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Old 05-15-2009, 06:25 PM   #1
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Derm says lichen planus..im not so sure!

I am a 31 year old black female. I have been suffering from a scaley rash that was on both of my legs. These rashes are very itchy and scale over. When they start to heal they are redish purple. I have gone through a extremely stressful period within the last year and now the rash has spread to nearly 50% of my body. I went to a dermitologist who took a look at me and said he believed it was lichen planus. He did a skin biopsy and gave me some meds that did help me alot. During the time I was waiting on my test results I did alot of research on the internet and Im now VERY suspicious that maybe I have Lupus. I did not associate my horrible rash with the rest of the symptoms I have been feeling.
Im just curious to know if it is at all possible that I really have lupus.
Please see my other symptoms below.

Joint pain (hips and back are bad, as well as my knees feel like they are out of place)
Fatigue (ranges from extreme exhaustion to mid range fatigue)
Depression
Anemia
sore throats /Swollen glands in neck(i have had these on and off for years
The sun exhuast me so much I try not to be out in it for long. If im out watching the kids in the yard when I come in I have to go to bed im so tired and itchy if my skin has been exposed.
Had two pregnancies..developed high blood pressure and preclampsia but did deliver both kids at 37 weeks
I was diagnosed with mono when I was 17 and it lasted for months. I was so sick I almost didnt graduate.

Im sorry for the long post I guess I just need someone to tell me whether maybe I should go see a rheum about this and if my concerns are valid?

 
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Old 05-16-2009, 03:00 AM   #2
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Re: Derm says lichen planus..im not so sure!

Toobcherished, hello & a great big welcome. I'm only a (dumb!) patient, so please take what I write for what it's worth. That said, I re-read your post a few times. Each time, I had diverse reactions: what you wrote FIRST about your widespread rash hits me differently than the SECOND part of your post.

YOUR RASH: Itch, "scale", color (reddish purple), biopsy results, and the fact your prescribed meds actually helped---*maybe* these things do actually hold together pretty well for a Dx of lichen planus...? But even if your rash is absolutely, for-sure LP, I think you're right to wonder about the other things!

AN ASIDE: Have you read about the various lupus rashes? e.g., butterfly (malar); two subacute cutaneous (SCLE) rashes, one = annular (targetlike), the other = psoriasiform or papulosquamous (looks somewhat like psoriasis but isn't); discoid; bullous; tumid; etc. A lupus-specific rash, when subjected to immunofluorescent stain tests, can (but not always, unfortunately) yield results that are seen ONLY in lupus. To read more, try your local library or large bookstore & look for Dr. Daniel Wallace &/or Dr. Robert Lahita. Also, you could ask your dermie for a copy of your skin biopsy report, to take it along for other appts, plus any recent bloodwork you've had done.

BUT whether your rash is, or isn't, lichen planus, if I were you, I'd DEFINITELY want to see a rheumie, to discuss joint pain, fatigue, anemia, etc. You could ask things like---

1. Can LP explain my other symptoms? If not, can LP ever *co-exist* with other condition(s) that might account for these other symptoms?

2. What's causing my anemia? (If, over time, the rheumie can't get to the bottom of it, he/she could send you to a hematologist. I *think* there are quite a few possible causes. Since anemia alone can knock you flat, I really hope your doctors look into this further.)

3. Do my skin biopsy results make sense to you? (Maybe the rheumie would call for a 2nd biopsy, if he/she thinks one is warranted, to revisit whether your rash is LP vs. a lupus-specific rash vs. something else entirely. Or even have your first skin sample recalled from the lab that did it & have more tests run on it.)

During many years of problems, incl. recurrent rashes, I was absurdly unable to get my local drs. to look at my symptoms as a "whole cloth", so I think you're very smart to try to get that to happen ASAP. I hope others chip in soon. Post more when you can, OK? Meanwhile, sending my best wishes to you. Sincerely, Vee

 
Old 05-16-2009, 03:56 PM   #3
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Re: Derm says lichen planus..im not so sure!

Vee I am so appreciative of the tme you spent reading and replying to my post. Yes the meds to my rash definitly did help the only problem is that once I get one large spot under control another spot turns up and starts all over again. Doc gave me medication that lasted me a month. Told me that it should clear it up and I should be fine. I called him back after a few weeks and explained that although most of my rash was starting to heal there are new ones that keep popping up. He thought that odd and mentioned light therapy. Im thinking about takind him up on that, the only issue is I know that when im out in the sun It makes the itching so bad. I think I will see a rheumi before I take my doc up on the light therapy three times a week. I wish I could post pics of my rash here. I have one that has just showed up on my arm within the last few weeks It is red around the outside currently and dry and scaled over in the middle. I also forgot to mention that I have moderate adema. Doc has put me on a water pill. If I dont take it my hands and feet swell up like and feel really really tight and feels like pins and needles are sticking in them.

Thanks again!


Quote:
Originally Posted by VeeJ View Post
Toobcherished, hello & a great big welcome. I'm only a (dumb!) patient, so please take what I write for what it's worth. That said, I re-read your post a few times. Each time, I had diverse reactions: what you wrote FIRST about your widespread rash hits me differently than the SECOND part of your post.

YOUR RASH: Itch, "scale", color (reddish purple), biopsy results, and the fact your prescribed meds actually helped---*maybe* these things do actually hold together pretty well for a Dx of lichen planus...? But even if your rash is absolutely, for-sure LP, I think you're right to wonder about the other things!

AN ASIDE: Have you read about the various lupus rashes? e.g., butterfly (malar); two subacute cutaneous (SCLE) rashes, one = annular (targetlike), the other = psoriasiform or papulosquamous (looks somewhat like psoriasis but isn't); discoid; bullous; tumid; etc. A lupus-specific rash, when subjected to immunofluorescent stain tests, can (but not always, unfortunately) yield results that are seen ONLY in lupus. To read more, try your local library or large bookstore & look for Dr. Daniel Wallace &/or Dr. Robert Lahita. Also, you could ask your dermie for a copy of your skin biopsy report, to take it along for other appts, plus any recent bloodwork you've had done.

BUT whether your rash is, or isn't, lichen planus, if I were you, I'd DEFINITELY want to see a rheumie, to discuss joint pain, fatigue, anemia, etc. You could ask things like---

1. Can LP explain my other symptoms? If not, can LP ever *co-exist* with other condition(s) that might account for these other symptoms?

2. What's causing my anemia? (If, over time, the rheumie can't get to the bottom of it, he/she could send you to a hematologist. I *think* there are quite a few possible causes. Since anemia alone can knock you flat, I really hope your doctors look into this further.)

3. Do my skin biopsy results make sense to you? (Maybe the rheumie would call for a 2nd biopsy, if he/she thinks one is warranted, to revisit whether your rash is LP vs. a lupus-specific rash vs. something else entirely. Or even have your first skin sample recalled from the lab that did it & have more tests run on it.)

During many years of problems, incl. recurrent rashes, I was absurdly unable to get my local drs. to look at my symptoms as a "whole cloth", so I think you're very smart to try to get that to happen ASAP. I hope others chip in soon. Post more when you can, OK? Meanwhile, sending my best wishes to you. Sincerely, Vee

 
Old 05-16-2009, 05:16 PM   #4
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Re: Derm says lichen planus..im not so sure!

Toobcherished, hi, again. Which dr. put you on the med for edema, your GP? Did he speculate what's causing the edema? Is the med lasix or something akin? Did your skin rashes start before or after you started the water retention med?

Why I'm so curious: I *think* lasix & the like come with big cautions re: certain conditions. Lupus is one. Kidney issues, heart & liver, also, I think. And reaction to sulfa drugs is another. (FYI, people with lupus are more apt to have problems with sulfa drugs than the general population.) What it all means, I don't know... But if I were you, I'd also ask about the edema med.

You could list your symptoms, meds, etc. into chronological order, to take along when you see the rheumie. I think you should go back as far as you remember, for sure including mono at 17, high BP & pre-eclampsia during pregnancy, etc. (A good rheumie will ask for a lifetime medical history, so if you prepared brief notes in advance, you wouldn't forget anything while scribbling away under time pressure in the waiting room.)

If you feel like reading more, check out the "sticky posts" at the top of the thread list. For much more detail, there are some excellent lupus hardcover authors available in most libraries & bookstores: one is Dr. Daniel Wallace, another is Dr. Robert Lahita. While reading can't Dx you, it can help you formulate better questions & understand your doctor's answers better.

Another aside: there's a form of lupus called drug-induced, abbreviated DILE. Certain drugs can actually induce a milder form of lupus, or trigger flares in someone who already has it. Dr. Wallace writes about DILE at length in his hardcover; and he cites certain heart rhythm and BP meds, cholesterol meds, sulfa-based meds, etc. by actual name.

I agree with your instinct NOT to have light treatments for the lichen planus (or whatever else it maybe is), given sun already makes you itchier. Why add anything new to the mix, right?! I hope you get a rheumie appt. set up soon. Stay in touch with us, OK? Meanwhile, thinking of you & sending you warm wishes, Vee

 
Old 05-16-2009, 07:40 PM   #5
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Re: Derm says lichen planus..im not so sure!

It was my general practioner who gave me meds for the adema. She first thought it was High blood pressure since I developed high blood pressure during my prenancies. When I went into her I complained of exhaustion and the need to sleep and she took my pressure and said that my pressure was high and that was causing the adema. She wanted to know what med I was on in the past and I told her I was'nt sure (had another doc before this) She put me on Hydrochlorothiazide temporarily to reduce my pressure and told me to come back within a week to see if I needed a stronger med. When I went back in that week we both noted I had lost 7lbs in 4 days. She checked my blood pressure and it was normal...127/73 which is my normal. She told me there was no need to give me blood pressure meds as it seems the edema is the issue and is solved my the water pill. I take this pill religiously as if I dont I blow up like a balloon and makes me even more sluggish then I already am. Your post made me deeply curious so I did a google search on the hydrochlorithizide and the results blow my mind.

" Systemic Lupus Erythematosus--Hydrochlorothiazide--
Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus."

So now im really starting to wonder. Thanks for the excellent advice yet again.

2B

Last edited by Toobcherished; 05-16-2009 at 07:45 PM. Reason: mispelled word

 
Old 05-17-2009, 02:57 AM   #6
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Re: Derm says lichen planus..im not so sure!

2B, good morning. It was your last line in your previous post, about the water retention pill, that you added almost as an aside, that made me wonder. I can't begin to guess how your puzzle pieces will fit together, when seen as a whole by (hopefully) a rheumie; but I really think this sort of info is exactly what you should take with you to your upcoming appt.

AN ASIDE: The doctors I saw along the way didn't strike me as exactly open-minded, so I went in low-key & didn't reveal that I'd been reading, or anything remotely like that. Interesting to me that the rheumie who did know the most (the one who Dx'ed me) was quite curious as to what I "thought" I had. The others dressed me down like a school child.

JUST CURIOUS: Did you read that "sticky post" with "alternative criteria"? It's in with the "stickies" (permanent info posts) at the top of the thread list here. It reinforces that your *lifelong* medical history should be of interest.

So here's to better days ahead for you, the soooner, the better! We'll be watching for your updates. Bye for now, with my best to you, Vee

 
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