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dermdoc19
dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 4069
Experience:  30 years practice in general and cosmetic dermatology
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My friend has an unknown rash that keeps coming back they

Customer Question

Hello my friend has an unknown rash that keeps coming back they have her on steroids again and nobody can help her maybe one of you can, I have pictures, her rash is not isolated it is all over her body, it is red, blisters and very itchy. She explains that it us like there is spiders walking all over her body and she wants to scratch and rub everywhere. Help me please!
Submitted: 1 year ago.
Category: Dermatology
Expert:  Dr. Pravin replied 1 year ago.

Hello

Welcome and Thank you for your query posted.

My name is***** and being a Skin, Hair and Nail specialist I would be able to provide you with an appropriate solution to your concern.

Please note that my Goal is to provide you with an Excellent Service .

Before I answer your question I would like to get some more information:

Could you send me a photo of the condition at your convenience?

You can upload the photo on www.photobucket.com and send me the link

Other method of uploading photo or a file is:

1.Click the paperclip icon

2.Click the Browse icon

3.Click the Browse button

4.Select your file and click Open

5.Click OK

6.Click Insert

7.Click Save Changes on this page

Please note that the answer provided is for information purpose only and does not substitute a Doctor - Patient Consultation in Clinic

Customer: replied 1 year ago.
Here are the pictures
Customer: replied 1 year ago.
They form like hives.
Expert:  Dr. Pravin replied 1 year ago.

Thank you very much for the photos provided

Expert:  Dr. Pravin replied 1 year ago.

I do observe that there are bullae or big blisters on the patches of hives on the forearm.

I would like to know the following:

Do these increase with sun exposure?

Do these blisters or hives come on the scalp , face , legs , genitals ?

What is the age of your friend?

Has your friend done any investigations till date?

Customer: replied 1 year ago.
We live in Canada so she has not really exposed them to sunlight at all. Yes they are everywhere. She is 52. Yes she has they have been incunclusive. She has also had two past strokes. And she has also had a skin biopsy
Customer: replied 1 year ago.
The last episode lasted 7 month.
Expert:  Dr. Pravin replied 1 year ago.

Thank you very much for the information provided.

Did the skin Biopsy mention anything like Bullous Pemphigoid?

This is what the lesions look like.

This is an autoimmune condition associated with hive like lesions all over the body and consequent blistering on the areas of hives. This condition can be treated with Pulse Corticosteroid medications that she may have been .

However , there a number of newer Non steroidal medications available for the management of this condition.

The first thing she needs to get done is certain markers for this condition and the differential which includes Desmoglein antigen assay ( for Pemphigus Vulgaris ) and also a Direct Immunoflurescence study to check for immunology area of blister.

Does she get a lot of itching on the areas?

Customer: replied 1 year ago.
Itchy all the time.
Customer: replied 1 year ago.
The one doctor said that she is too, young for this condition you speak of.
Expert:  Dr. Pravin replied 1 year ago.

I dont think she is too young for this condition. We so see so many cases in our clinical practice that we prove on Skin biopsy and further Direct Immunofluorescence studies and Antigen testing.

The lesions she has can be an atypical variant of Bullous Pemphigoid , Subacute Cutaneous LE , Erythema Multiforme.

However , these conditions need immunohistochemistry studies and histopathology marker studies.

Bullous Pemphigoid lesions are itchy , hive like and present a blister. If the Doctor mentions that she is too young clinically for this condition , he needs to also get the DIF study on skin biopsy to prove it is not BP , SCLE or EM.

Expert:  Dr. Pravin replied 1 year ago.

Hello

I am awaiting a response from your end.

Does she get joint pains , mouth ulcers?

Customer: replied 1 year ago.
The rash at its worse went into her mouth, throat causing a couph
Customer: replied 1 year ago.
No joint pain. But her skin becomes hot so a ice pack helps.
Customer: replied 1 year ago.
She had a skin biopsy and the skin doctor said she has Bullous P.
Customer: replied 1 year ago.
But everyone (meaning other doctors) say it can't be that because she is too young she is 53.
Customer: replied 1 year ago.
But she has had a stroke as a young girl and a British study says this can come about because of that.
Expert:  Dr. Pravin replied 1 year ago.

Thank you very much for the information provided.

The lesions are very classic of Bullous Pemphigoid. The blistering over lesions of hives are classic of Bullous Pemphigoid. I had mentioned this to before you revealed the skin biopsy report.

The stroke is not directly related to Bullous Pemphigoid but can be related to a spectrum of autoimmune diseases.

So indirectly it can be related but to Directly.

We see many cases in our clinical practice of Bullous pemphigoid in the age group of 40 to 60.

So age cannot be considered as a reason to rule out the disease.

Apart from Steroid medications there are number of non steroidal options like Mycofenolate Mofetil , Azathioprine and Biologicals like Rituximab that can also work at the root level to treat her condition. She needs to discuss the feasibility of these medications I have mentioned to control her disease.

The skin becomes hot with the hive like feature as pathology shows that there are number of eosinophils in the skin that causes the skin to become allergic / hot and hence ice packs help.

The mouth involvement can also happen due to autoimmune blistering disease like Pemphigus vulgaris . She should also do a blood work up called Desmoglein 1 and 3 antigen assay . This would give a great insight into her condition.

Is it possible to check if she has done this above report ?

Customer: replied 1 year ago.
I think so, she is going to see the doctor on the 28th
Expert:  Dr. Pravin replied 1 year ago.

Hello

Do you have any updates on her case?