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Had neuro-dermatitis and then scalp psoriasis. Have developed dry skin around pubic area with white patches

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Practicing since : 2006
Answered : 2016 Questions
I had neuro-dermatitis in 2001 when I was 16 which initially looked like mosquito bites only to become kind of thick and dark purplish. Then in 2010, I developed scalp psoriasis, which is still there. And now I'm 27, and I have developed 3 other skin problems.
1. Dry skin around pubic parts,which losses dead skin
2. White patches with slightly dark and rough skin surrounding it
3. Black spots around my body

Please help, as I'm loosing my confidence.
Posted Thu, 3 Oct 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 1 hour later
Brief Answer:
Please read a detaile answer below

Detailed Answer:
Thanks for writing to us.
I have read the description and seen the images quite diligently. What I feel is these manifestations could be varied presentation of the same disease.

The diagnosed lesions of neurodermatitis/ prurigo nodularis can also have lichen planus or lichenoid psoriasis as its differentials.
Similarly flaky scalp can occur in psoriasis, seborrheic dermatitis and lichen planus
Those white scaly patches could be seen in psoriasis or seborrheic dermatitis too.
Similarly dry red skin in pubic parts can be seen in psoriasis, seborrheic dermatitis or any fungal infection.

The black spots over your body could be sequelae of healed lesions or could have appeared spontaneously without any preceding lesion( lichen planus pigmentosus- a variant of LP).

So you can see, similar presentation can have many differentials.

I would really appreciate if you could attach images showing your scalp lesions, pubic area lesions, black spots( pic attached of nape of neck not clear), neurodermatitis lesions( again need better resolution pics).

let me see the images first, so that i can suggest you the most probable diagnosis.

The best way to confirm the diagnosis is definitely biopsy of skin lesions.

Please do not lose confidence skin diseases are chronic but can be brought into remission.
All the above mentioned probabilities can be treated to patient's satisfaction.

In the interim use a mild soap and moisturiser like cetaphil. use steroid cream like betamethasone cream over affected areas and wash your scalp with ketoconazole and tar based shampoo daily. Apply steroid lotion over scalp in night.

Hoping to hear from you soon
Above answer was peer-reviewed by
Follow-up: Had neuro-dermatitis and then scalp psoriasis. Have developed dry skin around pubic area with white patches 2 hours later
I use a coal tar and salicylic solution as shampoo for scalp every alternate day. And Halobetasol Propionate solution at night sometimes. I used to apply night cream few days ago, but i have developed something like prickly heat thing( it doesn't itch, but it looks like that). Also, It might have developed due to increase in body temperature due to periods.
I have uploaded the pubic part's picture. Please look at it, by no means, it looks like a vagina of 27 year old. My sexual life has also been affected , since the dryness around vagina and rectum looks very bad, and I can not get the confidence to be intimate with my husband.
Answered by Dr. Kalpana Pathak 25 hours later
Brief Answer:
please read a detailed answer below

Detailed Answer:
I can totally understand your concern.
I have gone through all the images attached. Clinically somehow, I would like to keep seborrheic dermatitis and psoriasis as possible differentials for all your skin concern.

Now for few weeks I would like you to follow below mentioned prescription.

1) Use a mild soap like cetaphil for bathing and use cetaphil dam moisturiser
2) use ketoconazole tar based shampoo like protat k or konaz CT and alternate it with sebowash shampoo ie shampoo your hair daily and use these products alternately. Keep the shampoo atleast for 10 minutes and then wash off. Use warm coconut oil only once in a week over scalp.
3)Apply clobetasol salicylic acid lotion over scalp every night( topisal)
4) For other skin lesions like ears, arms,face and pubic area apply momatasone terbinafine cream ( momoz T cream) twice in a day.
5) if lesions are itchy please take tablet cetrizine

Our primary aim now is to control scaling dryness and itching. Once its gone, we will concentrate on the pigmentation left behind.
So please follow this prescription for 15 days with full compliance and get back to me after 15 days for follow up.

Hope this helped. Should there be any other doubt, please write back.
Take care

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