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What Does Pulse Dosing Of Steroid Mean?
Question: Hello, I had a query out with you last week however couldn't respond for a few days due to a heavy work load and the query has since been closed.
I have some follow up questions to your response:
Based on my description of issues, could this be anything other than LPP?
Please further explain what pulse dosing of steroid means and in what form / quantity are the twice weekly doses of steroids (every saturday and sunday) you referenced.
Thanks
I have some follow up questions to your response:
Based on my description of issues, could this be anything other than LPP?
Please further explain what pulse dosing of steroid means and in what form / quantity are the twice weekly doses of steroids (every saturday and sunday) you referenced.
Thanks
Brief Answer:
Oral Minipulse Steroids; Upload a clear photo
Detailed Answer:
Hi.
By Pulse dosing I actually mean Oral Minipulse (OMP) i.e giving steroid just twice weekly rather than daily (e.g every Saturday and Sunday).
I usually give OMP as 5 mg of Betamethasone Or Dexomethasone on 2 consecutive days to my patients ( e.g every Saturdays and Sundays). This can be continued for 4-6 months. They would be available on prescription.
The advantage of pulse dosing is that the side effects that are encountered with daily oral steroids are somewhat reduced.
I would like you to upload a very good clarity digital photo, once again. In the previous photo I was not able to see the lesions clearly. However going by the biopsy report I asked you to take the above mentioned treatment.
You may upload as many photographs as you can, from different affected areas on your scalp, so that I am able to have a better understanding of the condition affecting your scalp. Make sure you upload clear photos.
Regards
Oral Minipulse Steroids; Upload a clear photo
Detailed Answer:
Hi.
By Pulse dosing I actually mean Oral Minipulse (OMP) i.e giving steroid just twice weekly rather than daily (e.g every Saturday and Sunday).
I usually give OMP as 5 mg of Betamethasone Or Dexomethasone on 2 consecutive days to my patients ( e.g every Saturdays and Sundays). This can be continued for 4-6 months. They would be available on prescription.
The advantage of pulse dosing is that the side effects that are encountered with daily oral steroids are somewhat reduced.
I would like you to upload a very good clarity digital photo, once again. In the previous photo I was not able to see the lesions clearly. However going by the biopsy report I asked you to take the above mentioned treatment.
You may upload as many photographs as you can, from different affected areas on your scalp, so that I am able to have a better understanding of the condition affecting your scalp. Make sure you upload clear photos.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry, photos now added. Penis shots do not truly demonstrate the inflamation I normally have.
I've been taking prednisone daily for past 4 weeks which hasn't really helped. The injection is th only thing that has stopped the hair loss.
Could this be anything else, the MDs are running out of ideas.thanks
I've been taking prednisone daily for past 4 weeks which hasn't really helped. The injection is th only thing that has stopped the hair loss.
Could this be anything else, the MDs are running out of ideas.thanks
Brief Answer:
In the photo this does'nt seem like LPP
Detailed Answer:
Hi
LPP is usually not very symptomatic. There may be scaling which is associated with hair loss. Moreover hair loss in LPP leaves behind patches of cicatricial alopecia, which are permanent.
Oral steroids are usually effective in LPP, in arresting the progression.
In the photos you have posted I could not really see any patches of hair loss. Just based on the photo I cannot say that this is LPP.
-Do you have scalp scaling?dandruff?
-Are there any bald patches?totally devoid of hair?
-Have you been prescribed any topical steroid lotion too? Or a shampoo?
-Whats the dose of oral prednisolone?
Regards
In the photo this does'nt seem like LPP
Detailed Answer:
Hi
LPP is usually not very symptomatic. There may be scaling which is associated with hair loss. Moreover hair loss in LPP leaves behind patches of cicatricial alopecia, which are permanent.
Oral steroids are usually effective in LPP, in arresting the progression.
In the photos you have posted I could not really see any patches of hair loss. Just based on the photo I cannot say that this is LPP.
-Do you have scalp scaling?dandruff?
-Are there any bald patches?totally devoid of hair?
-Have you been prescribed any topical steroid lotion too? Or a shampoo?
-Whats the dose of oral prednisolone?
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
No dandruff or scale of any note
20mg per day of steroid
Clobatersol daily
No big bald patches, but persistent thinning in random lines / patterns all over my scalp
The scalp just feels inflamed / unhealthy
Thanks
20mg per day of steroid
Clobatersol daily
No big bald patches, but persistent thinning in random lines / patterns all over my scalp
The scalp just feels inflamed / unhealthy
Thanks
Brief Answer:
I would suggest a repeat biopsy
Detailed Answer:
Hi.
I can keep another possibility of follicular mucinosis, based on your symptoms and the response to treatment.
The significant points that i can gather from your queries are that your treatment history includes an oral immunosuppressive (mycophenolate mofetil) and also oral steroids and in your history you also mention about random blisters/fluid filled lesions on scalp; I suppose an immunobullous disease like pemphigus must also have been a possibility and requires confirmation.
A repeat biopsy is definitely warranted in your case for a confirmatory diagnosis.
Regards
I would suggest a repeat biopsy
Detailed Answer:
Hi.
I can keep another possibility of follicular mucinosis, based on your symptoms and the response to treatment.
The significant points that i can gather from your queries are that your treatment history includes an oral immunosuppressive (mycophenolate mofetil) and also oral steroids and in your history you also mention about random blisters/fluid filled lesions on scalp; I suppose an immunobullous disease like pemphigus must also have been a possibility and requires confirmation.
A repeat biopsy is definitely warranted in your case for a confirmatory diagnosis.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your responses.
Regarding the blister / spot like lesions, they shwo up randomly for 2-4 days on their own and then disappear. From review of the internet, the alterantive you suggest on first glance appear to have spots which are possibly too big to accord with my symptons. Do these blisters appear with LPP?
The blistery rash on my chest lasted less than 10 days, and has never reappeared.
The rash on my penis head has remained, no itching or raised lesions.
I intend to get another biopsy asap.
Thanks
Regarding the blister / spot like lesions, they shwo up randomly for 2-4 days on their own and then disappear. From review of the internet, the alterantive you suggest on first glance appear to have spots which are possibly too big to accord with my symptons. Do these blisters appear with LPP?
The blistery rash on my chest lasted less than 10 days, and has never reappeared.
The rash on my penis head has remained, no itching or raised lesions.
I intend to get another biopsy asap.
Thanks
Brief Answer:
Scalp biopsy for a conclusive diagnosis
Detailed Answer:
Hi.
No, LPP does not present with blisters.
Yes, do get a biopsy for a conclusive diagnosis.
Regards
Take care
Scalp biopsy for a conclusive diagnosis
Detailed Answer:
Hi.
No, LPP does not present with blisters.
Yes, do get a biopsy for a conclusive diagnosis.
Regards
Take care
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Yogesh D
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