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How To Rule Out Vasculitis When Diagnosed With Whole Body Itching?

Posted on Fri, 23 Jun 2017

Question: I'm 35 year old female. I'm broke in a rash from head to toe. It's very itchy and now painful. I've had this for over 2 weeks. I first seen an immediate care Dr who treated me for hives with 20 mg prednisone, benadryl and 2.5% hydrocortisone cream. none of it helped. today I seen a dermatologist who believes I had Strep throat that caused a psoriasis flare up and gave me Cephalexin 500 mg and triamcinolone acetonide ointment(which I've use before and never helped). I went for a 2nd opinion to my family dr. who did blood work but will take days to get back. She believes a possible auto immune disorder is possible. And said it's very aggressive and she's neber seen anything this bad. I attached some images. please give me your opinion. My skin now feels like sandpaper almost and it's stiff ..

Answered by Dr. Naval Mendiratta (2 hours later)

Brief Answer:
IS it vasculitis

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well, I have gone through your pictures and it does some very wide spread rash...More of vasculitis( that is blood vessels inflammation)....I highly doubt if any antibiotics are going to work here...

I would like to ask you a few queries before guiding you further?

1. Did you experience fever at the start of it?

2. Any new medicine you tried recently before the rash started?

3. Any complaints of pain in the stomach or loose stools??

4. Any joint pains/oral ulcers/hair fall??

5. If you have any blood work, you can attach those here.. Wanted to see the ESR< CRP reports mainly

Do let me know these queries. You may need a higher dose of steroids for a short run, but before that we may need a skin biopsy to confirm the diagnosis

Await your reply

REgards
Dr Naval

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

Follow up: Dr. Naval Mendiratta (8 hours later)

I just got some test results back. No fever or stomach pain. I attached the results

Answered by Dr. Naval Mendiratta (7 hours later)

Brief Answer:
Blood reports interpretation

Detailed Answer:
Good evening

I have gone through the results...

Your CRP levels are high...and Serum Creatinine is a bit on the higher side...It does look like some inflammatory reaction.....

I would advise you get a few more tests done to look at the exact cause:

1. ANa( IFA)

2. ANCA( ELISA)( PR3 and MPO)

3. Complement C3, C4

4. Urine routine

These are a few immunological tests to see why it happened and will it happen again....

As for the treatment I would suggest you consult your GP and start on three anti allergics...

1. TAblet Cetrizine 10 mg

2. Tablet Atarax 25 mg in the night

3. Tablet Allegra 180 mg

IF needed , we may need to introduce steroids...But I would prefer keeping a step wise approach...Get the bloods done and if they are negative and it still doesnt improve, we may need a skin biopsy...and adequate water intake for your Kidney function test which is just on the margin.

Do let me know for more queries

REgard
Dr Naval

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Naval Mendiratta (18 hours later)

I got two more test results back I attached as well

Answered by Dr. Naval Mendiratta (26 hours later)

Brief Answer:
Delayed Reply

Detailed Answer:
Good evening

Sorry for the delayed reply. Had a long emergency duty

Well, the results are the same only. I had seen all of them... Didnt find anything extra..can you recheck once more for the screen shot??

Could you update me about your rashes condition as well??

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (2 hours later)

sorry it didn't upload I will send u the results and what it looks like now

Answered by Dr. Naval Mendiratta (8 hours later)

Brief Answer:
Rash

Detailed Answer:
Good evening

Well, it doesnt look like it s improving.. I felt the scaling and peeling is going on. It has begun to look like Psoriasis now...Maybe that s why the steroids were not working in your case...

Try to see a dermatologist early and get a skin biopsy or skin peel ..So we can start you on treatment straight away

DO let me know for more queries

REgards
Dr Naval

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Kampana