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Experience:  Licensed in Georgia, Board Certified Family Practice
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Have you ever heard of a vinegar smell in skin lesions (prurigo

Customer Question

Have you ever heard of a vinegar smell in skin lesions (prurigo nodularis)? Where can I get help?
I am on an insecure network. I will ask you again when i get home. Don't want to put my credit card numbers on this insecure line. Sorry. Thank you.
Submitted: 7 years ago.
Category: Medical
Expert:  FamilyMD replied 7 years ago.
There are a lot of treatments offered for prurigo nodularis. Here are some of the latest in the literature:


Prurigo Nodularis

Author: Daniel J Hogan, MD, Affiliate Teaching Faculty, Sun Coast Hospital; Investigator, Hill Top Research, Florida Research Center
Coauthor(s): Siobahn M Bower, MD, Internal Medicine Resident, Creighton University; Sharron M Mason, MD, BS, Staff Physician, Department of Intrernal Medicine, University of Kansas School of Medicine; Stephen H Mason, MD, Assistant Professor of Dermatology, Medical College of Georgia

Medical Care
Current available treatments of PN have had mild-to-moderate success at best. Often, combinations of several medications or physical modalities may be used in an attempt to control this process.


•Topical, oral, and intralesional corticosteroids have all been used in attempts to decrease inflammation and sense of itching and to soften and smooth out firm nodules. The improvement with corticosteroids is variable, and corticosteroids are sometimes not helpful.

•Menthol, phenol, pramoxine, capsaicin cream,14 vitamin D-3 ointment,15 and topical anesthetics are some other topical agents used to reduce pruritus. Treatment with DuoDerm or other occlusive therapies has been suggested to flatten lesions while at the same time preventing patients from directly scratching nodules.16

•UV light treatment using UV-B17 or UV-A plus psoralen may be beneficial for severe pruritus. Consider the adverse effects of prolonged UV exposure before such treatment. Monochromatic 308-nm therapy may be helpful for recalcitrant lesions.18 UV-A1 has also been reported to benefit lichen simplex chronicus and PN.19

Antihistamines, anxiolytics, opiate receptor antagonists, and (most recently) thalidomide are oral medications other than steroids used for PN. Thalidomide20,21 has been shown to aid in several severe dermatoses, including PN with or without associated HIV disease.17,22 Severe teratogenic effects are well known and documented, and all women of childbearing age should be on adequate birth control methods. Patients taking thalidomide have an increased risk of peripheral neuropathy.

•For steroid unresponsive patients or those with lesions on thin skin, a few case reports and small studies have shown efficacy of the topical immunomodulators tacrolimus and pimecrolimus.

•Anecdotally, gabapentin has been reported to benefit PN.23 Sedation is the main problem with this generic medication.

•Habit reversal therapy for the itch-scratch cycle associated with PN may be helpful and can be administered by dermatology nurses trained in this therapy.24

Surgical Care

•Cryotherapy with liquid nitrogen helps reduce pruritus and flatten lesions.25,26

?Thirty-second thaw cycles with 2-4 treatments are recommended, depending on the size of the lesion.

?Understanding the risks of scarring and change in pigmentation (especially in darker-skinned individuals) is important.

?Cryotherapy may be combined with other modalities (eg, intralesional corticosteroids).

•Pulsed dye laser therapy may help reduce the vascularity of individual lesions.

Please talk to you dermatologist about the above treatments to see which is best suited for your condition. Please review the article below:

http://emedicine.medscape.com/article/1088032-overview

Dr. Pandya
Customer: replied 7 years ago.

So do I understand the botXXXXX XXXXXne is that I have a chronic condition that is not always responsive to treatment? Obviously, "don't pick it." But that seems to be the only success that I have. When the lesions are completely "cleaned out" then they heal, leaving minimal scarring, considering the amount of trauma the skin experiences.

Does anybody look at the pathology of what "comes out" of the lesions?

I have some biology/microbiology/anatomy background - enough to be curious and read research, but not enough to do my own pathological analysis. I'd love to be in a study or meet with a dermatopathologist who would analyze my specific situation.

Question - what is the vinegar/acidic smell in the blood of some of my lesions?

Thank you so much!!

Would you be willing to see me if I drove to Georgia?

Again, thank you!

Expert:  FamilyMD replied 7 years ago.
The vinegar-type smell is coming from a chemical called priopionic acid, which is present in many sweat samples. Propionic acid is a breakdown product of Priopionibacteria, that live in the sweat glands (sebaceous glands). Because propionic acid is chemically similar to acetic acid (vinegar), it also shares a similar odor.

The good news is that there are many good treatments available for prurigo nodularis, including surgical care.

I would recommend that you should drive to either Atlanta or Augusta for expert dermatological care at Emory or Medical College of Georgia. I am honored that you would drive to see me, but I do not currently reside in Georgia. Thank you very much!

Dr. P.
FamilyMD and 7 other Medical Specialists are ready to help you
Customer: replied 7 years ago.
Thank you!!
Expert:  FamilyMD replied 7 years ago.
You are very welcome:)