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What Causes Discolored Skin Patches Over Knuckles And Small Joints Of Toes?
Question: skin pigmentation at toes knuckles. applied propysalic acid ointment, clobesatol ointment and later no results but got worsened by getting more darker toes and surrounding area skin got whitened. no itching but skin abnormal discolouration dark black on toes and white and brownish in surrounding pls help with correct solution :( PERSISTING from last two years. two years ago i was wearing leather safety shoes without socks for a month. after that the problem started before that only dead cells used to come intermittently.now after applying the above creams the skin has become more darker and very uneasy to walk bare foot
Brief Answer:
Acanthosis nigricans
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query and I have also reviewed the Images.
This is actually 'acanthosis nigricans' which has presented as rough, dark, thick/ velvetty patches of skin over knuckles and small joints of toes.
You have been using topical steroids which are unlikely to benefit because acanthosis nigricans is not a steroid responsive condition.
If I was the treating doctor I would suggest you to use a topical retinoid e.g tretinoin 0.05% cream once daily at night.
In morning you may use a moisturizer, specially the one which contains glycolic acid and cetaylated fatty esters e.g Xerina cream, once daily.
These are prescription products and I suggest that you use them under supervision of a doctor in your vicnity.
Regards
Acanthosis nigricans
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query and I have also reviewed the Images.
This is actually 'acanthosis nigricans' which has presented as rough, dark, thick/ velvetty patches of skin over knuckles and small joints of toes.
You have been using topical steroids which are unlikely to benefit because acanthosis nigricans is not a steroid responsive condition.
If I was the treating doctor I would suggest you to use a topical retinoid e.g tretinoin 0.05% cream once daily at night.
In morning you may use a moisturizer, specially the one which contains glycolic acid and cetaylated fatty esters e.g Xerina cream, once daily.
These are prescription products and I suggest that you use them under supervision of a doctor in your vicnity.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok doctor thank you for the reply. But please tell me the right procedure of applying the cream and how to care. also mention any side effects of the medicines and symptoms which may occur. I have had the cream retino-A for few days but later discontinued due to no results. It is also tretinoin-0.05%. can I continue the same cream or any other product u suggest.
Please give me a detail of how much i need to apply and how and how long will it take to get syptoms of improvement.
Thank you
Please give me a detail of how much i need to apply and how and how long will it take to get syptoms of improvement.
Thank you
Brief Answer:
Application method
Detailed Answer:
Hi.
A thin film of tretinoin is to be applied at night, once daily and similarly the other cream (Xerina), once during day. You may continue with the cream which you used earlier (i.e tretinoin 0.05% cream). These are absolutely safe and unlike topical steroids (which you have been using) can be continued for a length of time.
Response varies from individual to individual and I suggest you to try these at least for 1-2 months.
Regards
Application method
Detailed Answer:
Hi.
A thin film of tretinoin is to be applied at night, once daily and similarly the other cream (Xerina), once during day. You may continue with the cream which you used earlier (i.e tretinoin 0.05% cream). These are absolutely safe and unlike topical steroids (which you have been using) can be continued for a length of time.
Response varies from individual to individual and I suggest you to try these at least for 1-2 months.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Okey thank you, I am going to use it as advised. I have one more query regarding the same problem. Due to application of steroid creams( propysalic acid and clobesatol) the surrounding are of my foot has thinned skin/ whitened skin which is not my actual colour. Due to this whitening of near by skin the affected toe are is more highlighted. So please advise me how to regain back my original colour from the affected white colour which has been result of the steroid creams. And any other method which can lead to results please let me know. thank you
Also please tell me what all food supplements can be taken to overcome AN. is it due to dietary problem? because for last 3-4 years am not having my food properly and some doctor had mentioned me to take Xtragrape 4G. Are there any vitamin deficiency which is causing me AN?
Also please tell me what all food supplements can be taken to overcome AN. is it due to dietary problem? because for last 3-4 years am not having my food properly and some doctor had mentioned me to take Xtragrape 4G. Are there any vitamin deficiency which is causing me AN?
Brief Answer:
Whitening due to steroid abuse would benefit from topical immunomodulators
Detailed Answer:
Hi.
Whitening of surrounding skin and thinning is due to overuse/ abuse of steroids and it would improve with time Or else you may use a topical immunomodulators e.g tacrolimus 0.1% ointment or pimecrolimus 1% cream over the affected area, twice daily. These are prescription products and I suggest you to use them only after getting one of these prescribed from a dermatologist in your area.
AN can be due to underlying glucose intolerance or being overweight which causes insulin resistance state. Therefore I suggest you to test for blood sugar and fasting insulin levels. If overweight is an issue, weight management is definitely going to help. However, Acanthosis nigricans is idiopathic in most of the cases i.e there is no identifiable cause.
Regards
Whitening due to steroid abuse would benefit from topical immunomodulators
Detailed Answer:
Hi.
Whitening of surrounding skin and thinning is due to overuse/ abuse of steroids and it would improve with time Or else you may use a topical immunomodulators e.g tacrolimus 0.1% ointment or pimecrolimus 1% cream over the affected area, twice daily. These are prescription products and I suggest you to use them only after getting one of these prescribed from a dermatologist in your area.
AN can be due to underlying glucose intolerance or being overweight which causes insulin resistance state. Therefore I suggest you to test for blood sugar and fasting insulin levels. If overweight is an issue, weight management is definitely going to help. However, Acanthosis nigricans is idiopathic in most of the cases i.e there is no identifiable cause.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Okey Doc, but I am not overweight My height is 178Cm and I am 72Kgs. Do you suggest me to get blood sugar tested?? Okey tacrolimus ointment cant be used while am using Retino-A or I should use them seperately?
I am using Emolliz for Xerina because in my area I am not getting xerina and emolliz is having same composition as xerina.
are there any oral medicines you would suggest for AN?
I am using Emolliz for Xerina because in my area I am not getting xerina and emolliz is having same composition as xerina.
are there any oral medicines you would suggest for AN?
Brief Answer:
Use tacrolimus and tretinoin at separate times
Detailed Answer:
Hi.
I suggest testing for both blood sugar as well as fasting insulin levels. These might come out as Ok, though.
You may use tacrolimus ointment, twice daily, during day (morning and afternoon), on whitened area. Rub it in. Tretinoin is to be used at night and anyways on the dark patches of AN.
If I was the treating doctor I would have also added a tablet of metformin (Glycomet-500 mg) once daily, at night. You must take it after getting your treatment plan reviewed by your dermatologist.
Regards
Use tacrolimus and tretinoin at separate times
Detailed Answer:
Hi.
I suggest testing for both blood sugar as well as fasting insulin levels. These might come out as Ok, though.
You may use tacrolimus ointment, twice daily, during day (morning and afternoon), on whitened area. Rub it in. Tretinoin is to be used at night and anyways on the dark patches of AN.
If I was the treating doctor I would have also added a tablet of metformin (Glycomet-500 mg) once daily, at night. You must take it after getting your treatment plan reviewed by your dermatologist.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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