question-icon

This Is On Behalf Of My Father-in-law. He Is 83

default
Posted on Tue, 11 Aug 2020
Question: This is on behalf of my father-in-law. He is 83 years old. He has a history of cardiac issues and has a pacemaker. He also had angioplasty twice and has stents in his arteries.

Regular medicines he takes: ecospirin 75, plavix 75, roseday 10, olsara 20, pan 40, and vertin 8 mg

Last month he had a fall and had to have a surgery in his hip. He has since been bed bound only.

Now he has extensive rashes and severe itching all over his body. (Appears to have red lesions all over) These were present even before the surgery but much lesser than now. Over last two weeks this has become very severe - there is uncontrollable itching, bleeding (due to scratching), and now blisters in several places all over (hands, legs, armpits, backside (on sitting place)) and spreading more. The blisters break and there is a foul smell. I have attached some pictures to show. Skin peels off and falls as flakes while scratching.

He consulted a doctor online (not able to visit hospital due to Covid situation in city) 10 days back and was given medicine as follows: Zydip lotion (twice a day), tab LCZ 5mg (twice), tab Defcort 6mg (once) - all to be taken for 14 days. (Diagnosis was disseminated eczema). However, there is no improvement and it seems to be worsening with more blisters coming.

He is also very weak, and bed bound and finds it difficult even to sit up. (He used to be able to walk around the house before the surgery). He has a catheter for passing urine, since his surgery last month. He also had chills and feels dizzy while standing up. (his sodium levels are on the lower side - 127).

My questions:

1. What to do now? Any different medicines? How to control the itching and blisters?

2. Is this eczema or can it be a sign of some other underlying illness?

3. Should he try to go to a hospital as an emergency case? Can this develop into more serious illness? Hospital outpatient clinics may not be open there. (he is staying in Thakurli (Thane dist) near Mumbai).

Thank you.
default
Follow up: Dr. Dr. Kakkar (0 minute later)
This is on behalf of my father-in-law. He is 83 years old. He has a history of cardiac issues and has a pacemaker. He also had angioplasty twice and has stents in his arteries.

Regular medicines he takes: ecospirin 75, plavix 75, roseday 10, olsara 20, pan 40, and vertin 8 mg

Last month he had a fall and had to have a surgery in his hip. He has since been bed bound only.

Now he has extensive rashes and severe itching all over his body. (Appears to have red lesions all over) These were present even before the surgery but much lesser than now. Over last two weeks this has become very severe - there is uncontrollable itching, bleeding (due to scratching), and now blisters in several places all over (hands, legs, armpits, backside (on sitting place)) and spreading more. The blisters break and there is a foul smell. I have attached some pictures to show. Skin peels off and falls as flakes while scratching.

He consulted a doctor online (not able to visit hospital due to Covid situation in city) 10 days back and was given medicine as follows: Zydip lotion (twice a day), tab LCZ 5mg (twice), tab Defcort 6mg (once) - all to be taken for 14 days. (Diagnosis was disseminated eczema). However, there is no improvement and it seems to be worsening with more blisters coming.

He is also very weak, and bed bound and finds it difficult even to sit up. (He used to be able to walk around the house before the surgery). He has a catheter for passing urine, since his surgery last month. He also had chills and feels dizzy while standing up. (his sodium levels are on the lower side - 127).

My questions:

1. What to do now? Any different medicines? How to control the itching and blisters?

2. Is this eczema or can it be a sign of some other underlying illness?

3. Should he try to go to a hospital as an emergency case? Can this develop into more serious illness? Hospital outpatient clinics may not be open there. (he is staying in Thakurli (Thane dist) near Mumbai).

Thank you.
doctor
Answered by Dr. Dr. Kakkar (1 hour later)
Brief Answer:
Regarding infected eczema

Detailed Answer:
Hello and welcome to ask a doctor service..I have gone through your query and viewed the images.

In addition to the existing treatment I would like to add oral antibiotics e.g Amoxicillin with clavulanic acid for a week to help with secondary infection/ oozing of eczema. I would also like to add oral hydroxyzine 25mg, three times a day for his itching. The dose of deflazacort is too low to be effective. One needs to give at least 4 times this dose to have some effect. Topically, condy's compresses and a moderately potent steroid and antibiotic combination cream like betamethasone valerate + fusidic acid or mometasone furoate + fusidic acid cream combination would be preferable. You can discuss with your treating doctor regarding these changes.

Hope I have answered your query. Let me know if you need any more assistance.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Dr. Kakkar (0 minute later)
Brief Answer:
Regarding infected eczema

Detailed Answer:
Hello and welcome to ask a doctor service..I have gone through your query and viewed the images.

In addition to the existing treatment I would like to add oral antibiotics e.g Amoxicillin with clavulanic acid for a week to help with secondary infection/ oozing of eczema. I would also like to add oral hydroxyzine 25mg, three times a day for his itching. The dose of deflazacort is too low to be effective. One needs to give at least 4 times this dose to have some effect. Topically, condy's compresses and a moderately potent steroid and antibiotic combination cream like betamethasone valerate + fusidic acid or mometasone furoate + fusidic acid cream combination would be preferable. You can discuss with your treating doctor regarding these changes.

Hope I have answered your query. Let me know if you need any more assistance.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
default
Follow up: Dr. Dr. Kakkar (2 hours later)
Thank you, Doctor, for your prompt response. Please help me with my following queries:

1. Can I get a prescription for the medicine mentioned by you, as the pharmacy here may need one to give us the medicine.

2. You mentioned, infected eczema - does this mean that he had eczema and then it got infected by bacteria/virus? What is the consequence of this? Is it worse than normal eczema?

3. Can this aggravate his cardiac condition? Is it anyway related to that? Should he also consult his cardiologist about this?

Thank you.
default
Follow up: Dr. Dr. Kakkar (0 minute later)
Thank you, Doctor, for your prompt response. Please help me with my following queries:

1. Can I get a prescription for the medicine mentioned by you, as the pharmacy here may need one to give us the medicine.

2. You mentioned, infected eczema - does this mean that he had eczema and then it got infected by bacteria/virus? What is the consequence of this? Is it worse than normal eczema?

3. Can this aggravate his cardiac condition? Is it anyway related to that? Should he also consult his cardiologist about this?

Thank you.
doctor
Answered by Dr. Dr. Kakkar (11 hours later)
Brief Answer:
Regarding infected eczema

Detailed Answer:
hi.
By infected eczema, I mean that it has superimposed bacterial infection. It needs an oral antibiotic in addition to treatment for eczema. My concern is his recent hip surgery since oral steroids may hinder healing. You need to talk to his orthopedics doctor if it would be ok to give a 2-4 week course or deflazacort 24-30mg and whether it would affect his hip replacement. Also talk to his cardiac surgeon and ask him to opine if taking a higher dose of deflazacort would affect his cardiac condition. As far as prescription is concerned, yes you would need it. You may talk to a doctor in your vicinity or follow up with the one you already consulted earlier after discussing about a higher dose of deflazacort with him in tandem with orthopedic and cardiac surgeon.
Take care.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Dr. Kakkar (0 minute later)
Brief Answer:
Regarding infected eczema

Detailed Answer:
hi.
By infected eczema, I mean that it has superimposed bacterial infection. It needs an oral antibiotic in addition to treatment for eczema. My concern is his recent hip surgery since oral steroids may hinder healing. You need to talk to his orthopedics doctor if it would be ok to give a 2-4 week course or deflazacort 24-30mg and whether it would affect his hip replacement. Also talk to his cardiac surgeon and ask him to opine if taking a higher dose of deflazacort would affect his cardiac condition. As far as prescription is concerned, yes you would need it. You may talk to a doctor in your vicinity or follow up with the one you already consulted earlier after discussing about a higher dose of deflazacort with him in tandem with orthopedic and cardiac surgeon.
Take care.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Dr. Kakkar

Dermatologist

Practicing since :2002

Answered : 9600 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

152 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
This Is On Behalf Of My Father-in-law. He Is 83

This is on behalf of my father-in-law. He is 83 years old. He has a history of cardiac issues and has a pacemaker. He also had angioplasty twice and has stents in his arteries. Regular medicines he takes: ecospirin 75, plavix 75, roseday 10, olsara 20, pan 40, and vertin 8 mg Last month he had a fall and had to have a surgery in his hip. He has since been bed bound only. Now he has extensive rashes and severe itching all over his body. (Appears to have red lesions all over) These were present even before the surgery but much lesser than now. Over last two weeks this has become very severe - there is uncontrollable itching, bleeding (due to scratching), and now blisters in several places all over (hands, legs, armpits, backside (on sitting place)) and spreading more. The blisters break and there is a foul smell. I have attached some pictures to show. Skin peels off and falls as flakes while scratching. He consulted a doctor online (not able to visit hospital due to Covid situation in city) 10 days back and was given medicine as follows: Zydip lotion (twice a day), tab LCZ 5mg (twice), tab Defcort 6mg (once) - all to be taken for 14 days. (Diagnosis was disseminated eczema). However, there is no improvement and it seems to be worsening with more blisters coming. He is also very weak, and bed bound and finds it difficult even to sit up. (He used to be able to walk around the house before the surgery). He has a catheter for passing urine, since his surgery last month. He also had chills and feels dizzy while standing up. (his sodium levels are on the lower side - 127). My questions: 1. What to do now? Any different medicines? How to control the itching and blisters? 2. Is this eczema or can it be a sign of some other underlying illness? 3. Should he try to go to a hospital as an emergency case? Can this develop into more serious illness? Hospital outpatient clinics may not be open there. (he is staying in Thakurli (Thane dist) near Mumbai). Thank you.