[44F] Experiencing a range of symptoms including skin sores and severe fatigue

Patient Description

A 44-year-old female has been experiencing recurring painful skin sores, predominantly on the right side of her body and hairline, for the past 6 months. These sores blister, pop, then turn scaly and hard, leading to hair loss along the hairline. She is also suffering from severe fatigue, a crawling sensation on her skin, and a hot, flushed, prickly sensation on one side of her face. The patient reports pins in her feet while walking, digestive issues, headaches with dull pain behind the eye accompanied by severe neck pain, muscle cramps, and a decreased hand grip strength, making it difficult to perform tasks such as squeezing a tube of toothpaste or holding a pen. She also experiences vertigo, clumsiness, mood swings, and insomnia, unable to sleep more than 3-4 hours a night. The patient has a history of migraines and lupus, diagnosed 20 and 10 years ago, respectively. Current medications include Pregablin 150 mg twice a day, fluoxetine 40 mg, prazosin 5mg, and Zolpidem 12.5 mg taken daily, along with a women's complete vitamin, ibuprofen, and Benadryl as needed. No known allergies to medications have been reported, although most sleep medications have the opposite effect on her.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Lupus: Given your history of lupus, many of your symptoms could be related to a flare-up of this condition. Lupus is a chronic autoimmune disease that can affect many parts of the body, including the skin, joints, and internal organs. Symptoms can vary greatly from person to person, but commonly include fatigue, joint pain and swelling, skin lesions, and a butterfly-shaped rash across the cheeks and nose.

    • Treatment typically involves managing symptoms and preventing flare-ups. This can include anti-inflammatory medications for joint pain and stiffness, and immunosuppressive drugs to control the body's immune response.
  • Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. It amplifies painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals.

    • Treatment often involves a combination of medications, exercise, stress-management measures, and healthy lifestyle habits.
  • Peripheral Neuropathy: This condition results from damage to the peripheral nerves and causes weakness, numbness, and pain, usually in your hands and feet. It can also affect other areas of your body.

    • Treatment typically involves managing the underlying condition causing the neuropathy, as well as medications to manage symptoms.
  • Dermatitis: This is a general term that describes a skin irritation. Dermatitis is a common condition that has many causes and occurs in many forms. It usually involves itchy, dry skin or a rash on swollen, reddened skin.

    • Treatment typically involves identifying and avoiding products that cause symptoms, as well as applying creams or ointments to help soothe the skin.

What you can do

It would be best to consult a doctor about your symptoms so that they can provide a formal assessment and order relevant tests if necessary. In the meantime, you can try the following:

  1. Keep a symptom diary: This can help you and your doctor identify triggers or patterns to your symptoms, which can be useful in determining the best treatment approach.
  2. Stay hydrated and eat a balanced diet: This can help manage your fatigue and support your overall health.
  3. Practice good skin care: Keep your skin clean and moisturized, and avoid any products that seem to irritate your skin.
  4. Stay active: Regular physical activity can help manage symptoms such as fatigue and joint pain.
  5. Practice good sleep hygiene: This includes maintaining a regular sleep schedule, creating a restful sleep environment, and avoiding caffeine and other stimulants close to bedtime.

What you should look out for

Reasons to seek immediate medical attention:

  • If you notice a sudden increase in the severity of your symptoms
  • If you develop a high fever or severe headache
  • If you notice a sudden change in your vision or ability to move
  • If you have any symptoms that you find particularly concerning or that are significantly affecting your quality of life.

Please remember that while I strive to provide accurate and helpful medical information, this advice is intended to support, not replace, the relationship that exists between you and your healthcare provider. Always consult a healthcare professional for a diagnosis.

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People Also Ask


What are the common symptoms of a lupus flare-up?

Common symptoms of a lupus flare-up include fatigue, joint pain and swelling, skin rashes, and sometimes fever. It can also cause headaches, hair loss, and sensitivity to sunlight.


How can fibromyalgia affect daily life and what are its symptoms?

Fibromyalgia can cause widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties, often referred to as 'fibro fog.' It can significantly impact daily activities and quality of life.


What are the causes and symptoms of peripheral neuropathy?

Peripheral neuropathy is often caused by diabetes, infections, or autoimmune diseases. Symptoms include numbness, tingling, and pain in the hands and feet, and it can also lead to muscle weakness.


How can dermatitis be managed and what are its common triggers?

Dermatitis can be managed by avoiding irritants and allergens, using moisturizers, and applying topical treatments. Common triggers include soaps, detergents, and certain fabrics or foods.


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