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DLE, hard painfull boils - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Average Posted in: Skin Hair and Nails
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
User :   Hi I am a SLE patient fro the last 10 years and an year back a biopsy was done on my skin which was diagonsed as DLE.
The Biopsy Report indicates the following: "In view of Clinical features these findings are consistent with lichenoid discoid lupus erthematosus
Histopathological differencial diagnosis includes lichen planus"

I am currenly having some scars / boils on my arms and hands, have showed them 2 doctors and have applied some skin creams but none seem to work. Please advice.
Doctor :   hi
User :   Hi Doctor
Doctor :   May I know your age and gender?
User :   Age = 61, Gender = Female
Doctor :   Can you describe the scars?
User :   Little hard painfull boils on both the hands and arms. They are a bit swollen.
Doctor :   Ok
User :   If there is any provision to send some snaps I can send those
Doctor :   Can you send the pictures to YYYY@YYYY
User :   Give me a min
Doctor :   Are you there?

User :   Yes
User :   just attaching the files
Doctor :   Have you sent the picture?
User :   Yes
Doctor :   It may take a few minutes before I receive the file.
User :   yes it is around 4 MB
Doctor :   In the mean time, I would like to few more detail about your condition?
Doctor :   Shall I proceed?
User :   Yes
Doctor :   Since when are you noticed these rashes?
User :   Approx 1.5 years
Doctor :   Do you have itching?
User :   Yes
User :   a lot
Doctor :   Are these lesions present every day or they some time fade>
User :   No they are there everyday
User :   They remain as it is
Doctor :   Was the biopsy done on the same lesion or on a different one?
User :   Yes on the same one, basically from one of them
Doctor :   Ok
Doctor :   May I know the details of the treatment that you have receive till date?
User :   Initially Propinate Cream was applied for 3 - 4 months and orally Dapsone tablet was given but discontinued after 10 days as it was not suitable
Doctor :   Ok
User :   After that Momtas cream was applied for 3 - 4 months but no affect
User :   Just FYI I am also taking some medicines daily for SLE treatment
User :   HCQS - 200 mg 1 Tablet daily
Doctor :   Ok
User :   Cellcept - 2 Tablet 500 mg daily
User :   And till last month Risofos 75 mg, 2 times in a month (13th an 14th of evrey month)
User :   One doctor even suggested applying Clenoderm lotion, but this gave more pain and aggrevated the boils
Doctor :   Ok
Doctor :   I have received the file.
User :   Another mdeicine for BP that I take is Tenolol 25 mg daily 1 tablet
Doctor :   Let me have a look at it and will brief you.
User :   ok
User :   Hi Doctor I am extending the time as only 3 mins remain
Doctor :   I am sorry, as the file was a big one, its taking a few more minutes.
User :   no problem I ill go in for a recharge
Doctor :   Are you there?
User :   Yes
User :   I have done a recharge
Doctor :   I have seen the picture of your lesions.
Doctor :   Not let me brief you.
Doctor :   These lesions are more similar to the DLE.
Doctor :   DLE is a chronic condition.
Doctor :   A chronic conditions are hard to treat and it takes a long time and good support from the patient to heal it.
Doctor :   Unfortunately, this is one condition, where the complete cure is not known.
Doctor :   They are one which can be controlled.
Doctor :   The present lesions will slowly fade over the period of time.
Doctor :   But of its nature, the exact time cannot be predicted.
Doctor :   There are various forms of treatment available.
Doctor :   They include the use of oral or topical steroids, immunosuppresants, immunomodulators.
User :   Just FYI. Steroids were taken many times earlier
User :   Prednisolone
User :   Have stopped it now
Doctor :   Ok
Doctor :   Steroids are effective in the initial stages to the condition,
Doctor :   to help in treating the present lesions and for preventions, this is slowly changed to other form of treatment.
User :   Basically Steroids were given for the SLE
Doctor :   So if you are not finding any new lesions then its a sign of effectiveness of the treatment.
Doctor :   Propionate creams are topical steroids.
Doctor :   Have you followed what I am saying.
Doctor :   If there are rapid development of new lesions, then probably oral steroids may have to be reintroduced.
User :   Yes, but the thing is that these are very painful lessions and whenever they are coming on contact with anything there is a lot of pain
Doctor :   Occasionally due to the presence of fluid or infections, these lesions can get painful.
User :   These have been painfull from Day one
User :   Basically I need some remedy so that the Pain subsides and the lessions which are raised and swollen subside
Doctor :   Do you notice any discharge from these boils?
User :   No
Doctor :   If the pain is severe and is disturbing your activities, then you may need some pain controlling measures.
Doctor :   you can try medications such as Amitryptyline, gabapentins if necessary.
Doctor :   Since these are prescription only medications, I cannot prescribe to you over this chat.
Doctor :   You may have to report to your doctor to obtain these medications.
Doctor :   Have you followed what I have suggested?
User :   Yes, but I still did not get what should I do to control this Lessions as my SLE doctor has advised to consult a Skin Specialist
Doctor :   The treatment for these conditions are more or less similar to the ones of SLE, as DLE is a cause may be the same.
Doctor :   That is the use of topical steroids/oral steroids, immunomodulators, immunosuppressants.
User :   SLE is very under control and I do blood tests every month
Doctor :   Apart from these avoiding scratching, sun exposures and sunscreen lotions are helpful.
User :   So the only medications that I take I have mentioned earlier
Doctor :   But if you have not yet seen a dermatologist yet, I suggest you to consult him.
Doctor :   You may need modifications in the dose of the medications if necessary.
Doctor :   Have you followed what I have suggested?
User :   We have already consulted Slin Specialist and the Skin medicines that I have mentioned were prescribed by them only, but I have not got any relief
User :   To be more precise 2 - 3 skin specialists
Doctor :   As a general practitioner, my knowledge is restricted to what i have suggested till now.
Doctor :   I shall suggest you to take an opinion from our expert dermatologist who can be able to give you more information about it.
User :   How do I go ahead on that, Can you connect me to him
Doctor :   I shall give you the link through which you can post your queries to our dermatologist.
User :   ok
Doctor :   You can choose between getting a link through an email or you can discuss the issue on a phone talk.
Doctor :   I shall send you the link in a minute.
User :   ok
Doctor :   WWW.WWWW.WW Doctor :   This link will guide you to obtaining a specialist opinion.
User :   So the session with Dr XXXXXXXX Batra will also be part of the current session
Doctor :   If you opt for the second opinion now, the payment for this chat session will be refunded back to you.
Doctor :   Have you followed?
User :   ok
Doctor :   Do you have any other query?
User :   No, thanks. May I know your name Please, if it is fine with you.
Doctor :   I am D
Doctor :   Thanks for consulting me.
Doctor :   Bye for now.
User :   Bye
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