Body blisters a big concern
DEAR DR. ROACH: I have blisters on my body that are filled with yellow fluid. I have been to a skin doctor and even got bloodwork done.
The doctor recommended that I take prednisone. I was hoping you could recommend a different medication. The doctor’s report said I have bullous pemphigoid.
ANSWER: Bullous pemphigoid is an autoimmune disease, where the body is attacked by its own immune system. It occurs most commonly in older adults.
Symptoms often start with an itchy rash that may be indistinguishable from either eczema or hives. Most people will then develop large (1-3 cm, sometimes over an inch), tense blisters. These can be severely itchy.
Without treatment, the disease slowly progresses over years, greatly affecting quality of life and even can be life-threatening if the disease attacks the mouth and throat.
However, prednisone is a rapidly effective and inexpensive drug, commonly used as a first-line treatment for people with severe or extensive disease.
Some experts use high-potency steroid creams; however, these can be very expensive and hard to use over large areas of the body.
I want to gently remind readers that my primary goal is to educate people about both common and rare diseases. I don’t act as a physician to readers: I can’t, in absence of a thorough history, physical exam and review of the laboratory data.
DEAR DR. ROACH: I am 90 years old. Until age 85, I had not needed any regular drugs.
Five years ago, my systolic blood pressure was near 140, but I was feeling fine. Yielding to pressure from my health care provider, I was put on a daily dose of lisinopril and amlodipine. That reduced the blood pressure, on average, to around 120 systolic.
Since that time, I have had cold hands and feet, plus weak, painful knees. Could there be poor blood circulation caused by blood pressure that is too low? If so, what should I do? My advisers seem to scoff at this idea.
ANSWER: It is both unprofessional and unwise to scoff at patients, as they generally know their bodies better than their doctors do, and we should listen carefully before making judgments.
In your case, coldness of the hands and feet is listed as a possible side effect. Joint pain also may happen, but it may be that this is unrelated to the drugs.
I don’t think it is a result of too low a blood pressure, although if you already had blockages in the arteries to your limbs, lower pressure might lead to less blood flow and thus cold hands and feet.
Some doctors like to use low doses of two medicines to reduce side effects; however, when a side effect does occur, it can be hard to figure out what is going on.
With your doctor’s permission, you might try stopping the amlodipine (I think it’s the more likely culprit) to see the effect on your blood pressure and on the hand and foot coldness.
Email to ToYourGoodHealth @med.cornell.edu.