32years housewife with 7 months amenorrhea ( primi) presented with intense pruritis with Erythromatous papule & pustules both legs symmetrical below knee edematous with superficial ulcerations. No h/o Drug intake No h/o allergy in past Normtension/Non diabetic CBC..TLC 6.3/HB.7.5 DLC..N80%,L12%,E.2.9%. PLATELETS 1.33.. TSH.. 5.6 LFT/KFT (n) kindly give your expert advise

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She is anaemic with Hb-7.5.TSH is raised 5.6.Adv blood sugar nd exclude diabetes.Urine for albumin.Anaemia nd hypothyroidism in pregnancy causing edema of the legs, secondary infection with cellulitis.

Non diabetic... Hb raised to 8grams/dl by now..
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I want to have more differential Diagnosis in this case. I was asked for Hematological opinion for Anaemia.. I prescribed Iron sucrose 300mg thrice weekly for till hemoglobin is above 11grams/dl.. Iron Rich diet High protein diet.. Will see what Dermatologists writes on the case files.. Patient is admitted in Obstreticians & Gynaecologists unit.. THANKS

Pemphigoid gestationis with cicatricial pemphigoid.to be treated with topical steroids

Thanks a lot
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Necrobiosis lipidioca dd necrobiosis xanthogranuloma ,necrobiosis granuloma annulare. tt. Topical steroids +antibiotic,emmoients, Oral deflazacort ,aspirin, pentoxyfiline, nicotinamide,antihistamines cyclosporine.

Suggestions of so many medicatiin In a primipara, dangerous practice.
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she is severe anaemic treat Anaemia odeama duo to hypo proteinimia treat on these grounds antibiotic anti allergic orally mixed cream daily clean with aataril soap blood purifier syrup will help

Sir which syrup is blood purifier???
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Since it is 7th month pregnancy We have enough time to raise her Hemoglobin No blood transfusion advised by me..

In immunocompromised pateints like pregnant woman with anemia prone for systemic fungal infection with candida, can use local antifungals and oral antioxidants like b complex vitamin e, vitamin c, ask her to take sprouts and more fresh vegetables and fruits

Thank you for requesting to answer Dr. Sapana Bhosale . It looks like gestational pemphigoid.

It could be pupp with secondary contact dermatitis

Bilateral symmetrical pin head sized purpuric lesions point towards vasculitis

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