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In 2009 I had a skin punch biopsy done of my elbow which…

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In 2009 I had...

In 2009 I had a skin punch biopsy done of my elbow which indicated hyperkeratosis, focal parakeratosis and superficial and deep perivascular lympohohistiocityic infiltrates. The findings were of superficial and deep perivascular dermatitis. No features of sarcoid. I continue to have severe pain in my hands/ ankles, feet and all joints, and muscle pain. I have had an elevated ACE level. What would you suggest for next steps?

Doctor's Assistant: How long have you been dealing with the skin issue? Have you noticed any major changes in your overall skin or nails recently?

For at least 10 yrs

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I have dx of Common Variable Immune Disorder, OA, severe Raynauds disease, HTN, IBS, GERD. Medications include Metoprolol, Omeprazole, Zantac.

Submitted: 6 months ago.Category: Dermatology
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Customer reply replied 6 months ago
I also want to add I have a progressive rash on my cheeks, like small spider veins popping out and red raised blemishes pop up at times. If I put a low dose of cortisone cream on it the redness reduces. The rheumatologist I saw wants me to see a pulmonologist that specializes in sarcoid but I don't believe this is sarcoid. Thoughts?
Answered in 16 minutes by:
12/29/2017
Dermatologist: Dr. David, Board Certified Physician replied 6 months ago
Dr. David
Dr. David, Board Certified Physician
Category: Dermatology
Satisfied Customers: 49,911
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Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

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Dermatologist: Dr. David, Board Certified Physician replied 6 months ago

you may not have sarcoidosis.

Other conditions such as Gaucher disease, untreated hyperthyroidism, psoriasis, adults with amyloidosis, and histoplasmosis have been associated with increased levels of ACE.

you should still see a pulmonology doctor

but you should also see a rheumatology doctor

you could have psoriasis.

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Customer reply replied 6 months ago
I have seen rheumatology, no help, referring me to pulmonary. I am neg for hyperthyroidism, have never had psoriatic plaques. Not sure what Gaucher disease is but will check into that. My other symptoms are a feeling of severe muscle fatigue and physical fatigue to point where there are days I can't function, just need to lay down. The muscle and joint pain are daily and fluctuate from moderate pain to severe pain impacting my ability to function. When I take deep breaths it is like I feel a tight squeeze around my chest and feel tightening in my lungs, at times pain with deep breathing. I am not sure why the facial rash is progressive with visible vessels and blemishes only responding to steroid cream. I feel like it is all autoimmune based but no one can saw what the cause is. ...
Dermatologist: Dr. David, Board Certified Physician replied 6 months ago

I would see a lung doctor and get a lung biopsy to check for sarcoids so you get more information.

you may have to see a rheumatology doctor at a larger academic medical center for more testing

do you have elevated ANA levels? anti ds DNA antibody levels?

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Customer reply replied 6 months ago
The Rheumatologist was at UofM and Henry Ford Medical. My ANA is off the chart high, but the doctors always say that can be normal for a woman .. and my anti ds DNA antibody levels I believe were negative. Only positives are the elevated ANA and elevated Ace level. My pain is becoming progressive, all over with allodynia with light touch. One rheumatologist over 10 yrs ago diagnosed me with Fibromyalgia. I will schedule with the lung doctor. This is just getting debilitating and not sure what to do, the pain is at times unbearable. The only time the pain goes way down is with steroids.
Dermatologist: Dr. David, Board Certified Physician replied 6 months ago

steroids can suppress the formation of scar tissue from sarcoidosis.

a lung biopsy can help check for that diagnoiss.

steroids can also help with many other autoimmune conditions.

high ACE levels can be associated with sarcoids and other conditions I mentioned.

a biopsy can help find amyloidosis diagnosis as well

Let me know if you have other questions.
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