| Comments from Faculty and Members |
Professor Camillo Di Cicco M.D., Professor of Dermatology,
University of Rome, Italy on Sept 30, 2004
Pain following "Zoster sine materia".
Tegretol ( carbamazepin)
Stephen Glinick M.D., Providence, RI, USA
on Sept 30, 2004
I do not know what this unfortunate patient has. However the
lesion is sitting right on top of the supraorbital nerves and
I suspect an entrapment or compression phenomenon. Have nerve
conduction studies been done? Has capsaicin been tried? Neurontin?
If neuropathy is suspected then I wonder if cautious exploration
by a head and neck surgeon might free up the nerve.
Caroline Koblenzer M.D., Professor of Dermatology and
Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
on October 1, 2004
This unfortunate man's history,trekking from doctor to doctor,
in a variety of specialties, in the course of a long and fruitless
search for relief, is entirely typical of those with cutaneous
dysesthesia. In this case there was objective evidence of pathology,
which is quite unusual, in my experience.
From the report, I understand that MRI and CT scans were unrevealing.
Would ultrasound be helpful ? I understand that it does a good
job in soft tissue. Also, perhaps a biopsy at a time when erythema
is evident ?
Unfortunately the treatment of unexplained dysesthesia tends
to be a matter of trial and error, but I have found both carbamazepine
and gabapentine effective in some cases. I have also considered
that it may represent a type of tactile halucination, and on
that basis have used anti-psychotics, particularly pimozide,
again with some success. There is also the possibility that
in some cases dysesthesia may be a somatic expression of depression,
and I have had some success also with the SSRI's. I look forward
to a follow-up.
Benjamin Barankin MD, Department of Dermatology, University
of Alberta, Edmonton, Canada on October 1, 2004
I would consider trying one of the anti-epileptics. A no-promises
trial of BOTOX might be beneficial. He may benefit from anti-depressants
for what sounds like a reactive depression to his longstanding
condition.
Joel Schlessinger M.D., Omaha, NE, USA on
October 1, 2004
I would try a prophylactic course of valacyclovir. Although
herpes may not be the main pathology here, it deserves to be
ruled out as a provocateur.
Donald Huldin M.D., Kalamazoo, MI, USA on
October 4, 2004
DX---post herpetic neuralga RX Trial Bcomplex 2cc IM q 3 weeks
X 6..Avoid all stimulents!!! esp caffeine
Richard Sontheimer M.D., Professor of Dermatology,
University of Iowa Carver College of Medicine, Iowa City, IA,
USA on October 7, 2004
I asked a senior neurology resident at the Uiniv. of Iowa Hospitals
and Clinics who is a personal associate of mine for her opinion
on this case. Her answer was:
"In regards to the case, I agree that there likely is neural
injury causing the pain. I think that while scarring and fibrosis
of the nerve may have been the cause, the recurrent redness
and swelling didn't really fit with that. Other possibilities
include an underlying neuroma or other benign neural tumor of
the opthalmic division of the trigeminal nerve. From my experience,
cases like this almost always have a prominent psychological
componenent. As work-up however, I would suggested the possibility
of an ultrasound and a HR MRI with a 3 tesla unit which should
be able to pick up even small abnormalities in the hands of
an experienced radiologist. The suggestions for pain control
all seemed reasonable, neurontin, tegretol and TCAs. I end up
sending most of my similar cases to the pain clinic. They usually
start narcotics."
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