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Dr. Andrew Rynne

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Proper diagnosis for mucha habermans disease?

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Dr. Sudarshan

Dermatologist

Practicing since :2005

Answered : 1391 Questions

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Posted on Mon, 28 Jan 2013 in Skin Hair and Nails
Question: Good Afternoon! I am male, 59 years old, controlled hypertension, retired Dentist and just read an article on Mucha-Habermann Disease in a young athlete in N.J. I have not been able to get a definitive diagnosis after many visits to Dermatologists, Internists, etc. My symptoms SCREAM of every detail I can find related to this disease. Retired, with only the income from a new business, my funds are quite limited. Where in the Chicago area might I find a research program to enter into? Your help is appreciated. There is little doubt in my mind that this is the definitive diagnosis...possibly a classic version of it.
doctor
Answered by Dr. Sudarshan 6 hours later
Hi XXXXXXX,

Thanks for writing in.
Mucha habermans disease or Pityriasis Lichenoides et Varioliformis Acuta
(PLEVA) is a parapsoriasis.
The lesions most often appear on the trunk and the arms and legs. Lesions tend to develop in small groups. Mucha-Habermann disease most often affects children or young adults. A more severe variant of this disorder, known as febrile ulceronecrotic Mucha-Habermann disease, can cause life-threatening complications in adults.
Do your symptoms match this?

The disease takes a chronic form in adults known as Pityriasis lichenoides chronica.
It has waxing and waning cource with reddish elevated skin lesions over extremities which heal on itself leaving hypopigmented marks.
However treatments are available to treat it and control it.
Phototherapy is found to be safe and effective.

If you can detail your symptoms and upload few photos of affected area It will be of great help in predicting the condition .

I will be available for follow up.
Hope this helps.

Regards.
DrSudarshan
MD
Dermatology.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 18 hours later
Greetings Dr. Sudarshan-
Symptoms started about two year ago (Feb 2011) when I noticed small pinpoint lesions on my thighs and legs. At first I thought that they might be insect bites of some sort. No real itchiness, but when I did scratch them, there was an immediate white flake that would detach from the underlying tissue, and the larger ones would bleed instantly. Clotting time seems normal, but as is obvious from the pictures, they seem to stop organizing after the clot forms...so there is no complete healing. One very noticeable attribute of the clot is that it seems to be much more strongly attached to the underlying tissue. No pain associated with it, other than the expected mental anguish of being in a unique malady. I scratch in my sleep which I think is more reflex habit than having to relieve an itch. Scalp is involved on the sides and back of my head where there is still hair left. Hope the symptomology will help you in your opinions. I spoke with my Pharmacist regardign methotrexate treatment. I know I have to do what I have to do, but can the oral administration be as effective as the injections? I don't do real well with the whole needle scene. Look forward to hearing from you.
Thank you!
XXXXXXX
doctor
Answered by Dr. Sudarshan 18 hours later
Hi XXXXXXX,
Thanks for the details and images.
After going through the images it feels that you have got psoriasis vulgaris rather than
anything else.

It is a common condition and can be treated effectively.
Methotrexate is very effective drug for treatment.Oral dosage is as effective as injectable.My recommendation would be to go for 7.5 mg of methotrexate per week orally.Oral administration is safe and as effective as injectable.Haemoglobin levels and cell counts have to be monitored every 15 days.
Oral methotrexate is safe effective and cheaper.
Along with this oral antibiotics and topical steroids will be helpful.

There is nothing to be worried and the condition will improve significantly after starting treatment.

Hope this helps.
I will be available for follow up.

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