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Dr. Andrew Rynne

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Exp 50 years

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Have itchy white patch on knee and elbow. Not cured by medicine. Suggest effective medicine

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Dr. Kalpana Pathak

Dermatologist

Practicing since :2006

Answered : 2015 Questions

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Posted on Thu, 7 Feb 2013 in Skin Hair and Nails
Question: Hello Doctor

I have this strange white flakish path on my knee which is very itchy. I have similar path on my elbow as well. I have applied clobetasal + calcitrol ointment which I had been given for a different problem but it is not having any effect at all. In fact both these regions have been growing slowly and itch has been increasing.
Please see the attached pics and help me with diagnosis and line of treatment,

Regards
doctor
Answered by Dr. Kalpana Pathak 1 hour later
Hi XXXXXXX

Thanks for writing to us.

Red, itchy elevated thick scaly lesions over knees and elbows could be due to
1) Psoriasis
2) Another possibility could be lichen planus; however it rarely occurs over the knees and elbows
3) It could also be another entity - pityriasis rubra Pilaris.

You have uploaded three images of which only last one is clear and the lesion in that image looks like psoriasis.

The treatment that you are taking is quite effective for psoriasis. If the lesions are too itchy, you may take cetrizine after discussing with your current treating doctor.

I would like to know
A) How often have you been applying these medicines and since how long?
B) Why were these medicines prescribed to you?
C) What are the other areas involved and since how long are you having these lesions?

Hoping to hear from you soon...

Take care


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kalpana Pathak 9 hours later
Hello Doctor

These medicines were prescribed to me for psoriasis which used to occur on my fingers leading to itching and painful cracks in the fingers.

The patches now I have on knee and elbows at least look very different from those I used to have on fingers. One essential feature of my problem on fingers was that the patches would crack up and become very painful. This medication has proven to be very effective for my fingers' problem. However, it is not having any effect on the knees and elbows.

I am applying these about once daily.

Apart from elbows and knees, sometimes XXXXXXX also develops similar itchy patch but currently it is not there.

Regards
doctor
Answered by Dr. Kalpana Pathak 2 hours later
Hi XXXXXXX
Thanks for writing back.

The lesions of psoriasis manifests itself as thick, raised, red itchy, scaly lesions over body, face and scalp. However, over palms and soles, these present itself as thickening of skin along with fissuring and cuts. You might also notice few nail changes like small pits, discoloration of nail, longitudinal lines etc.

The involvement of palms and soles, knees, elbows and shins along with the image you have sent points towards psoriasis.

To treat the same-
Continue with the same topical treatment of clobetasol- calcitriol combination; however, it should be used twice over your knee and elbow lesions.
Continue with moisturex, it is a moisturising cream with urea and lactic acid having very good results in extremely dry skin
If the lesions are very itchy, you may take oral cetirizine.
Use a mild hydrating soap like cetaphil or dove soap bar and always hydrate your skin immediately after bathing to lock in moisture.

If you feel that with sorvate c, you are not having much response, one may also try steroid and salicylic acid ointment under occlusion over body lesions. The same combination should not be used over hands if having fissures or cuts as salicylic acid will irritate the skin.
Always keep an eye on psoriasis lesion because if you feel the number is increasing rapidly and if other body areas are getting involved the treatment regime would be changed.

I would also advise you to contact your dermatologist, as these being prescription drugs should always be applied or taken under a doctor's follow up.

Psoriasis is a chronic skin disease with periods of remission and relapse, a little bit of patience and compliance with medicines is expected.

Hope that answers your query.
Wish you a speedy recovery.

Above answer was peer-reviewed by : Dr. Shanthi.E
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