SLE (Sytemic Lupus erythematosus) treatment


Question

dear sir,

my wife is suffering from SLE and also taking hcqs-400 predmet-4mg daily one tablet.she is filling comfortable from pain.but problem is that her face is very darkness day by day and also rashes is coming.may be butterfly rases has coming.please help how can we protect these types of problem.she is 33 years old and also she can not pregnent till(11 years after marriage)

with regards

xxxx

Answer

Dear Mr.xxxxxxx,

Many Thanks for contacting me online. I would certainly be glad to help. Since SLE is quite a complex problem, I need to know the full details of her history. Once I know the details, I could certainly give you a call and discuss in detail. If you can please upload her details and some good quality photos on http://www.onlineskinspecialist.com/user-registration.php , I can certainly help. The online case- sheet contains a set of questions, that would help me base my diagnosis and treatment advice. So please do enter as many details as possible.

If you leave your phone number, I could call you once I have had a look at her case sheet and pictures. My website www.onlineskinspecialist.com should give you all the information regarding fees (300 Rs). If you wish to go ahead, please email me back and I shall give you details as to how to pay me through my Indian Bank Account. There is a problem at the moment with accepting Indian bank cards online.

Please do mail me back if you have any other questions or problems navigating through the links above. I look forward to hearing from you again.

Regards

Dr.Sasi Attili. MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

www.onlineskinspecialist.com

www.onlineskinspecialist.wordpress.com

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Black spots on body, scrotal hairs and LASER, veins on the penis, small bumps under the penis, penile papules, phimosis


QUESTION

Current age- 18.

I have attached a few pictures..(1).I want to know what are those black spots and what is the cause for their increase in number.(2)Its quite embarassing to confess that I had shaved my scrotum when I was like around 12 or 13..and now a lot of hairs are growing down there. Is there any topical cream or any other safe method to get rid of it permanently(3)what are those small hairs growing on the under side of the penis and 3greenish veins elevated on the penis and small bumps on the under side of the penis? (4)are those blisters-penile papules and what can be done to treat and eradicate smegma?(5)am I a phimosis patient and is there any non surgical method to treat it?.please check them and let me know how much am I to pay for the consultation./And I request you not to put up any of those pictures anywhere./. Thank you

ANSWER

1. The black spots look like simple moles. Unless they are rapidly changing, I would not worry.

2. Hairs on the scrotum and penis are extremely common and is not a disease. There is no way to get rid of them painlessly. You can have Light Sheer diode LASER therapy but it is quite painful in that area.

3. And 4. – I agree they are harmless perly penile papules. I am quite impressed by your self diagnosis. Again one cannot treat these unless one burns these off under local anaesthetic. http://dermnetnz.org/site-age-specific/penile-papules.html

4. I am not sure you definitely have phimosis. Are you saying that you cannot pull back your foreskin completely? If you cannot- then yes you have phimosis. But I would suggest you use ‘Clobetasol propionate’ ointment once daily and try manually gently pulling the skin down a little bit everyday with a little bit of lubrication. Do not do it too much if you pull too much and it bleeds or if it cuts, you will have more problems!! Most physiological phimosis resolve in adult life and do not need treatment. But if it doesn’t then you are better off getting Circumcision. There is no ‘treatment for smegma as it is not a ‘disease’.

Best of luck.

Regards

Dr.Sasi Attili

Consultant Dermatologist (GMC Registration No.: 6036602)

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Skin Care Talk: Why random medical advice over the internet is not a good idea!!


I had a very very interesting experience yesterday. As I’ve mentioned in my links above, I am mainly doing this as a hobby and do not intend to become rich from this tele-dermatology service!!

One of my patients in the UK who was pleased with my service suggested that I should register in a forum called ‘Skin Care Talk’, and get myself known. I was not aware of this forum and did not like the idea of randomly advertising to an internet community. Anyway I thought I’d give it a look and registered on the site. It is actually a very useful forum for people to share their skin problems online and seek advice. However the forum rules clearly state that they are not responsible for advice given and the advice posted should not be treated as ‘medical’ advice. This is perfectly reasonable considering that the users of the forum are non-medical personnel.

I was a bit sceptical to start with but did post on a few threads offering an opinion on case histories and pictures posted. What followed however within the next couple of hours completely caught me unawares. I was met with a personal scathing attack on my reputation and was banned from the forum, for offering ‘medical’ advice. I was sent a message that I was banned because the forum rules state that ‘medical’ advice is not allowed. I was/am completely flabbergasted. If they do not allow medical advice, why in the first place are they running the forum. What’s the point of random non-medical advice, which would probably end up confusing everyone?

I think the forum is ruled by a bunch of moderators who are used to their reputation of being half-wits and could not bear with the idea of someone ‘medical’ stealing their ‘fame’!! Anyway, I think I have learned my lesson and it is probably best I stick to my blog. As with every doctor, his/her own patients are the best publicity.

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LASER, Acne and Acne scarring


Question

i have pimples and have scars of pimples sir so i have want to take treatment of laser theorapy is it right to remove all pimples and scars on my face permenantly

Answer

Many Thanks for contacting me online. I am not quite sure I understand your question. Are you asking if LASER is going to remove scars and pimples? If that is the question, the answer is no. LASERS are of different types and some re-surfacing LASERS (in the right expert’s hands), can help with acne scarring. However they do not help with acne itself and one should not attempt LASER therapy until the skin is clear of acne. Hope that answers you question. Do feel free to mail me back if not.

Regards

Dr.Sasi Attili. MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

www.onlineskinspecialist.com

www.onlineskinspecialist.wordpress.com

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Pemphigus vulgaris treatment


Question

heloo sir,

i am the patient of pemphigus vulgaris….

i am taking treatement from past 1 year by dr

js pasricha in delhi.. he is giving me DP therapy every 28 days. i wanted to know that is there any better treatment of this disease.

and i also wanted to know that what is the actual cause of this disease. and yes i am a smoker can it harm the treatment in any way……

thanku

ramesh mehta

Answer

Dear Mr. Ramesh Mehta,

Many Thanks for contacting me online. I understand you are under the care of Dr.Pasricha and are having Dexamethasone Pulsed (DP) therapy. I would certainly be glad to give a second opinion and advice. However due to the complex nature of the disease and treatment, it is best I discuss this over the telephone. If you wish to go ahead with the consultation, please note that the website is currently not able to accept payment through credit cards.So please do a direct online/ phone back transfer to my account as per instructions in my email.

Pemphigus is quite a serious disease, but now-a-days with modern treatments, most patients can be effectively controlled. High dose steroids (like DP) are the mainstay of treatment for Pemphigus, but can be associated with serious side effects in the long run. I usually therefore prefer alternatives to help reduce steroid side effects. The alternatives completely depend on individual patients. I can discuss this all with you in detail during the consultation. In the meanwhile, you might like to browse this very useful patient information website on Pemphigus. http://dermnetnz.org/immune/pemphigus-vulgaris.html

Please send me an email reply once you have done that and I shall get back to you. If you leave your phone number, I could call you once I have had a look at your case sheet and pictures. Please do mail me back if you have any other questions. I look forward to hearing from you again.

Regards

Dr.Sasi Attili. MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

www.onlineskinspecialist.com

www.onlineskinspecialist.wordpress.com

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Itching and vaginal discharge


Question

i have a iching on my private area. that all area has been black. which cream shoud i use. please advice.

Answer

Many Thanks for contacting me online. I would certainly be glad to help. Due to the nature of your problem, it is difficult for me to advice without knowing the full details. If you can please upload your details on http://www.onlineskinspecialist.com/user-registration.php , I can certainly help. The online case- sheet contains a set of questions, that would help me base my diagnosis and treatment advice. You only need to answer the questions that pertain to your problem and save the case sheet. I know this is a sensitive issue, but if you can upload some pictures of the area, it would help me in my diagnosis. Otherwise, I would be giving blind advice. I can assure you that the photos are saved very securely and would not be accessible to anyone else.

Please send me an email reply once you have done that and I shall get back to you. If you leave your phone number, I could call you once I have had a look at your case sheet and pictures. If you do not wish to consult on the phone, I could just mail you back with treatment advice.

Please do mail me back if you have any other questions or problems navigating through the links above. I look forward to hearing from you again.

Regards

Dr.Sasi Attili. MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist

www.onlineskinspecialist.com

www.onlineskinspecialist.wordpress.com

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Happy New Year Everybody


Thanks for visiting my site. Wishing you all a Wonderful and Prosperous 2011

Dr.Sasi Attili

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