View this page "any way to avoid this trap???...suggestions welcome"
3 views
Skip to first unread message
Piyush
Jun 24, 2009, 10:09:34 PM6/24/09
to DERMA CORNER
Click on http://groups.google.com/group/derma-corner/web/any-way-to-avoid-this-trap-suggestions-welcome
- or copy & paste it into your browser's address bar if that doesn't
work.
raj d doc mandal
Jun 24, 2009, 11:07:34 PM6/24/09
to DERMA CORNER
intesting case, but i think to come out of this trap we have to little
bit more concious, as you hav written that on 2nd visit you hav asked
some leading question which ultimately revealed some very important
data and helped in revising diagnosis. i think on very first visit of
any patient we hav to take a detailed history and specially in our
subject, most patients had already visited 2-3 doctors before coming
to us. so it is obvious that the morphology of initial disease will
change. one more thing use of oral steroid should be considered if you
are sure about the diagnosis or if patient is in desperate need, in
this case there was no emergency u should hav waited for the HP
results. any way that my vision you may not agree with it, but this is
a interesting case and after reading the initial features the 1st
disease came in my mind was infact LP.
bit more concious, as you hav written that on 2nd visit you hav asked
some leading question which ultimately revealed some very important
data and helped in revising diagnosis. i think on very first visit of
any patient we hav to take a detailed history and specially in our
subject, most patients had already visited 2-3 doctors before coming
to us. so it is obvious that the morphology of initial disease will
change. one more thing use of oral steroid should be considered if you
are sure about the diagnosis or if patient is in desperate need, in
this case there was no emergency u should hav waited for the HP
results. any way that my vision you may not agree with it, but this is
a interesting case and after reading the initial features the 1st
disease came in my mind was infact LP.
DrPanx
Jun 25, 2009, 4:54:14 AM6/25/09
to DERMA CORNER
There are two things to be looked. First- in what doses you are giving
steroids. Second-for how much duration. If it is less than 40 mg and
less than 2 wks then steroids can be stopped without tapering and
topical steroids to be continued ( ill prefer 1:1 ratio of
Betamethasone cream & Cold cream as the area is large)..If doses are
higher then can be tapered in a wk to 10 mg. Then load the pt with
antihistaminics and start him on MTX 15mg wkly. Pustular psoriasis
does occur after steroid withdrawal but its not that common (it occur
sometimes, not always and in case it occurs MTX will take care of it.
If still you are not comfortable then you can continue 10 mg
prednisolone OD for a wk after starting MTX(in the meantime MTX will
build its effect).
To confirm whether its psoriasis, its diffficult. For this look for
the nail changes, the type of scaling, oral mucosa for LP.But I agree
that diagnosis becomes difficult in treatment modified cases like
this. I will appreciate if you post a high resolution pic of the
lesion ( minimum 5 megapixel) so that we can have a look on the
lesions closely.
steroids. Second-for how much duration. If it is less than 40 mg and
less than 2 wks then steroids can be stopped without tapering and
topical steroids to be continued ( ill prefer 1:1 ratio of
Betamethasone cream & Cold cream as the area is large)..If doses are
higher then can be tapered in a wk to 10 mg. Then load the pt with
antihistaminics and start him on MTX 15mg wkly. Pustular psoriasis
does occur after steroid withdrawal but its not that common (it occur
sometimes, not always and in case it occurs MTX will take care of it.
If still you are not comfortable then you can continue 10 mg
prednisolone OD for a wk after starting MTX(in the meantime MTX will
build its effect).
To confirm whether its psoriasis, its diffficult. For this look for
the nail changes, the type of scaling, oral mucosa for LP.But I agree
that diagnosis becomes difficult in treatment modified cases like
this. I will appreciate if you post a high resolution pic of the
lesion ( minimum 5 megapixel) so that we can have a look on the
lesions closely.
Piyush
Jun 25, 2009, 8:12:18 AM6/25/09
to DERMA CORNER
hi guys...its great to see so quick response....
well...here is somethin i wanna stress upon...i said HP slide is
suggestive of psoriais...bt there is no suprapapillary
thinning...moreover there is pigmentary incontinence...i will be
posting HP pics soon..u can see urself...moreover psoriasis lesions
dont heal with hyperpigmentation...but this pt is havin many
hyperpigmented macules and patch....this is somethin against
psoriasis..wat do u say?...
regardin startin steroid....well this pt received steroids 4m outside
also...moreover we didnt think of psoriasis....it all started when HP
slides arrived...it has some features of psoriasis...as well as
LP...bt thr is no lichenoid infiltration..
1 thing that really needs to be considered is Lichenoid reaction...it
has many atypical features...but the h/o scaling, scalp
involvement...well...its all complicating the things
well...here is somethin i wanna stress upon...i said HP slide is
suggestive of psoriais...bt there is no suprapapillary
thinning...moreover there is pigmentary incontinence...i will be
posting HP pics soon..u can see urself...moreover psoriasis lesions
dont heal with hyperpigmentation...but this pt is havin many
hyperpigmented macules and patch....this is somethin against
psoriasis..wat do u say?...
regardin startin steroid....well this pt received steroids 4m outside
also...moreover we didnt think of psoriasis....it all started when HP
slides arrived...it has some features of psoriasis...as well as
LP...bt thr is no lichenoid infiltration..
1 thing that really needs to be considered is Lichenoid reaction...it
has many atypical features...but the h/o scaling, scalp
involvement...well...its all complicating the things
Reply all
Reply to author
Forward
0 new messages