Dermatologist appointment

Zizzle · Post by **Zizzle** » Thu Jun 21, 2012 6:05 pm

I finally saw the dermatologist my rheumatologist referred me to. He was as underwhelming and disappointing as the rheumatologist

. No wonder they refer to each other. His office was a patient mill, with rude staff, and no one getting more than 10 minutes of his time. To get all my questions in, I had to talk a million words per minute, much as he did. At the 5 minute mark, he was already telling me he had to get to another patient. With my final question, he said we should schedule a real f-up appointment when I get my stitch out, so I can ask my questions then. Nice.

Anyway, he does believe I have most of the skin markers for Dermatomyositis (despite normal muscle enzymes), and he did a biopsy of my skin rash. He explained that all AI issues are on a spectrum, and mine may be very mild, perhaps no need for medication, no muscle involvement, etc. He said my sun sensitivity may not mean absolute sun avoidance, but no sun bathing either. He urged me to get a GYN check-up, because dermatomyositis (DM), especially the rash, is often an indicator of underlying cancer.

I haven't been to the GYN in 2 years...

He confirmed that the small red spots on my torso during sweating and exercise are hives (cholanergic urticaria), and yes, mast cell related, like my dermographia. My beet red, burning face is hives too. He suggested I take a Zyrtec before every workout. I think I prefer no workouts instead.

It seems some people develop an IgE reaction to their own sweat. I guarantee I do.

Now I've been reading about the link between DM and Epstein Barr Virus.............

jmayk8 · Post by **jmayk8** » Thu Jun 21, 2012 7:23 pm

Zizzle, 2 years since the gyn?! Get your 'you know what there' ASAP!

Zizzle · Post by **Zizzle** » Thu Jun 21, 2012 8:52 pm

I know, I know. More like 1.5 years, and I've never had an abnormal pap, so I don't need them yearly anymore. I guess my reproductive organs have been the least of my worries lately (just making sure they never reproduce again! Lol).

I forgot to mention, the derm asked "what is lymphocytic colitis? I've never heard of it." I said MC. Still no clue. I said "lymphocyte infiltration of the colonic mucosa". He looked puzzled. So I said "basically ulcerative colitis without the ulcers?" He said, "oh! So you have non-ulcerative colitis!!" I said, "uh, I suppose so?" Sigh.

Post by **tex** » Thu Jun 21, 2012 9:47 pm

Zizzle wrote:He said, "oh! So you have non-ulcerative colitis!!" I said, "uh, I suppose so?" Sigh.

At least now he has a vague idea of what you were talking about.

Tex

MBombardier · Post by **MBombardier** » Thu Jun 21, 2012 11:53 pm

Since you've never had an abnormal PAP and you are in a monogamous relationship and have been for years, you don't have to worry about going to the gyn yearly, as you obviously know. Although I agree with the dermo, you should go now...

I went to the gyn in 2010 for the first time in seven years. The best thing to come out of that was she convinced me to get a colonoscopy. I should probably go back one of these days. I'd at least like to thank her in person.

Zizzle · Post by **Zizzle** » Mon Jun 25, 2012 11:54 am

So, the morning after my dermatology appointment, I woke up with a cherry hemangioma/angioma half an inch UNDER MY LEFT EYE!! It's only 2 mm x 1 mm and flat so far, but it's obvious, and it's forever!!!! What is going on with me?!?! I asked him about the multiple tiny angiomas on my torso, and he said it was a normal part of aging. But I'm only 38, and I don't see many other women like me with red dots all over their bellies.

So I looked it up, and low-and-behold...

A significant increase in the density of mast cells has been seen in cherry hemangiomas compared with normal skin.

http://en.wikipedia.org/wiki/Cherry_hemangioma

I seem to be the queen of skin mast cell problems, and they are getting worse by the minute. I think there is an underlying vasculitis associated with it all. I hope the biopsy provides some clear answers (and they count the mast cells!).

jmayk8 · Post by **jmayk8** » Mon Jun 25, 2012 12:30 pm

Zizzle,
Oh my goodness!!! I have the SAME problem! I have them all over my belly, and forearms. My Dr told me they are nothing to worry about either-it's just aging. Really?! bc I am only 29! I knew it had something to do with mast cells! I hate them, Im sorry to hear that you have one that big near your eye. I had one under my eye a few months ago and it went away. My others on my stomach just seem to be getting bigger and more red. They are gross and embarrassing!
Jenny

Zizzle · Post by **Zizzle** » Mon Jun 25, 2012 1:18 pm

Jenny,
We ought to seek medical care as a package deal! Seriously, so much in common! I have tiny angiomas all over my inner biceps and forearms...just noticed them, thanks!

I used to wonder whether I was just bleeding out under my skin, but those would be petechiae (I get them too), and they would/could go away. A doctor friend explained these are abnormal clustering of capillaries just under the skin, and therefore are hard to treat. I might need a laser treatment to deal with the one under my eye. But there will be others, so WTF?!?
Yes, I see these on aging people, but of the 60+ variety!!

My dermatologist is going to hate me when I'm through with him.

I'm wondering if I should call his office to make sure they ordered a mast cell count on the skin biopsy.

jmayk8 · Post by **jmayk8** » Mon Jun 25, 2012 1:46 pm

I would ck on the mast cells in the biopsy... The spots on my inner biceps and forearms are all tiny too but, are def there. My Dr looked at me like I had 20 heads when I was pointing them out to him.

Zizzle · Post by **Zizzle** » Mon Jun 25, 2012 1:56 pm

The other thing the doctor confirmed is that I have Miliaria crystallina (a.k.a. prickly heat)-- that's the sweat-filled blisters that develop on my torso when I sweat. My husband keeps telling me I need to sweat MORE and scrub my skin to open the pores. Everything I read just says to avoid sweating. It seems normal staph bacteria may be to blame. Scrubbing to open the pores, of course, creates a mast-cell related rash, so I can't win. I've been getting these blisters since college, when I used to work out and sweat all the time, so I don't think more sweat is my solution. Hmmm.

The mildest form of heat rash affects the sweat ducts in the topmost layer of skin. Miliaria crystallina is marked by:

Clear, fluid-filled blisters and bumps (papules) that break easily
The blisters that occur with miliaria crystallina aren't itchy or painful. This type of heat rash usually clears on its own but can come back if hot, humid weather persists. And though it's common in newborns, adults can develop it, too.

DebE13 · Post by **DebE13** » Mon Jun 25, 2012 8:35 pm

Zizzle,

I don't have anything helpful to offer but I wish the best for you. You're not alone in the postponing the gyn exam- mine was over three years ago. I just got mine done on Friday. I agree with you, right or wrong, I never had an abnormal pap and had other things to deal with and couldn't stand the thought of dealing with another doctor appointment. I went to the appointment fasting and was able to get the full thyroid panel done that I've been putting off for months. Should have the results tomorrow which hopefully will explain some of the odd and not so common problems I've been having. I've had very mild heat rash on occassion and empathize with your situation.

Gloria · Post by **Gloria** » Mon Jun 25, 2012 9:53 pm

I was at the beach on Saturday and had itchy bumps on my head, chest and leg by Sunday. It happens every summer. I sat in the shade with a hat on, too. I guess this will be my fate at least once each summer. I think it's a mast cell reaction.

Gloria

Martha · Post by **Martha** » Tue Jun 26, 2012 7:25 am

I have red dots on my torso and thighs. I started getting them about 10 years ago, and I'm 59 now. My dad had them too. I remember seeing them when he'd go swimming. My doctor said they are nothing to worry about. But now it sounds like you're saying they indicate mast cell involvement.

Does the fact that I have red dots mean I need to look at my diet more closely? I am gf, df, and sf (well really, legume-free), but I've just sort of skimmed over the mast cell posts. Should I go back and read those more carefully?

Deb · Post by **Deb** » Tue Jun 26, 2012 8:09 am

As I'm reading this I just noticed a very small one on my thigh and upon a closer look, one on my belly. Now that I think of it I've seen them before. Now I'm curious!

Zizzle · Post by **Zizzle** » Tue Jun 26, 2012 8:33 am

Eek, I do think cherry hemangiomas are a normal part of aging, and I don't think they alone serve as an indicator of a mast cell problem, per se. Although they have more mast cells in them, I'm not sure what came first, the mast cell issues on the skin, or the capillary clustering at the skin's surface? Also, we don't know if these mast cells degranulate more often than they should, and with what stimuli. In any event, skin mast cell proliferation is not necessarily an indicator of the number or activity of mast cells in your gut.

That said, these concern me because of their sudden and somewhat widespread onset in my early 30's. If there were more, they might be an indicator of an underlying malignancy, much like my other rash

. But in general, I don't think a hanfdul of hemangiomas are anything to worry about.