Suggest Treatment For Acute Lichen Planus

Posted on Wed, 16 Apr 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 16 Apr 2014 Answered on

Mon, 5 May 2014 Last reviewed on

Question : Hello Doctor, I am 46 female, I have been suffering from rash on my both hands and feet for the more then a month, and for that I consulted a Doctor but the medicines he prescribed did not show any improvement. The rash continues spreading from my one hand to another. Here are the medicines the doctor prescribed. Antarax 10mg, flutibact ointment, and cap. zifi lbx 200. At the moment I have stopped the medicines and in distress. Note the rash is just on my both hands and only one feet. I have no any allergies and I am a housewife. The skin is red and itchy. Boils flare up and keep spreading around like ringworms .The other parts of my body are fine.Please help me with some better medicines.

Answered by Dr. Dr. Kakkar (11 minutes later)

Brief Answer: Need more information Detailed Answer: Hello and welcome to healthcaremagic I am Dr. Kakkar. I have gone through your concern and I have understood it. I would keep a possibility of either Fungal Infection OR Chronic cummulative irritant contact dermatitis(which is common in housewives) OR Dyshidrotic eczema/Pompholyx. Judging from the previous medicines, i believe there is an element of secondary bacterial infection/oozing too. I would like to gather some more information from you in order to be able to help you better. -Is the rash scaly? -Are there fluid filled vesicles on the sides of the fingers and toes or in the palm/soles? -Are the nails involved too?I mean are they yellowish, thick and deformed? -Can you upload a few pictures, which show me the lesions clearly?I would be able to help you much better after having a look at it. regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (36 minutes later)

Hello Dr. As in the picture uploaded, the rash is only on one hand to a certain area not all over the hand, few days back a few boils appeared on the other hand too with the same symptoms. The same on my one feet right below the knee to a few inches only, not on the other leg. The problem it does not get healed after all the treatment done so far. Nails and feet all are fine so the other parts of the body. No any rash on elbows, underarms or the inner parts of the body. Just a few prickly heats boils due to the summer in India. I also like to mention we use soya oil for cooking. Fish is our daily diet as I live in Goa, India. Now due to this rash i have cut down on oily food.The affected parts are itchy and red as I am fair in color.

Answered by Dr. Dr. Kakkar (12 minutes later)

Brief Answer: Acute Lichen planus Detailed Answer: Hi. Thanks for the pictures. This is in fact Lichen planus, which can present as itchy, red to purple papules on volar aspect of wrist and forarm, shins, abdomen etc. Generalized rash is very itchy. In such a case I would suggest that you use a potent topical steroid e.g clobetasol propionate, twice daily for 2 weeks. One popular marketed by XXXXXXX in india, by the name of Tenovate ointment contains clobetasol propionate and would be ideal in this case. Flutibact that you had previously applied is too mild to be effective. The condition in fact warrants a short course of an oral steroid for a weeks or 10 days for rapid relief, in addition to the topical steroid that i have mentioned. My choice of oral steroid would have been Tab. Methylprednisolone 32 mg once daily after breakfast for 2 weeks. An Antacid e.g Tab. Pantoprazone 40mg, once daily, empty stomach (before breakfast) needs to be taken as long as you are on oral steroid. An OTC antihistamine e.g cetrizine 10mg once daily in the evening would help you symptomatically. regards take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (44 hours later)

Hello Doctor, First I must say I am sorry for the picture I uploaded by mistake, it was not of my hand. Here I am uploading fresh recent photos. Please now looking at this fresh photos should I continue with the above medicines you prescribed, please let me know. Thank you.

Answered by Dr. Dr. Kakkar (23 minutes later)

Brief Answer: Infected Eczematous dermatitis Detailed Answer: Hi, The recent photographs have an element of infection as well, visible as open sores, oozing and crusting specially on legs. If I was the treating doctor I would have advised an empirical oral antibiotic for a week OR 10 days (My choice of oral antibiotic would have been Amoxycillin 500mg in combination with clavulanic acid 125 mg, thrice daily, for a week OR Cephalexin 500ng thrice daily OR Cefadroxil 500mg twice daily, for a week). That would take care of the infection. In such a case I would suggest that you use a potent topical steroid+antibiotic combination cream e.g clobetasol propionate+Neomycin cream, twice daily for 2 weeks. One popular marketed by XXXXXXX in india, by the name of Tenovate-Gn cream contains clobetasol propionate+Neomycin, and would be ideal in this case. The rest of the treatment remains the same i.e A short course of an oral steroid for a 2 weeks or 10 days for rapid relief. My choice of oral steroid would have been Tab. Methylprednisolone 32 mg once daily after breakfast for 2 weeks. An Antacid e.g Tab. Pantoprazone 40mg, once daily, empty stomach (before breakfast) needs to be taken as long as you are on oral steroid. An OTC antihistamine e.g cetrizine 10mg once daily in the evening would help you symptomatically. regards take care

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar