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Skin inflammation - Online Doctor Chats

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

General & Family Physician
Practicing since : 2005
Answered : 2580 Questions
User :   Hi, may I answer your health queries right now ?
Doctor :   Hi Dr XXXX here
User :   Hello sir
Doctor :   Hi
User :   my query is related to a skin inflammation in the axila
User :   my wife has this problem for the last 3 years
Doctor :   ok, can u give me some additional details
User :   ya , sure
Doctor :   may i know her age, weight and how did this issue begin ?
User :   there is the inflammation in the skin which aggravates occasionally to become swollen
User :   and then pus comes out and the would heals...
User :   but then after few days it again resurfaces.
User :   this has been happening for the last 3 years
User :   her age is 29 and weight is 80 kgs and height is 5 ft10 inc
Doctor :   how large is the swelling ? and are they multiple ?
User :   there is only one swelling and the dia is around 1 cm when swollen
Doctor :   i guess she has lymphadenitis
Doctor :   a infection of the lymph node
Doctor :   i would advice u to get that examined and culture sensitivity done
User :   several tests have been done including biopsy.....
User :   but nothing conclusive came
User :   what is culture sensitivity?
Doctor :   has she taken antibiotics ?
User :   yeah she is taking a no. of antibiotics
Doctor :   when was the biopsy done ?
Doctor :   Is she diabetic ?
User :   biopsy was done about 3 months back
User :   no she isn't diabotic
User :   i mean diabetic
Doctor :   what was the report
User :   the report says and i quote
User :   skin biopsy from left axila
User :   shows pyperkeratosi
User :   hyperkeratosis
Doctor :   ok
User :   and moderate to marked irregular acanthosis
User :   no subcutaneous tissue is included
Doctor :   i think she has sebborrhic dermtitis, with superadded infection
User :   dermis shows a diffuse infiltrate
User :   composed of sheets of plasma cells.
User :   final diagnosis says
User :   acute and chronic inflammation with abscess formation in left axilla
Doctor :   I would advice you to get her examined by a general surgeon or a dermatologist, who can either remove the pus, completely via a minor procedure or treat the dermatitis condition
Doctor :   persistance of the infection, chronically can cause such a presentation
User :   we have shown to a no. of dermatologists in XXX and the pus was also removed during biopsy but the condition did not improve much
User :   i need to ask few questions related to her ongoing treatment?
Doctor :   Does she have similar lesions anywhere in the body ?
Doctor :   ok, please proceed ?
User :   no she hasn't any lesions anywhere
Doctor :   ok
User :   she has been taking dalacin c300 for the last 6 months and augmentin 625 for the last 2 months
User :   also with this dose is vizylac
User :   will it have harmful effects on the body in the long run??
Doctor :   no not as such
User :   ok...
User :   my another question pertains to a particular medicine...Rcin600
User :   The doctor gave this medicine one week ago....
Doctor :   rifampicin (U mean )
User :   yes...
Doctor :   ok
User :   the wound has shown improvement
User :   and now it has healed....but not sure for ever
User :   unless it does not reappear
Doctor :   ok
User :   because in the past also , it has healed many times but resurfaced whenever sweating and
User :   physical activity is done
User :   in excess
User :   the doctor suspected focussed tuberculosis and hence had recommended this medicine
Doctor :   ok , i guess her condition is Hydradenitis Suppurativa,
User :   his thought was that because pus is almost continuous in nature it might be focussed TB
Doctor :   where in sweat can cause infection to increase in the sweat & hair follicles and then reactivate the infection.
Doctor :   So was any TB test , done , before starting the treatment ?
Doctor :   Do u have any query regarding the Rcin 600 ?
User :   yes the TB test was done.....maltova test ...but nothing came
Doctor :   ok, thats fine
User :   also biopsy did not show anything....but the doctor still suspects
User :   and hence he recommended Rcin
User :   Now what should we do??
Doctor :   ok , first of all, i feel that your wife is having a condition called hydradenitis suppurativa,
User :   okk.....
User :   even our doctor says it could be that
Doctor :   Hidradenitis suppurativa is a skin disease that most commonly affects areas bearing sweat glands or sebaceous glands, such as the underarms, breasts, inner thighs, groin and buttocks
User :   and all line of treatment was for this only
Doctor :   HS often goes undiagnosed for years because When they do see a doctor or medical practitioner, the disease is frequently misdiagnosed or prescribed treatments are ineffective, temporary and sometimes even harmful
User :   but since it did not yield any result , he tried Rcin
Doctor :   ok
User :   now what should we do...the doctor is also not confident
Doctor :   There is no known cure nor any consistently effective treatment
Doctor :   Carbon dioxide laser surgery is currently considered the last resort
User :   every time new medicines is tried which sometimes aggravates the problem ..once he gave sortet and that aggravated the problem
Doctor :   where the affected areas are excised, and the skin is grafted.
Doctor :   Surgery doesn't always alleviate the condition, however, and can be very expensive.
User :   so this means that there is no medicines available ??
Doctor :   treatments can be done withs teroid injections
Doctor :   vitamin A supplementation,
User :   could you please elaborate what these injections are and how they work ??
Doctor :   antiandrogen therapy , and Immunosuppression
Doctor :   Here these medications reduce the immune response and prevent the inflammatory response in the affected area
User :   it is looking very scary !
User :   are these safe///
User :   and what about long term implications ??
Doctor :   No its not scary, but there is need to be patient
Doctor :   these drugs dont have major side effects as they are given by local injections only to the affected site,
Doctor :   with minimal systemic absorption
User :   but why does biopsy not show this disease?
Doctor :   the biopsy has already given the diagnosis to be probably hydradenitis suppurativa, as considered by me
Doctor :   the findings in the biopsy are 50% -75 % classic to this condition
Doctor :   and also u have the classic finding, that the condition flares with stress and when sweating occurs
User :   also, none of the medicines showed any improvement but then RCIN shows improvment
User :   is this only incidental ??
Doctor :   Rcin has effects on anaerobic bacteria, seen in that area, due to superadded infection
User :   ok\
Doctor :   but the underlying condition, which causes the inflammation needs to be corrected
User :   ok
User :   so is there any point in continuing with the existing medicines ?
Doctor :   what i will advice you, is to see an experienced dermatologist, and ask him CO2 laser treatment, i possible to help u put
Doctor :   the existing medicines basically antibiotics will help to control the infection
Doctor :   may i know where u reside ?
User :   we have met two senior consultants in XXX and sir XXXXXXXX
Doctor :   ok ,
User :   who confidently started the treatment but of no avail....and now we are really drained
Doctor :   i understand,
User :   sorry i had to make payment...hence the delay
Doctor :   thats fine
User :   so as per you the only treatment is CO2 laser
Doctor :   yes, there are alternative medicines like immunosuppressives
Doctor :   But i would start with steroid injexctiions
User :   do you stay in XXX ?
Doctor :   No I practice in XXX
User :   ok....could you suggest some really understanding doctor in delhi
User :   who would understand our problem and effectively deal with it
Doctor :   You can try XXX
User :   could you name a doctor if it's ok
Doctor :   Can u give me some time
User :   yeah sure......
Doctor :   i can help u out by emailing you after i do some research
User :   ok. that's fine...
User :   my email id is YYYY@YYYY
User :   can i have yours??
Doctor :   YYYY@YYYY
User :   ok..thanks...
User :   i want to ask a basic question
User :   why she got this disease ?
Doctor :   give me a minute
User :   ok
Doctor :   i will include all details in the email
User :   ok...thanks
User :   please do tell me the approximate cost involved in the treatment you proposed
User :   she has been on medicine for past several months and now i have started to worry about its repurcussions...
Doctor :   sure
User :   the cost can you give a rough idea now ??
User :   also , the pain involved in CO2 surgery??
User :   or steroid injections....
Doctor :   the laser therapy can cost 4000 per session
Doctor :   steroids are cheap, less than 100 INR
User :   actually she is writing UPSC we need a treatment which does not hamper the study
User :   can steroids treat this fully ??
Doctor :   they can reduce the inflammation
User :   and the side effects if any and how many injections may be required??
Doctor :   one in 2-3 months
User :   if she takes injections and inflammation subsides...
User :   then is it ok even if the disease is inside the body ??
Doctor :   yes
User :   ok
Doctor :   as long as the inflammation is reduced ,its fine
User :   can laser therapy completely cure it ??
User :   approximately how many sessions would be required and how much time would be required for complete healing after the therapy
Doctor :   It depends
Doctor :   sometimes it can heal within 1 -2 sessions
Doctor :   but first start with steroid injections which may do the trick
User :   ok...
User :   but then she has to take this lifelong as it won't cure but only subside the inflammation ?
Doctor :   i will include some details of the treatment modalities as well as a list of dermatologists inXXX
Doctor :   no the steroid shots can be stoped once the inflammation is reduced and the area heals
User :   when she touches the inflammed area from where the pus exudes, she can feel a tube like inflammation inside
User :   we want to know what is that ? is it characteristic of this disease?
Doctor :   Please be patient and remember that all problems can be solved when u have confidence and be strong
Doctor :   yes
User :   yes...i understand....
User :   but she is really getting impatient
User :   and she has dealing with this pain for more than 3 years
User :   hence i am asking so many questions....
Doctor :   let me give u a few details on facing this issue
User :   and also none of the doctors have given assurance despite so much spending of effort , time and money...
User :   you are the first person to say this
User :   and also you could read the biopsy report in this light
Doctor :   A list of treatments that are possible
Changes include
Doctor :   diet avoiding inflammatory foods, foods high in refined carbohydrates.
Doctor :   Warm compresses , hydrotherapy,
Icing the inflamed area daily until pain reduction is noticed
Doctor :   Weight loss can also help
User :   ok
Doctor :   the best antibiotics = Rcin and clindamycin
Doctor :   steroid injections - into the lesion also help very well
Doctor :   vitamin A supplementation, can help in reducing the hyperkeratosis, and thick skin
Doctor :   IV infusion of medicines called anti-TNF-alpha drugs such as infliximab also help by immunosuppresion
User :   this means till now the treatment has been directionless......
Doctor :   No thats not the thing
Doctor :   i guess the doctors were trying to treat the most common condition , that is TB
Doctor :   even i would have done the same
Doctor :   but since i know that TB is not the cause, i then think of rare conditions
User :   so what made you think it isn't TB.....every doctor started with supritiva but then came to TB.....
User :   the XXX doctor concluded the first day with supritiva but then the medicines did not work
Doctor :   As ur history said that sweating increases the severity
User :   ohh
Doctor :   and as such the TB test was negative
User :   that is the crucial test
Doctor :   and then the biopsy findings are not specific to TB
User :   ok
User :   thanks a lot was really an eye opener
Doctor :   u r welcome
User :   are you a skin specialist ?
User :   or a surgeon ?
Doctor :   I am an Internal medicine specialist
User :   I would be eagerly waiting for your email....please suggest someone who would really be capable of treating it from its roots.
User :   just the way you suggested
Doctor :   ok
Doctor :   i will try to help u in anyway i can
User :   should we continue with the medicines ?
Doctor :   u can continue the Rcin
User :   currently she is on dalacin, rcin and augmentin and vizylac and also she applies sumag every morning and night
User :   on the inflammation
Doctor :   dalacin is also fine
Doctor :   she can take that as well
Doctor :   she is on the right regimen as far as medicines are concerned
User :   can we do away with dalacin as it is very costly ?...but not at the cost of her health
Doctor :   consult your doc, to change it to clindamycin
User :   our doc doesn't support us at all...i am sorry to say this but he is not open
User :   and does not answer our basic questions....
User :   could u suggest a medicine having cindamycin
Doctor :   dalacin is clindamycin
User :   yeah...but it is very costly.....
User :   is there any substitute ?
Doctor :   but there are generic versions which u can get it at the pharmacy
User :   for clindamycin doesn't have any...only pfizer manufactures it as per the pharmacy stores
Doctor :   clindamycin is the effective drug in case of skin infections
User :   okk....we will keep it....
User :   eagerly waiting for your when can i expect it ??
Doctor :   if the infection and inflammation has settled, then u can stop it later on
Doctor :   by 1-2 hrs
User :   great.....thanks a lot once again.....u seem god sent...good night...
Doctor :   please leave ur feedback as u log out,
User :   sure....bye
Doctor :   please u can contact via mail as well
Doctor :   bye for now
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