into a recluse. I've worked in hospitals for almost thirty years, mostly lab. I don't have lupus, neg ana, neg hep c, neg hiv. Thank you very much. XXXXXXX
doctor
Answered by Dr. Chakravarthy Mazumdar (17 hours later)
Brief Answer:
As a clinician biopsy report is bible for me

Detailed Answer:
Hi,

You should have uploaded a picture that assist the case.

If I have two differential diagnosis in mind, I would straight go with a biopsy and expect a dermatopathologist help me to zero in the diagnosis easily.

Biopsy is supreme for clinicians. So I would go ahead with Lichen complicatus simplex if the report mentions it. I would go ahead with treatment. It is important for you to stay away from water and soap contact, and applying emollients. Topical steroids of higher strength are almost always needed to control the symptoms. Cut your nails short and cover the areas of blisters so that you do not scratch them at night unknowingly.

Take my opinion to your Dermatologist.
Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
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Follow up: Dr. Chakravarthy Mazumdar (3 hours later)
thank you, but as this began it presented with tense blisters, and you can seet h fluid in them. Both biopsies were different, possible pseudo pct to beging with, the Doctor was very surprised.. Will this ever go away? and with the thalidomide it scares me to death and makes me feel like my insides are racing. I am on xanax an zoloft, and I stilll can't sleep. I don't pick, I wrap and cover, will it ever go away and I get go out normally. I usually swim three miles a week and the water is a big part of my life. What would bring on Lichen at this time in my life? Thank you very much for your wisdom. I have no nails either, could never grow them. sincerely, XXXXXXX Sorry, I forgot to mention Hashimoto's I'm on levoxyl 112 mcg q day, tpo is in the hundreds, could that have any affect to bring this on? I am vegetarian also I grew up that way. I tried to upload a picture and it didn't work.
doctor
Answered by Dr. Chakravarthy Mazumdar (16 hours later)
Brief Answer:
Bullous pemphigoid like picture

Detailed Answer:
Hi,

You had said that you have Hashimoto's and the TPO is in hundreds. Which means there is an autoimmune process is suspected behind the skin lesions.

This kind of picture is in Bullous pemphigoid, which is most common autoimmune disease of skin. This is common in this age. Please ask your dermatologist about this. There is complete treatment for this.

Hope this gives you a valuable direction.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
Answered by
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Dr. Chakravarthy Mazumdar

General & Family Physician

Practicing since :2004

Answered : 2086 Questions

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Suggest Treatment For Lichen Complicatus Simplex

Brief Answer: As a clinician biopsy report is bible for me Detailed Answer: Hi, You should have uploaded a picture that assist the case. If I have two differential diagnosis in mind, I would straight go with a biopsy and expect a dermatopathologist help me to zero in the diagnosis easily. Biopsy is supreme for clinicians. So I would go ahead with Lichen complicatus simplex if the report mentions it. I would go ahead with treatment. It is important for you to stay away from water and soap contact, and applying emollients. Topical steroids of higher strength are almost always needed to control the symptoms. Cut your nails short and cover the areas of blisters so that you do not scratch them at night unknowingly. Take my opinion to your Dermatologist.