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Suggest treatment for skin allergy

DOCTOR OF THE MONTH - Feb 2018
Feb 2018
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Answered by

General Surgeon
Practicing since : 1984
Answered : 16001 Questions
Question
Hi again Dr. Chandrakant,

Thanks for answering my question a couple weeks ago, it was very helpful.

I have another question. My husband has been suffering with a condition that has affected him for the last 35 years or so. He has some problems with the skin on his fingertips, most predominantly his thumbs; but it affects the index fingers and some others as well. He is 66 years old and is in good health. His AiC is an average of 5.6. He keeps his glucose under 125, sometimes its lower, and eats a strict diet that is very healthy. No insulin. No metformin or other diabetes pills. When he was a younger man, he worked as a pool technician and came in contact with chlorine gas throughout the course of his work during those years (and other chemicals such as soda ash, borax, and cyaneric (sp?) acid.) My husband has consulted with dermatologists throughout the years and when he lived in XXXXXXX Nebraska he went to a Univ. teaching hospital to try to get help with this problem. He was also worked up by allergists at the same facility. It causes enormous pain and disability sometimes. He had a lot of different types of treatment. He has had UV treatment, prednisone, other types of topical cortisone/steroid treatments and other creams such as clobetasol proprionate, steroid shots, he has wrapped his hands in saran wrap and worn gloves, both plastic and cotton with creams of all sorts to treat the condition overnight - none of the treatments have made any difference whatsoever. Sometimes he has brief remissions and the minute he uses his hands to try to open something or use a tool or he abrades it in any way, it cracks and bleeds and he's disabled. What do you think of this picture and what would you recommend that he do next to try to solve this puzzling and painful riddle?
Thank you, doctor, I am deeply appreciative when you have time to respond to this complex set of factors.
Sincerely,
XXXXX and XXXXXXX XXXXXXX (patient)
Posted Sun, 17 Aug 2014 in Lump
 
 
Answered by Dr. T Chandrakant 9 hours later
Brief Answer:
please post the Photograph with this query.

Detailed Answer:
Hi XXXXXXXXXXX .
Sincere thanks for your appreciation and faith.
This history is classical of the FDR- we call this as Fixed Drug Reaction but in your husband's case there is no drug but instead is a chemical or group of chemicals which have for a fixed chemical reaction causing a permanent change in the milieu if the skin and the underlying structures.
Read the whole set of treatments Mr XXXXXXX XXXXXXX has undergone. Yes you have tried almost everything.
I would have been happy to get the actual photograph of the fingers.

I would suggest the following based on your history and description and may help.
Vitamin A and D in therapeutic doses preferably single shots.
Stop all other treatments.
Please take a notebook and start noting which of the contacts triggers or increases the problem, This is going to be the list of the objects he is not supposed to touch at all- Remember, the dictum is avoid the allergens. This includes soaps and everything, even the preservatives in foods , beverages also can cause this. This is very important exercise.

You can try only one cream- Urea cream, I am sorry that I can not tell in what name it would be available at your place, you may please ask the pharmacy nearby. This is applied only at bed times when in problem. IT may be available in the name of Cotaryl ( I will also try to find out).
This is the only cream that may help in long term.

Keep the diabetes well under control as is kept now.


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