RSD Puzzle #009

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #9
Hair Changes In RSD

"Can RSD cause change of hair color, change of consistency of the hair, and change of skin color".

The skin and the nervous system both originate from the same germinal cells in very early fetal stage. It is not surprising that nerve dysfunction commonly manifests itself in the form of skin diseases. Neurodermatitis is quite commonly seen in both somatic and sympathetic nerve dysfunction's. In the somatic form, the neurodermatitis is in the distribution of dermatomes whereas in sympathetic nerve dysfunction it is in the distribution of thermatomes. The skin changes are quite varied with several manifestations. The commonest form is swollen, somewhat shiny, pale, pink or mottled skin. The skin looks like it is too tight because of the swelling of the tissue under it. Other manifestations are in the form of breakdown of the skin, progressively enlarging ulcer, and skin lesions that look like infected and non-healing, irregular shaped, relatively deep ulcer. Other manifestations are in the form of skin rash, urticaria, eczema, xerosis (very dry and wood-appearing type of skin). The hair growth or lack of the same is quite common.

The abnormal hair growth may show a mutation to a thicker, darker hair or may be in the form of a thin, fragile and fuzzy hair.

The skin may become thin and fragile easily developing ulcers or may become quite thick with a venous and lymphatic inflammation developing in elephantiasis or resulting in what appears to be a superficial phlebitis. This has been in erroneously mistaken for the development of phlebitis in RSD patients. This is nothing but a superficial inflammation of the venous circulation due to the inflammatory nature of RSD but does not have anything in common with the standard forms of phlebitis that can cause remote blood clots.

Treatment consists of standard treatment of RSD.

Nerve blocks, especially sympathetic ganglion nerve blocks, epidural nerve blocks, skin patch such as Clonidine patch, and corticosteroid creams are quite effective.

The majority of skin changes become self-contained and self- controlled when the proper treatment of RSD is initiated. The unattractive change of skin or hair color should not be corrected with plastic surgery because it will result in disastrous complications. The large ulcers which become larger with surgical excisions are best treated by avoidance of surgery, and avoidance of bandages and tight dressings, and treatment with sympathetic blocks applied proximally as well as systemic sympathetic blocks. Application of epsom salt and warm water is quite effective. The hyperosmolar effect of the epsom salt and warm water markedly reduces the inflammation and enhances the growth of the normal skin. The use of hot bath along with the application of epsom salt is quite effective in treatment of such conditions.

When the patient has extensive inflammation, swelling, itching, eczema and neurodermatitis, treatment with Atarax, as well as Seldane (which is an antihistaminic type of medicine) can be helpful. In patients who have severe spells of neurodermatitis during the night keeping them awake, combination of antidepressants such as Zoloft 50mg t.i.d., Paxil 20mg b.i.d., or Trazodone 150 to 300mg at night along with Atarax may be quite helpful.

Whereas corticosteroid type of creams are quite helpful in the treatment of the skin lesions, the use of Prednisone to cut down or Cortisone by mouth or systemically should be avoided. Instead, treatment with ACTH which is not a corticosteroid but a protein similar to endorphine can be quite helpful in stimulating the patient's own adrenal glands to secrete the patient's own cortisone without causing atrophy of the adrenal glands and causing additional stress.

H. Hooshmand, M.D.

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2006 H. Hooshmand, M.D.