Brief Answer: you can take Loratadine tablet Detailed Answer: Hello Madam, It’s always a pleasure to talk to you again after long period of time. I am happy to know that you enjoyed your vacations with great zeal. Do consider Jaipur in your next vacations. But it’s really sad to know that there had been an episode of swollen lips, swollen throat, shortness of breath and quiet voice. If I am getting it correctly then it might be angioedema which is one of the severe form of hives. If it occurred for the first time then you should carefully recollect any change in diet or surrounding within hours of the occurrence of the incidence. This will help us in preventing any such episode in future. Do let me know what was the diagnosis given by the doctor treating your episode of swollen lips, swollen throat, shortness of breath and quiet voice. The individual bites & itchiness all over the body can be part of hives which is medically known as urticaria. Urticaria is a common condition caused by bursting of allergy producing cells known as "mast cells" due to certain aggravating factors present in the environment. As the chemical inside them is released it produces either itching or and red areas of individual bites which you have mentioned. These remains for few hours and then subsides completely. Do let me know if your insect bite type of lesion persists for few days or subsides and then reappear in 12 -24 hours. In more sever of the problem it can result in swollen lips, swollen throat, shortness of breath and quiet voice known as angioedema. There can be multiple factors producing this condition which are included in day to day life and some times it is really difficult to find one exact cause. The long term effective treatment for this is by oral anti histamine like loratadine under medical advise. It is one of the drugs which is not having any side effects and can be taken for long term usage. If I were your dermatologist then I would have started with 2 tablets 12 hourly and could have increased up to 3-4 times if less improvement was seen. Do not scratch or rub the skin as it can lead to further aggravation. For the part of further involvement of right leg- This is the right time when you should ask your treating doctor to get a biopsy done and confirm the diagnosis. This will not only help us in proper diagnosis but also in deciding the course of steroid therapy to be given to you. In your next meeting with the treating doctor, you should elaborate the problem of insect bite type of lesion. If these are persisting for few hours or less than a day then you can even take few pictures to shoe to the doctor. Also tell the doctor about the episode of swollen lips, swollen throat and related symptoms. Ask your doctor to correlate all the things and can make out best out come of the condition. Therefore from your skin side you can talk to your doctor regarding biopsy for the diagnosis of panniculitis and rule out the possibility of urticaria with angioedema. For the time being period you can take Loratadine tablet as suggested above. I hope these informations will help you in dealing the problem. I will be glad to reply any further queries. With good health wishes, regards, Dr Sanjay Kumar Kanodia MD- Dermatology

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Brief Answer: Go for skin biopsy at the earliest Detailed Answer: Hello Madam, I am really empathetic to know that your problem is getting worsened in last 2 days. It is also distressing to know that the doctors were not able to diagnose the condition of recurrent rash all over body along with the episode of swollen lips, swollen throat, shortness of breath and quiet voice. As I told you in previous mail that is typical of a condition known as “Angioedema” which is a real medical emergency. The complete of your symptoms give a clear indication of the same. Anyhow, It is basically a high time to meet dermatologist immediately. If I were treating you directly then I would have gone for two plans of actions: - To go for skin biopsy immediately and diagnose the exact entity of complete skin problem. - To start with oral steroid in the dose of 1-2 mg /kg body weight to halt the disease activity. I suggest you to meet a dermatologist at the earliest and get a proper management accordingly by skin biopsy and oral and topical steroids in proper dose. Till that time you can add tablet hydroxyzine 25 mg two times a day along with loratadine. Applying a high potency steroid cream such as clobetasol for two times will help in alleviating the problem. With good health wishes, regards, Dr Sanjay Kumar Kanodia MD- Dermatology

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