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What is the treatment for skin problems and lipodystrophy while on suffering from HIV and diabetes?

Dec 2013
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Practicing since : 2002
Answered : 4168 Questions
I've used drugs- some pretty heavy at times- in the past and have skin problems probably because of it - What is the best way to treat it - ? I'm also a "face picker" sometimes severely. I'm on Zoloft - is there something better? also diabetic and HIV+ I'm 49 but look much much older I think - Got some lipo-dystrophy too - sunk in eyes - hollow cheeks ---
Posted Tue, 28 Jan 2014 in Skin Hair and Nails
Answered by Dr. Sanjay Kumar Kanodia 40 minutes later
Brief Answer: Kindly send details with high resolution pictures Detailed Answer: Hi, Welcome and thanks for posting your query to healthcare magic. I can understand your concern towards skin problems in yourself. Your query is too short to reach to any conclusive point and to guide you further accordingly. Therefore I request you to kindly take pains in letting me know certain important information regarding your skin problems: 1. Since how long you have the skin problem. 2. Is it in form of some bump or rash. If yes then how often these bumps or rashes appear and disappears. 3. What are the areas affected by the rash or bumps. I can make out that face is affected, what are the other areas if affected. 4. Do you feel any burning or pain or itching sensation over the areas. 5. If you feel burning or pain or itching, then is it mild/moderate/severe. 6. Any treatment take for the same. Other of the drugs used. Are you on antiretroviral medicines. It would be best to send few good resolution pictures of the area yourself and your daughter so that it can be analyzed best. You have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your queries better. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia). "Wish you good health" with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)
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Follow-up: What is the treatment for skin problems and lipodystrophy while on suffering from HIV and diabetes? 11 hours later
Thank you for your response. sorry I'm just now getting back to you. It will be later today before I can respond, but I will answer your questions and send a face shot. I will be able to address your questions better at that time. Thank you - I just sent the requested information via e-nail with your name in the subject line. Please review and get back to me. thank you.
Answered by Dr. Sanjay Kumar Kanodia 13 hours later
Brief Answer: “Eosinophilic Folliculitis”; check you CD4 count Detailed Answer: Hi, Thanks for follow up and uploading all the information along with the pictures. After thoroughly analyzing your condition and discussing with XXXXXXX colleagues let me guide you regarding your condition and further suggestions for it: The condition is known as “Eosinophilic Folliculitis” which is a typical of the problem with HIV positive persons. It is a simple and benign condition which occurs due to inflammation of the hair root and oil glands. You can consider these same as acne or pimples occurring in young people. Though in youth period pimples occurs due to hormonal influence, but in HIV positive persons the exact cause is still to be identified. In some of the cases it is considered to be due to certain bacteria or fungus or even some mites. It is specifically seen due to shift of immunity and more so in persons with low CD4 cell counts. I suggest certain points for help: 1. Do not pinch or pop the areas as it can cause more aggravation as well as florid infection. 2. Stay in cool places. 3. Do not apply any creamy or oily stuff or any other cosmetics over face. 4. Try to avoid any home remedies suggested by your friends or family members or otherwise self implicated therapies also. 5. Try avoiding situations of direct continuous exposure to sunlight or heat and humidity for long hours. Make your room properly ventilated it will improve the status of eruptions. DO not expose yourself to extreme of weather conditions. Heat and humidity always causes aggravation of this situation. 6. Kindly do not use any oral antibiotic as self medication (as you are taking doxycycline). 7. Wash your scalp daily with some good shampoo and let there be no dandruff in your scalp (because dandruff itself causes blockage of pores of oil glands and then eruptions). 8. Take your opportunistic infection drugs (OI drugs) regularly (fluconazole and cotrimaxazole) to prevent any opportunistic infection. I further suggest you to go for your CD4 cell count as well as viral load. If CD4 cell count is below 500 or if the viral load is high then should meet your treating doctor to act in this matter so that if any change in the combination of Anti-retroviral drugs. If it had been done in recent 1 month of period then you can let me know your CD4 cell count as well as viral load status. Additionally you can go for culture and sensitivity of the affected area so that we can know that if bacteria is responsible or not to the problem. And if responsible, then is it sensitive to doxycycline or not. Let me know you sugar status. Have you any time gone for Glycated hemoglobin (hemoglobin A1c, HbA1c) which tells the status of sugar in last three months or do you monitor your sugar regularly. I will suggest you further course of action after getting the latest information regarding CD4 cell count as well as viral load. The most important thing is “NO TOUCHING, PINCHING, POPPING OR SQUEEZING” the area by any means. I hope these information will help you in dealing you condition better. "Wish you good health" with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)
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Follow-up: What is the treatment for skin problems and lipodystrophy while on suffering from HIV and diabetes? 11 hours later
Thank you for your response - Labs done 11/5/2013 CD4 = low 700's Viral load = undetectable A1C most recent early December 2013 - was between 6.5 and 7.0 - - I am using insulin pump therapy - For face washing I normally use the Neutrogena Acne Face Wash -- Ok to continue??? For hair - I switch back and forth between Head and Shoulders - the 2 in 1 with conditioner - and I sometimes use a volumizing shampoo because I have such fine hair. Would I be able to XXXXXXX any cosmetic reconstruction procedures like botox or fillers? What about for the severe wrinkles on my forehead and the hollowness in my cheeks? Would I ever be able to have a hair transplant? I sometimes use a face lotion for dry skin - Cerame' ?? Do you think the Zoloft is sufficient for the face picking? Should I seek more aggressive treatment?? Thank you - any help or direction is greatly appreciated - I am in utter dismay when I look at the photos -
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer: Apply combination cream; maintain good hygiene Detailed Answer: Hi, Thanks for your follow up and further queries. I can see your CD4 count and viral load done in May 2013. Ideally one should go for these investigations once in 6 months. Even in this part CD4 counts are on marginally side. I suggest you to go for latest of the CD4 count and viral load. For the part of eosinophilic Folliculitis – I f I were your treating dermatologist then would have opted for a cream containing moderate potency steroid (such as mometasone) with a antibiotic (such as fucidin) combination to be applied twice daily in a very thin layer. Once the adequate response occurred then would have tapered to once daily application before completely stopping it. Additionally I would have opted for an antihistamine drug such as Loratadine (Claritin) twice daily to reduce the irritation and urge to itch. Once the irritation got reduced then fixed to single daily dose or as and when required basis. In terms of your HbA1c- It is marginally high. I suggest you to improvise your insulin therapy so that it can be reduced to below 6.5. In raised sugar level there is always a chance of super added bacterial proliferation. So if you can improve and monitor your sugar level then it would be quite beneficial to you. Neutrogena Acne Face Wash and Head and Shoulders shampoo with conditioner are completely fine and you can continue the same without any problem. I further recommend you to do shampoo on daily basis to improve and maintain scalp hygiene. For cosmetic reconstruction procedures like botox or fillers- As these are totally non-invasive procedures so you can very well go for both the botox or fillers and there is no harm in going for such procedures. While botox will take care of fine lines and wrinkles, In terms of fillers specifically there are special volumizing fillers available which helps out in regaining the facial atrophy and deeper lines to normal side. You can ask your cosmetic dermatologist for the same. For hair transplant: on the part of diabetes it is quite important for you to talk to your doctor as it is invasive procedure and can lead to complications if sugar level is not maintained. It depends on the treating dermatologist or the transplant surgeon also to decide about this procedure for you. I would not suggest you to use any type of creamy stuff on face or to be used in least minimal amount on account of blockage of pores. I further suggest you to maintain good hygiene along with good diet and and healthy daily routine. Give yourself positive feedback, do some light exercises and keep yourself busy. Yoga is one of the very relaxing and soothing exercise which can be done on daily basis to reduce your stress level as well as improving your health condition. I hope these information will help you in dealing you condition better. "Wish you good health" with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)
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Follow-up: What is the treatment for skin problems and lipodystrophy while on suffering from HIV and diabetes? 1 hour later
Thank you - this is very helpful - my CD4 and viral load were done November 5, 2013 instead of May 2013. I normally see my infectious disease doc every 3 months as well as my endocrinologist. My sugars and diet need work. I will try and do better. I try to do one Claritin daily and will increase to twice daily because the itching seems to be the starting point for much of the incidences. I will try to drink more water to stay hydrated. It is encouraging to know that I can pursue cosmetic procedures. I will definitely approach my doctors with the information about the steroid crèmes. How should I treat "the places" when I have irritated them and caused a major spot that takes many days to clear up??? Pain and swelling occurs frequently. I will try to have better hygiene. Some days I am depressed and non-caring and will avoid showering. I am sure that my problems are aggravated when I do this. Thank you again to your attention to my concerns. Do you see much damage from the drug use?
Answered by Dr. Sanjay Kumar Kanodia 6 hours later
Brief Answer: Apply Kojic acid with arbutin for spots Detailed Answer: Dear Friend, I am really happy to know that my suggestions cleared your mind and now it seems that you are pretty relaxed after knowing all the facts. If your CD4 count and viral load were done recently in NOV 2013 then you can wait for next 1-2 months before going for the tests. For the areas which got darker, in my opinion you can use a cream ( under dermatological supervision) containing Kojic acid with arbutin and mulberry extract in it. Alternatively Azelaic acid gel can be applied over the affected area of pigmentation. These are one of the best and safest creams to be applied. Apply any of these creams in a very thin layer at night time only so that these should not be visible to naked eye. Apply at night time before sleeping. The only and most important part from your side is not to even try to touch or pinch the areas. This is the sole most important part in the management of your skin condition. I am fully confident that you will resume to your normal life after simple changes in daily routine. Do not get depressed; HIV is also not uncommon like diabetes and other health problems in today's world. You never get depressed about your condition. Take best of your diet, maintain hygiene and take your medicines regularly. All my best wishes for your healthy life. I hope these informations will help you. If you have further queries I will be glad to help or if not then can close the query and rate the answer. Regards, Dr Sanjay Kumar Kanodia MD (Dermatology)
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