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What Causes Dry Lips And Severe Itching In Shoulder While On Isotretinoin?
Question: Hello doctor I m a 27 year male from XXXXXXX One month before I had protected oral sex with a csw girl in malaysia. During oral sex she licked my scrotum several times. After my exposure I am very much worried about hiv. 7 days from exposure a small red painless dot appeared on my inner thigh and abdomen area. I consulted a dermatologist and explained him about my exposure. He advised me that the rashes look like scabies. He advised me to take a hiv test to relieve from my anxiety. I took a hiv pcr rna real time test on 12 days from exposure and the result came as target not detected. After 10 days from exposure the rashes in thigh and abdomen disappeared and pimples like dots started coming in shoulder and chest area. It started growing in numbers and again I consulted a dermatologist and he advised Me to take vdrl test, hepatitis test and hiv test to relieve from my stress. I took hiv pcr rna real time test on 21 days from exposure and the result came as target not detected. I also took the vdrl and hepatitis test and all the result came as negative. I again took a hiv cmia duo test on 25 th day from exposure and the result came as non reactive. After 25 days from my exposure I started to take Isotretinoin tablet 20 mg for acne as suggested by dermatologist and after taking the tablets the acnes in shoulder and chest reduced. i took the tabs for 12 days. from 10 days i started to have a very dry lips and the skin started to peel off in lips and 5 days after that i stated to have severe itching in the shoulder and chest where the ACNES was there and now i am having a rash like thing in shoulder,chest and neck areas. i have attached the images of the rash after tablets. what"s the reason for this dry lips and rash? are these symptoms of any std or hiv? pls advice doctor
Brief Answer:
Dry lips & rash are known side effects of isotretinoin, not due to hiv/std
Detailed Answer:
Hi
Thanks for being at healthcaremagic
I am Dr Asmeet Kaur Sawhney, a dermatologist.
I have gone through your entire history and you should not take stress regarding HIV infection as you have not contracted the infection.
All your tests are negative which further favours that you haven't contracted the infection.
I have reviewed the attached photograph and you are having acne.
Dry lips and rash on the skin are known side effects of isotretinoin capsule.
Isotretinoin is known to cause these side effects.
These can be avoided by reducing the dose of isotretinoin and using a moisturising cream on the lips and the areas where the rash has occurred.
These are not the symptoms of any std infection or hiv infection.
Regards
Dr Asmeet
Dry lips & rash are known side effects of isotretinoin, not due to hiv/std
Detailed Answer:
Hi
Thanks for being at healthcaremagic
I am Dr Asmeet Kaur Sawhney, a dermatologist.
I have gone through your entire history and you should not take stress regarding HIV infection as you have not contracted the infection.
All your tests are negative which further favours that you haven't contracted the infection.
I have reviewed the attached photograph and you are having acne.
Dry lips and rash on the skin are known side effects of isotretinoin capsule.
Isotretinoin is known to cause these side effects.
These can be avoided by reducing the dose of isotretinoin and using a moisturising cream on the lips and the areas where the rash has occurred.
These are not the symptoms of any std infection or hiv infection.
Regards
Dr Asmeet
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks doctor for your valuable reply
I consulted two dermatalogists regarding the acne like
eruptions in shoulder and chest but they are not sure of the reason for the acnes? they initially decided it as due to scabies.
they are finally of the opinion that it may be due to psoriasis or due to hormonal changes.
i am very much worried regarding the acne like erupions.noe the acnes like eruptions have decreased and now i am having rash like thing on
the same areas where i had the acnes i.e; on chest, shoulder and neck and it is very much itching.
1. are these rashes due to isotretinoin tablets? will the rashes caused by isotretinoin be itchy?
2. what is the actual reason for acne like eruptions in my body with out a single acne or pimple on face?
3. i took a hiv duo test on 37 days from exposure and the result is non reactive.how far is this test result reliable after 5 weeks?
4. my doctor advised me that i am completely 100 percent free from hiv 1 infection due to negative test results of hiv pcr @ 12, 21 days, duo test
@ 25, 37 days, tridot test @ 35 days. how far are my test results conclusive regarding hiv1 infection?
5. He adviced me to do a hiv2 pcr to rule out hiv2 also just to relieve from my anxiety and he is sure there is no chance for hiv2 infection
what are the chances of hiv 2 infection from my exposure? is there any possiblity of hiv 2 from protected oral? please answer my queries doctor.
I consulted two dermatalogists regarding the acne like
eruptions in shoulder and chest but they are not sure of the reason for the acnes? they initially decided it as due to scabies.
they are finally of the opinion that it may be due to psoriasis or due to hormonal changes.
i am very much worried regarding the acne like erupions.noe the acnes like eruptions have decreased and now i am having rash like thing on
the same areas where i had the acnes i.e; on chest, shoulder and neck and it is very much itching.
1. are these rashes due to isotretinoin tablets? will the rashes caused by isotretinoin be itchy?
2. what is the actual reason for acne like eruptions in my body with out a single acne or pimple on face?
3. i took a hiv duo test on 37 days from exposure and the result is non reactive.how far is this test result reliable after 5 weeks?
4. my doctor advised me that i am completely 100 percent free from hiv 1 infection due to negative test results of hiv pcr @ 12, 21 days, duo test
@ 25, 37 days, tridot test @ 35 days. how far are my test results conclusive regarding hiv1 infection?
5. He adviced me to do a hiv2 pcr to rule out hiv2 also just to relieve from my anxiety and he is sure there is no chance for hiv2 infection
what are the chances of hiv 2 infection from my exposure? is there any possiblity of hiv 2 from protected oral? please answer my queries doctor.
Brief Answer:
Isotretinoin causes itchy rashes, acne due to hormonal changes
Detailed Answer:
Hi,
Yes these rashes are due to isotretinoin. It can cause these kind of itchy rashes.
These rashes are due to hormonal changes in the body. It is quite common that patients have acne on the chest, shoulders, back and arms without any lesions on the face.
The tests are 99.9 percent reliable at 5 weeks. To be 100 percent sure you can go for ELISA test for HIV 1 and 2 at 12 weeks. It is advocated by WHO as absolutely confirmatory for HIV.
There are no chances of your contracting infection from protected oral intercourse. You can just get an ELISA test at 12 weeks to relieve your anxiety.
Thank you
Isotretinoin causes itchy rashes, acne due to hormonal changes
Detailed Answer:
Hi,
Yes these rashes are due to isotretinoin. It can cause these kind of itchy rashes.
These rashes are due to hormonal changes in the body. It is quite common that patients have acne on the chest, shoulders, back and arms without any lesions on the face.
The tests are 99.9 percent reliable at 5 weeks. To be 100 percent sure you can go for ELISA test for HIV 1 and 2 at 12 weeks. It is advocated by WHO as absolutely confirmatory for HIV.
There are no chances of your contracting infection from protected oral intercourse. You can just get an ELISA test at 12 weeks to relieve your anxiety.
Thank you
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks doctor. Is there any possibility of any other std from my exposure. Now my dry lips have been cured and today I noticed a white sore inside my mouth and it is in lower chin area I.e, opposite to lower teeth row gums. Is this a side effect of isotretinion tablet. I stopped the tablet usage 10 days before itself.the rashes also appeared after stopping the tablet. Will side effects appears after ten days stopping the tablet. Please clarify doctor.
Brief Answer:
There is no possibility of any other std after your sexual exposure
Detailed Answer:
Hi
You don't seem to be exposed to any other std after your sexual contact.
Yes these side effects like sore and rashes can even occur after few days of stopping the medicine though your sore can be due to other reasons as well like any stress or nutritional deficiencies .
There is no possibility of any other std after your sexual exposure
Detailed Answer:
Hi
You don't seem to be exposed to any other std after your sexual contact.
Yes these side effects like sore and rashes can even occur after few days of stopping the medicine though your sore can be due to other reasons as well like any stress or nutritional deficiencies .
Above answer was peer-reviewed by :
Dr. Prasad
Thanks doctor for your patience and reply.
1. Is my hiv 1 negative result conclusive from my various test results?
2.I took a differential blood test on 9th day from my exposure and in that test result the lymph percentage was 32.8 percentage and again I took a differential blood test on 35 th day from my exposure and in that test result the lymph percentage was 45 percentage. What's the reason for this rise in lymph percentage?
3. Is the rise in lymph percentage indicates any viral infection?
4. I took a hiv pcr test on 21 day and the result is negative. I took a hiv duo test on 25th and 37th day and both the results are negative with values 0.09 and 0.06. Are these results conclusive that I m 100percent free from hiv1 ?
6. How much percent is my hiv duo test results on 25, 37 days reliable regarding hiv 2 detection?
7.Will herpes zoster, syphilis, any other std causes rashes and increase in lymph percentage? What's the reason for my sudden increase in lymph percentage?
Pls answer my questions doctor. Sorry to disturb you again and again with the same questions. Please help me doctor.
1. Is my hiv 1 negative result conclusive from my various test results?
2.I took a differential blood test on 9th day from my exposure and in that test result the lymph percentage was 32.8 percentage and again I took a differential blood test on 35 th day from my exposure and in that test result the lymph percentage was 45 percentage. What's the reason for this rise in lymph percentage?
3. Is the rise in lymph percentage indicates any viral infection?
4. I took a hiv pcr test on 21 day and the result is negative. I took a hiv duo test on 25th and 37th day and both the results are negative with values 0.09 and 0.06. Are these results conclusive that I m 100percent free from hiv1 ?
6. How much percent is my hiv duo test results on 25, 37 days reliable regarding hiv 2 detection?
7.Will herpes zoster, syphilis, any other std causes rashes and increase in lymph percentage? What's the reason for my sudden increase in lymph percentage?
Pls answer my questions doctor. Sorry to disturb you again and again with the same questions. Please help me doctor.
Brief Answer:
Details below
Detailed Answer:
Yes according to all the tests you have undergone it is almost conclusive that you are HIV 1 negative.
You definitely have a rise in lymphocyte count but it is not very high to suggest any specific infection.
This much variation can occur from mild changes taking place in the body.
This much rise in lymphocyte count is not significant enough to warrant any further tests or treatment.
The tests including the duo tests are conclusive of your being HIV 1 negative.
Even the duo tests are conclusive of HIV 2 infection upto 99.5 percent.
The only thing is that WHO recommends to go for ELISA test for HIV 1 and 2 at 12 weeks which they consider as confirmatory of hiv status.
Herpes zoster, syphillis and other stds cause rashes but they have different clinical presentations and they are not associated with increased lymphocyte counts.
I hope to have answered your query and would be happy to clarify any further doubts.
Details below
Detailed Answer:
Yes according to all the tests you have undergone it is almost conclusive that you are HIV 1 negative.
You definitely have a rise in lymphocyte count but it is not very high to suggest any specific infection.
This much variation can occur from mild changes taking place in the body.
This much rise in lymphocyte count is not significant enough to warrant any further tests or treatment.
The tests including the duo tests are conclusive of your being HIV 1 negative.
Even the duo tests are conclusive of HIV 2 infection upto 99.5 percent.
The only thing is that WHO recommends to go for ELISA test for HIV 1 and 2 at 12 weeks which they consider as confirmatory of hiv status.
Herpes zoster, syphillis and other stds cause rashes but they have different clinical presentations and they are not associated with increased lymphocyte counts.
I hope to have answered your query and would be happy to clarify any further doubts.
Above answer was peer-reviewed by :
Dr. Prasad
Thanks doctor.
1. What would be the reason for my sudden increase in lymph percentage?
2. I have been using accutane tablet for ten days when taking the second differential blood test. Will accutane drug causes a elevation in lymph percentage?
3. What are the possible causes for sudden increase in lymph percentage? Is increase in lymph percentage a symptom of hiv infection?
4. I am very much worried after the increase in lymph percentage. Is that a sign of initial hiv infection? I had hiv rna pcr test in 12 and 21 days from exposure. Will there be enough viral present at that time .my test limit of detection is 40 ml. At how many days is a hiv pcr test conclusive?
5. Will hiv1 pcr test show if hiv 2 is present in blood? Please advice me doctor. I am very much confused after seeing this increase in lymph percentage. Pls clarify .
1. What would be the reason for my sudden increase in lymph percentage?
2. I have been using accutane tablet for ten days when taking the second differential blood test. Will accutane drug causes a elevation in lymph percentage?
3. What are the possible causes for sudden increase in lymph percentage? Is increase in lymph percentage a symptom of hiv infection?
4. I am very much worried after the increase in lymph percentage. Is that a sign of initial hiv infection? I had hiv rna pcr test in 12 and 21 days from exposure. Will there be enough viral present at that time .my test limit of detection is 40 ml. At how many days is a hiv pcr test conclusive?
5. Will hiv1 pcr test show if hiv 2 is present in blood? Please advice me doctor. I am very much confused after seeing this increase in lymph percentage. Pls clarify .
Brief Answer:
Rise in lymphocyte count could be due to isotretinoin therapy.
Detailed Answer:
Hi
Rise in lymphocyte count could be due to isotretinoin therapy.
Though it is a rare but a reported side effect of isotretinoin.
Other causes of rise in lymphocyte counts could be any viral infection like glandular fever, hepatitis, protozoal diseases, chronic bacterial infections like tuberculosis and smoking.
Increase in lymphocyte count is not a symptom of HIV infection.
In HIV there is initial decrease in lymphocyte count followed by rise in lymphocyte count.
Moreover in HIV the subtypes of lymphocytes like CD4 T cell and CD8 T cell are to be measured.
Simply doing differential leukocyte count doesn't provide much information.
HIV pcr test is conclusive at 2 weeks. There will be enough viral load by that time for it to be conclusive of HIV infection.
HIV 1 PCR won't detect the presence of HIV 2 PCR.
I don't think you need to worry about your lymphocyte count as it is not significantly increased and moreover in HIV infection there is initial decrease in lymphocyte count rather than increase.
Regards
Rise in lymphocyte count could be due to isotretinoin therapy.
Detailed Answer:
Hi
Rise in lymphocyte count could be due to isotretinoin therapy.
Though it is a rare but a reported side effect of isotretinoin.
Other causes of rise in lymphocyte counts could be any viral infection like glandular fever, hepatitis, protozoal diseases, chronic bacterial infections like tuberculosis and smoking.
Increase in lymphocyte count is not a symptom of HIV infection.
In HIV there is initial decrease in lymphocyte count followed by rise in lymphocyte count.
Moreover in HIV the subtypes of lymphocytes like CD4 T cell and CD8 T cell are to be measured.
Simply doing differential leukocyte count doesn't provide much information.
HIV pcr test is conclusive at 2 weeks. There will be enough viral load by that time for it to be conclusive of HIV infection.
HIV 1 PCR won't detect the presence of HIV 2 PCR.
I don't think you need to worry about your lymphocyte count as it is not significantly increased and moreover in HIV infection there is initial decrease in lymphocyte count rather than increase.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks doctor.
1. U have adviced that there will be a initial decrease in lymph percentage in hiv infection. But in many websites they have told that if there is a viral infection and if the immune system is fighting that then there will be a increase in lymph percentage. Hiv is a virus is that not applicable for hiv infection?
2. you advised that the lymph percentage decrease in initial hiv infection I.e. Will the lymph percentage decreases if the hiv infection occurs with in 40 days of virus entering body?
3. What are the std causes a increase in lymph percentage?
4. I am first diagnosed as having scabies by my doctor then he gave the opinion that the acne like rashes are due to hormone change. Will scabies cause a increase in lymph percentage?
5. What are the protozoa disease causes skin infection that resembles pimples. My pimple like eruptions didn't itch and pain and the rashes which was caused after isotretinion only itched. What are the protozoa disease that causes a non itchy rashes? Please advice me doctor .
1. U have adviced that there will be a initial decrease in lymph percentage in hiv infection. But in many websites they have told that if there is a viral infection and if the immune system is fighting that then there will be a increase in lymph percentage. Hiv is a virus is that not applicable for hiv infection?
2. you advised that the lymph percentage decrease in initial hiv infection I.e. Will the lymph percentage decreases if the hiv infection occurs with in 40 days of virus entering body?
3. What are the std causes a increase in lymph percentage?
4. I am first diagnosed as having scabies by my doctor then he gave the opinion that the acne like rashes are due to hormone change. Will scabies cause a increase in lymph percentage?
5. What are the protozoa disease causes skin infection that resembles pimples. My pimple like eruptions didn't itch and pain and the rashes which was caused after isotretinion only itched. What are the protozoa disease that causes a non itchy rashes? Please advice me doctor .
Brief Answer:
Answers below
Detailed Answer:
In HIV infection there is initial fall in lymphocyte count followed by rise in lymphocytes.
This occurs due to viral invasion of lymphocytes followed by their death. In other viral infections lymphocyte invasion doesn't occur, so there is no fall in lymphocytes.
I had already mentioned that in case of HIV infection Subtypes of T lymphocytes that is CD4 and CD8 cells are important and are used for evaluation and monitoring.
Simply lymphocyte count doesn't have much value.
STDs are usually not associated with increased lymphocyte count.
Scabies also doesn't cause increase in lymphocyte count.
Protozoan diseases like toxoplasmosis and chagas disease have different presentation and doesn't look like pimples.
There are no protozoal diseases that cause acneform eruptions.
Drug reactions are usually associated with itching. That's why the rash that started after taking isotretinoin was itchy and your earlier pimples were asymptomatic.
Answers below
Detailed Answer:
In HIV infection there is initial fall in lymphocyte count followed by rise in lymphocytes.
This occurs due to viral invasion of lymphocytes followed by their death. In other viral infections lymphocyte invasion doesn't occur, so there is no fall in lymphocytes.
I had already mentioned that in case of HIV infection Subtypes of T lymphocytes that is CD4 and CD8 cells are important and are used for evaluation and monitoring.
Simply lymphocyte count doesn't have much value.
STDs are usually not associated with increased lymphocyte count.
Scabies also doesn't cause increase in lymphocyte count.
Protozoan diseases like toxoplasmosis and chagas disease have different presentation and doesn't look like pimples.
There are no protozoal diseases that cause acneform eruptions.
Drug reactions are usually associated with itching. That's why the rash that started after taking isotretinoin was itchy and your earlier pimples were asymptomatic.
Above answer was peer-reviewed by :
Dr. Prasad
Thanks doctor for your patience and convincing reply. Sorry to ask the same questions again and again.
1. U adviced that in initial hiv infection lymphocyte percentage will decrease and then there will be a rise. In initial hiv infection cd4 count in lymphocyte decrease and if the cd4 count decrease then the lymph percentage decreases is that correct doctor?
2. My differential blood test on 9th day from exposure has lymph percentage of 32.8 and lym value is 4.1 and the test on 35 th day has a value lymph percentage 45 percent and lym value 3.8. What's the reason for this if lymph percentage is low then lym value is high and if lym value decrease then the lymph percentage is high ? Does this indicates any infection?
3. My lym value is 4.1 on 9th day from exposure and it decreased to 3.8 on 35th day . Is this due to any infection or decrease in cd4 which indicates hiv infection? Please clarify doctor.
1. U adviced that in initial hiv infection lymphocyte percentage will decrease and then there will be a rise. In initial hiv infection cd4 count in lymphocyte decrease and if the cd4 count decrease then the lymph percentage decreases is that correct doctor?
2. My differential blood test on 9th day from exposure has lymph percentage of 32.8 and lym value is 4.1 and the test on 35 th day has a value lymph percentage 45 percent and lym value 3.8. What's the reason for this if lymph percentage is low then lym value is high and if lym value decrease then the lymph percentage is high ? Does this indicates any infection?
3. My lym value is 4.1 on 9th day from exposure and it decreased to 3.8 on 35th day . Is this due to any infection or decrease in cd4 which indicates hiv infection? Please clarify doctor.
Brief Answer:
Answers below
Detailed Answer:
Yes it's right that if lymphocyte count decreases then CD4 count will definitely fall.
Regarding your second question this kind of situation can arise if your total leukocyte count has changed. If it has increased then there can be some infection.
This much decrease in lymphocyte count from 4.1 to 3.8 is not significant enough to say that you have any infection or decrease in CD4 cells.
The normal range of lymphocyte count is 20-45 percent. So as long as it comes in normal reference range there is no need to worry.
Answers below
Detailed Answer:
Yes it's right that if lymphocyte count decreases then CD4 count will definitely fall.
Regarding your second question this kind of situation can arise if your total leukocyte count has changed. If it has increased then there can be some infection.
This much decrease in lymphocyte count from 4.1 to 3.8 is not significant enough to say that you have any infection or decrease in CD4 cells.
The normal range of lymphocyte count is 20-45 percent. So as long as it comes in normal reference range there is no need to worry.
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
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