Brief Answer: Kindly send details and photographs Detailed Answer: Hello Mr. XXXXXXX XXXXXXX Welcome and thanks for posting your query to the forum. We tried to find out Dr. B S XXXXXXX in our forum but there is no doctor with above name, therefore I am given the opportunity to guide you regarding your skin condition. I have gone through your complete query and I am quite empathetic to all the problems you are facing. Though you have tried to give us best possible details, even then I would like to ask you certain important information from your side: - Do you have the problem only on lips or inside the mouth also. - Do you feel any problem in your mouth on eating spicy or sour food. - Have you had taken any medicine 9 months back before the starting of the skin problem or are you taking any other medication other than for skin problem. - Any other health problems or any specific points which is important to mention. - It would be best if you can send few good resolution picturea of the affected areas (lips, trunk and limbs) so that I can analyze it better. For that you have a feature to upload images by yourself at the right side of the query page. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia). Hope to hear soon from your side. Wish you good health. Regards. Dr Sanjay Kumar Kanodia MD (Dermatology & STD)

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Brief Answer: Lichen planus; simple condition and treatable Detailed Answer: Hi XXXXXXX Welcome again to the forum and thanks for intimating all the important information along with important pictures so that I can now guide you best regarding your condition. After thoroughly analyzing all the pictures I can make out that you have the condition of “Lichen planus” which is one of the very simple, treatable and curable skin condition. To tell you elaborately about your problem- Our skin is multilayered structure which is divided into epidermis and dermis. The epidermis is further divided into more layers. These layers are renewed regularly. Sometimes due to an autoimmune injury (production of antibodies against our skin) to these layers, there is an internal skin damage which is expressed in form of red to violaceous skin lesion which can occur at mucous membranes (inside the mouth or genitalia) and on skin surface. You must be wondering that what exactly caused the problem or what are the causative agents or why this kind of autoimmune injury developed. In most of the cases we are not able to find out the cause but in identifiable causes there are certain drugs and chemical agents. These chemical agents breaks the protective barrier and therefore the antibodies are formed against our own skin layers. In you I can correlate Nicotine gum as an important chemical factor started almost 3 months before the starting of the problem. Though it is not confirmatory but there are multiple reports of Lichen planus like problem after nicotine gums. So it would be worth if you can stop the gums for few weeks and observe the improvement accordingly. For the main part of treatment- If I were your dermatologist then would have preferably started with halobetasol cream first on the affected areas. Once there is decrease in the size and shape of the affected area in few weeks then would have shifted to moderate potency steroid such as mometasone for next few weeks and then maintained with low potency one such fluticasone cream. These creams do not cause any systemic problem if used properly. For oral therapy - Though oral steroids are the mainstay of treatment but are to be used judiciously and carefully. This is only required to halt the further progression. If you do not have any increase in new area then you need not to take the same. As scratching the skin induces formation of new lesions so in my experience for oral therapy antihistamine provides the best relief for relief. These drugs are safest of all and reduce the itch and an urge to scratch. If I were treating you then I would have preferred for loratadine tablet to relieve itching. You can start with one to two tablets if there is moderate itching and can be increased to 3 times if it is higher. I also suggest you to not to scratch the areas because of the reason told above. I quite often see your kind of problem and in most of the cases it gets completely alright in maximum of 2 years. It is not a lifelong problem and not at all life threatening too. So do not worry about any type of grave possibilities which never occurs. Do not take stress of any type as stress itself can aggravate the problem. I hope these information will relax your mind. I will glad to answer any further queries or if not then can close the discussion and rate the answer. "Wish you good health" Regards, Dr Sanjay Kumar Kanodia MD (Dermatology)

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Brief Answer: Meet your doctor and do give me a followup Detailed Answer: Hi XXXXXXX I am really happy to know that you are quite relaxed now. In India we see your kind of condition quite frequently and is totally treatable. I am also quite thankful to you for giving me due importance in your case and can take any brotherly suggestions from my side. Meet your doctor tomorrow and do give me a followup so that we can together solve your problem. You please take your time before closing the discussion. My whole hearted best wishes for early recovery, "Wish you good health" Regards, Dr Sanjay Kumar Kanodia MD (Dermatology)

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Brief Answer: prednisolone is the mainstay of therapy Detailed Answer: Hi XXXXXXX Thanks for your follow up. Your doctor has provided you a to the point treatment and is the mainstay of the therapy. As I suggested in previous mail that oral steroids are the mainstay of treatment and therefore you have been prescribed with the Omnacortil Tablets which contains prednisolone in it. Additionally DEXOMET contains topical steroid and teczine is an antihistamine. I would like to suggest you some modification and further guidance: - For the part of Omnacortil - I prefer to give it in morning time at 8:00 AM after heavy breakfast so that there is best effect as well less stomach irritation. I prefer to give it for 5 days a week and then stop it for 2 days so that there is less long term side effects of steroids. So if I were your treating dermatolofgist tehn would have given 40 mg for 5 days then 2 days stoppage and tehn restarted with reducing dose of 30 mg for next 5 days and so on. This type of therapy is known as "Weekly pulse therapy" which considered safer than continuous therapy. Take a lot of milk products along wiht steroid therapy so that the calcium balance can be maintained. - For DEXOMET - Apply it two times a day on te affected areas only. Do not over apply the aream as can cause atrophy of the skin on long term usage. A rule of thumb is that a pea size amount is sufficient for palm size area. So you can use it accrdinlgy. At night time application it would be better if you can do warm water compression before the application of the cream. As soon as you see decrease in redness in about 10 days then can apply for a single time on improved areas and then can apply on alternate day basis. - For Teczine - It is a very good antihistamine containing levocetrizine and provides good relief in itching. There is a mild sedation due to this tablet. So in those cases where there is feeling of mild sedation I prefer to use Loratadine (Claritin) rather than teczine. Do plenty of moisturization with bland petrolatum gelly or any other moisturizing cream so that affected areas remains hydrated and there is less urge to itch. Rest of the treatment is one of the best treatment and you can follow the suggestions accordingly. My whole hearted best wishes for early recovery, I will be glad to help any further. "Wish you good health" Regards, Dr Sanjay Kumar Kanodia MD (Dermatology)

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Brief Answer: consider light therapy as a reserve option Detailed Answer: Hi XXXXXXX As I told prednisolone is the mainstay of therapy, so it would be better if you can strictly and judiciously follow the same. Though this light treatment is good but is not the mainstay of the therapy. You can wait for some time and observe the results of the steroid therapy which will actually heal up your most of the lesions. In case if the recurrence are more or there is less effect of the same then we can consider light therapy as a reserve option. I hope all these information will relax you and help you at its best. In future if you want any suggestions or guidance then can ask me directly at: bit.ly/drsanjaykanodia "Wish you good health" Regards, Dr Sanjay Kumar Kanodia MD (Dermatology)

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