Suggest treatment for Non-epidermolytic Palmoplantar Keratoderma
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Hi there, I would like to consult with a dermatologist about Diffuse Non-epidermolytic Palmoplantar Keratoderma - I have had this since birth and have used topical creams in the past. Most recently I have been prescribed 100mg of intraconazole (Sporanox) to rid the redness around the edges of the feet and deal with the thickened toenail fungus. 10 days from now I would like to head down south for a few days and was wondering if it was safe to take 400mg of itraconazole for two days and then decrease the dosage to 300 or 200 mg for 7 days in hopes that it speeds up in clearing the awful appearance of my skin on the feet. I am a 26 year old female and would like to start a family one day and so Im a bit concerned with birth defects that can be caused by this drug. Also, in my search online I came across an article of a man who who received intravenous chemotherapy with 5-fluorouracil (5-FU) for his PPK - after receiving a 12 week course of therapy of CI 5-FU at 250 mg/m2 per day his lesions were 95% improved and remained 90% clear 4 years later - are you aware of this type of treatment for PPK? This condition is so frustrating and I am willing to try whatever it takes to clear it as much as possible so I don't feel like an alien, especially in the summer time. I thank you in advance for your assistance and look forward to receiving your feedback.
Posted Mon, 3 Mar 2014 in Skin Hair and Nails
Answered by Dr. Sanjay Kumar Kanodia 15 minutes later
Brief Answer: Kindly send details with high resolution pictures Detailed Answer: Hello, Welcome and thanks for posting your query to the forum. I can understand your concern for Diffuse Non-epidermolytic Palmoplantar Keratoderma as well as use of Itraconazole and other possible safe therapies in getting better at the earliest. Though the history provided is enough to guide you regarding most of your queries even then to provide you the best information I request you to kindly provide some important details: - Any other systemic illness or other skin condition in yourself in last 1 year period or before that. - What is the main regimen (medications as well as supportive therapy) you are following for the treatment of keratoderma. - Any medications you are taking other than above mentioned medications. It would be best to send few good resolution pictures of the affected area so that it can be analyzed best. You have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your queries better. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia- Query Id : 95903). "Wish you good health" with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)
Follow-up: Suggest treatment for Non-epidermolytic Palmoplantar Keratoderma 17 hours later
Hello Doctor, Please find the attached reports and advise.
Answered by Dr. Sanjay Kumar Kanodia 18 hours later
Brief Answer: Keratolytics with Acitretin as main oral therapy Detailed Answer: Hello young lady, Thanks a lot for posting the important pictures so that now I can guide you best regarding your condition. I can see that you have moderate grade of keratoderma as well as fungal infection especially of toe nails. As the condition is present since birth so you must be knowing a lot of facts regarding treatment of your condition even then I would like to guide you regarding your condition. If I were your treating dermatologist then I would have preferred for Keratolytic therapy, such as 6% salicylic acid in white soft paraffin. Alternatively I would have preferred for a gel of 6% salicylic acid in 70% propylene glycol. Occlusion with polythene for a few nights enhances the efficacy of these preparations. In your kind of condition where there is additional fungal infection is present I would have added a Benzoic acid compound ointment which is is mildly keratolytic, and is useful in reducing fungal and bacterial overgrowth. Though in experience I have never used 5-fluorouracil (5FU) for keratoderma as 5-fluorouracil is quite toxic drug and can cause extreme side effects. In my patients with marked functional impairment I prefer to give Acitretin as main oral therapy. For the use of itraconazole – The condition of foot especially of the nails will take quite a long time of multiple of months to get better ( as toe nails grows quite slowly and the skin renewal also take bit longer time). So taking higher dose of itraconazole to 400 mg will not have any additional advantage to get early betterment. The best thing to help you out is by topical therapies along with best moisturization by paraffin gelly. I hope the information will help you. I will be glad for any further queries or if not then can close the discussion and rate the answer. With regards, Dr Sanjay Kumar Kanodia MD- Dermatology
Follow-up: Suggest treatment for Non-epidermolytic Palmoplantar Keratoderma 10 hours later
Thank you for your detailed answer, it is greatly appreciated. Can any of the above topical remedies you have suggested be purchased over the counter or would I need to see a dermatologist and have the topical ointment prescribed? Also with respect to the itraconazole my main concern for betterment is the redness around the edges of the feet - you dont feel that increasing the dosage would speed up the process in clearing it up? I do know that the nails will take a lot longer and am prepared to take the medication for the amount of time that is necessary. Thank you and looking forward to your response.
Answered by Dr. Sanjay Kumar Kanodia 2 hours later
Brief Answer: Whitfield's ointment & regular moisturization Detailed Answer: Hello young lady, Thanks for your follow up. Regarding the purchase of topical medications - In a specified therapy I start with low percentage of 3% salicylic acid and then increase the percentage up to 6 -18% according to the response of the treatment. As salicylic acid is quite irritant in nature so requires special monitoring in application of higher percentage. Therefore you can ask your treating dermatologist if he/she can help you for the exact guidanc eof the same. Even then for an over the counter purpose I would have prescribed you “Whitfield's ointment”as multipurpose over the counter medication to use regularly as it contains both salicylic acid as well as bezoic acid in it. Additionally I suggest you to do saline compression. For the same you can take half bucket of warm water, put a pinch of salt in it and dip your leg for 15 minutes two times in day. This will improve the hydration as well as helps in fast renewal of dead skin. An important point is proper hydration- your kind of cases requires a regular moisturization by paraffin gelly for multiple times a day. This will help in reducing the cuts and give a natural feel to the skin. For the part of redness and itraconazole- Though the ideal dose for itraconazole is 200 mg per day but keeping in mind a watch on the side effects of nausea , vomiting abdominal pain fatigue loss of appetite yellow skin jaundice) yellow eyes itching and most importantly the liver function side effects we prefer to give lower dose of 100 mg per day. Increasing the dose to 300 or 400 mg can cause side effects. The safe limit is up to 200 mg per day. Additionally increasing the dose will not improve the redness in your case within 10 days of period so I suggest you to take the same dose of 100 mg of the medicine. I hope the information will help you. I will be glad for any further queries or if not then can close the discussion and rate the answer. With regards, Dr Sanjay Kumar Kanodia MD- Dermatology