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What Causes Boils On Face Inspite Of Being On Treatment For Lichen Simplex Chronicus?
Question: Hi, my father is 78 yrs of age. He is taking baclofem bid since last many years. Telpress 40 for BP bid.. Few week back i referred to dr. Kakkar on this site... He has dignosed seeing pictures that my father is suffering from Lichen Planus/Lichen simplex chronicus (Ls ch).... Prescribed dipgenta + cream that i was applying and there is lot improvement in body . But recently he is getting many very small boil or acne like structures along with some water like filled fluid structures on face. It gets rupture and liquid come out... Similar is on groin area since last many days and it comes and goes. One GP has prescribed terbinafine 250 mg od and anti fungal cream fungi mx to be applied on intimate area.. He has taken this med as well but the things improve then same issue happen again & again.
Body ones are a lot better by dipgenta cream but it also come again & again but its intensity is less now..
Body ones are a lot better by dipgenta cream but it also come again & again but its intensity is less now..
Brief Answer:
Upload Photographs
Detailed Answer:
Hello again
Good evening, This is Dr. Kakkar. Yes, I do remember consulting you a while ago via this forum.
Good to know that your father noticed improvement in LsCh. However, LsCh is such a condition that it takes weeks to months of treatment and therefore it advisable that he continue with the topical steroid cream, twice daily. You may mix the topical steroid cream with an equal proportion of a moisturising cream (1:1) and use it twice daily at sites affected by LsCh.
Regarding the skin problem on face and groins, I would require a photograph clearly depicting the lesions involving these sites.
Regards
Upload Photographs
Detailed Answer:
Hello again
Good evening, This is Dr. Kakkar. Yes, I do remember consulting you a while ago via this forum.
Good to know that your father noticed improvement in LsCh. However, LsCh is such a condition that it takes weeks to months of treatment and therefore it advisable that he continue with the topical steroid cream, twice daily. You may mix the topical steroid cream with an equal proportion of a moisturising cream (1:1) and use it twice daily at sites affected by LsCh.
Regarding the skin problem on face and groins, I would require a photograph clearly depicting the lesions involving these sites.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
4 photos of face uploaded... I had applied dipgenta on face as well so photos are bit oily.... 2 pics of intimate area both sides near testicles. Kindly suggest topical cream? Any antibiotic med? Is this all is fungal infection ? Pls suggest
Brief Answer:
Upload pics of lesions on face
Detailed Answer:
Hi.
I have received groin images only. Kindly upload photographs of face. You may upload tomorrow.
Groin rash is suggestive of a fungal infection. Continue with Terbinafine (Tab. Zimig250 mg, marketed by GsK) once daily for 1 month.
Topically you may use Zimig cream, twice daily.
An OTC antihistamine e.g cetrizine 10 mg once daily would provide him symptomatic relief from itching.
What are the ingredients in Fungi mx cream?
Upload photographs of lesions on face. Dipgenta should not be used on face. I asked to use dipgenta only on legs. How long have you been using it on his face?
Regards
Upload pics of lesions on face
Detailed Answer:
Hi.
I have received groin images only. Kindly upload photographs of face. You may upload tomorrow.
Groin rash is suggestive of a fungal infection. Continue with Terbinafine (Tab. Zimig250 mg, marketed by GsK) once daily for 1 month.
Topically you may use Zimig cream, twice daily.
An OTC antihistamine e.g cetrizine 10 mg once daily would provide him symptomatic relief from itching.
What are the ingredients in Fungi mx cream?
Upload photographs of lesions on face. Dipgenta should not be used on face. I asked to use dipgenta only on legs. How long have you been using it on his face?
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Pic of face uploaded... Pls check.
Dipgenta is applied on face today only & few days back for 2-3 days.
The antifungal tab u prescribed is taken by him for 21 days and then stop... Gap of 2-3 week is there. I started again from today.
Fungi mx contains ofloxaxin+ ornidazole+terbinafine+clobetasol.
Applied dipgenta only on arms, shoulder, back, neck, chest where that problem was there. No where else. Kindly suggest.
Dipgenta is applied on face today only & few days back for 2-3 days.
The antifungal tab u prescribed is taken by him for 21 days and then stop... Gap of 2-3 week is there. I started again from today.
Fungi mx contains ofloxaxin+ ornidazole+terbinafine+clobetasol.
Applied dipgenta only on arms, shoulder, back, neck, chest where that problem was there. No where else. Kindly suggest.
Brief Answer:
Fungal Infection
Detailed Answer:
Hi.
I have still not received the photograph of facial involvement. All the photographs are of the cream that you have been using, "Funzi mx".
I would suggest you to stop using Funzi mx cream because it contains a potent steroid, clobetasol which should never be used on the delicate groin skin. You may rather use Zimig cream twice daily for full 1 month along with Zimig tab 250 mg once daily for full 1 month. Can give him cetrizine 10 mg for itch.
Once the fungal infection in the groin resolves, ask your father to use an antifungal dusting powder (Abzorb dusting powder) in the groins. The antifungal powder will keep the folds dry and also prevent fungal proliferation and therefore prevent recurrence.
Regarding the use of dipgenta cream, I would suggest that you mix it with an equal proportion of a moisturizing cream(1:1) and use it twice daily at the sites mentioned except face and groins
If you are having problem uploading pics of face you may mail me at YYYY@YYYY Or else you can go to the reports section and upload pics or you may also mail the pics at ' YYYY@YYYY ' with the subject line as "Attention:Dr Kakkar".
Regards
Fungal Infection
Detailed Answer:
Hi.
I have still not received the photograph of facial involvement. All the photographs are of the cream that you have been using, "Funzi mx".
I would suggest you to stop using Funzi mx cream because it contains a potent steroid, clobetasol which should never be used on the delicate groin skin. You may rather use Zimig cream twice daily for full 1 month along with Zimig tab 250 mg once daily for full 1 month. Can give him cetrizine 10 mg for itch.
Once the fungal infection in the groin resolves, ask your father to use an antifungal dusting powder (Abzorb dusting powder) in the groins. The antifungal powder will keep the folds dry and also prevent fungal proliferation and therefore prevent recurrence.
Regarding the use of dipgenta cream, I would suggest that you mix it with an equal proportion of a moisturizing cream(1:1) and use it twice daily at the sites mentioned except face and groins
If you are having problem uploading pics of face you may mail me at YYYY@YYYY Or else you can go to the reports section and upload pics or you may also mail the pics at ' YYYY@YYYY ' with the subject line as "Attention:Dr Kakkar".
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Face pics mailed on both mail ids sir
Brief Answer:
Bacterial infection
Detailed Answer:
Hi.
Facial lesions are actually bacterial infection (Impetigo/furuncle).
An Oral antibiotic e.g Cefadroxil+clavulanic acid(Tab. Droxyl-CV 500mg) twice daily for a week.
Topical antibiotic e.g fusidic acid (fucidin cream), twice daily for a week
Regards
Bacterial infection
Detailed Answer:
Hi.
Facial lesions are actually bacterial infection (Impetigo/furuncle).
An Oral antibiotic e.g Cefadroxil+clavulanic acid(Tab. Droxyl-CV 500mg) twice daily for a week.
Topical antibiotic e.g fusidic acid (fucidin cream), twice daily for a week
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doc... My father is taking all med suggested by u from 12 sept. Now on face improvement is there but not great.. Still new acne like red bolis are coming on face and neck.. When erupt they are little bloody.
Groin area is verst with full area getting red, increasing area wise and water filled blisters are also there. No itching or redness. But uncomfortable. Further he is getting this water like small blisters on other parts of body like hand which erupts after 2-3 days. Pls suggest as face is very slow improvement & groin area issue has increased after taking regular medicines. He is 78 yrs of age and taking telprress 40 bid for BP & baclofem bid with ur medicines. Iam very much worried. Rest body is now better.
Groin area is verst with full area getting red, increasing area wise and water filled blisters are also there. No itching or redness. But uncomfortable. Further he is getting this water like small blisters on other parts of body like hand which erupts after 2-3 days. Pls suggest as face is very slow improvement & groin area issue has increased after taking regular medicines. He is 78 yrs of age and taking telprress 40 bid for BP & baclofem bid with ur medicines. Iam very much worried. Rest body is now better.
Brief Answer:
Pemphigus vegetans is a possibility
Detailed Answer:
Hi.
I have reviewed the photographs. Face looks better but groins show blisters and raised, moist lesions. I suppose he is on oral + topical terbinafine. The lesions should have improved or at least started to show improvement but they haven't. This leads us to bring in the possibility of Pemphigus vegetans which is an autoimmune disease with erosions and vegetating lesions mainly in the flexures like axilla, groins etc, scalp and face.
The diagnosis of pemphigus is frequently misdiagnosed with fungal infection/intertrigo because of the site.
-I would like to know whether he has any lesions in the axilla? or in the oral mucosa? You said he has lesions on the neck?
-Any history of oral ulceration?
I would suggest a skin biopsy from one of the lesions to confirm the diagnosis of pemphigus vegetans. Treatment of pemphigus is entirely different and is based on oral steroids.
Regards
Pemphigus vegetans is a possibility
Detailed Answer:
Hi.
I have reviewed the photographs. Face looks better but groins show blisters and raised, moist lesions. I suppose he is on oral + topical terbinafine. The lesions should have improved or at least started to show improvement but they haven't. This leads us to bring in the possibility of Pemphigus vegetans which is an autoimmune disease with erosions and vegetating lesions mainly in the flexures like axilla, groins etc, scalp and face.
The diagnosis of pemphigus is frequently misdiagnosed with fungal infection/intertrigo because of the site.
-I would like to know whether he has any lesions in the axilla? or in the oral mucosa? You said he has lesions on the neck?
-Any history of oral ulceration?
I would suggest a skin biopsy from one of the lesions to confirm the diagnosis of pemphigus vegetans. Treatment of pemphigus is entirely different and is based on oral steroids.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir sorry for delay. At present he dont have any blister on axila or oral mucosa. But water filled small blisters are increasing in other parts of body like forehead, face, groins, some on hands and legs.. What is safe oral steriod at age of 76-78 and do we dont have other line of treatment of this problem??
Brief Answer:
Skin biopsy is required for confirmation
Detailed Answer:
Hi.
This can be an Immunobullous disorder, the possibilities being either Pemphigus vegetans or Bullous Pemphigoid.
I would strongly suggest a Biopsy to confirm the diagnosis. You should visit a dermatologist in your region, regarding the biopsy.
Oral steroids ideally are given in a dose of 1 mg/kg/day, after breakfast along with an antacid e.g pantoprazole 40 mg, empty stomach. However, there are other drugs/immunosuppressive like Cyclophosphamide, Azathioprone etc which may also be started simultaneously with oral steroids. Once the disease activity is under control, steroids would be stopped and immunosuppressive can be continued for maintenance of improvement.
However, I would strongly recommend confirmation of diagnosis with appropriate investigation e.g Skin Biopsy, before starting him on oral steroids, specially at his age. Moreover, once started on oral steroids or immunosuppressives, the patient need to be monitored with blood test like Complete Hemogram, LFT, KFT etc etc.
Oral steroids/immunosuppressives would be given under Oral antibiotic cover, since the skin lesions(bullae) are infected.
Regards
Skin biopsy is required for confirmation
Detailed Answer:
Hi.
This can be an Immunobullous disorder, the possibilities being either Pemphigus vegetans or Bullous Pemphigoid.
I would strongly suggest a Biopsy to confirm the diagnosis. You should visit a dermatologist in your region, regarding the biopsy.
Oral steroids ideally are given in a dose of 1 mg/kg/day, after breakfast along with an antacid e.g pantoprazole 40 mg, empty stomach. However, there are other drugs/immunosuppressive like Cyclophosphamide, Azathioprone etc which may also be started simultaneously with oral steroids. Once the disease activity is under control, steroids would be stopped and immunosuppressive can be continued for maintenance of improvement.
However, I would strongly recommend confirmation of diagnosis with appropriate investigation e.g Skin Biopsy, before starting him on oral steroids, specially at his age. Moreover, once started on oral steroids or immunosuppressives, the patient need to be monitored with blood test like Complete Hemogram, LFT, KFT etc etc.
Oral steroids/immunosuppressives would be given under Oral antibiotic cover, since the skin lesions(bullae) are infected.
Regards
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
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