b12/lipo injections Lipo-B (MIC) for Weight Support B12 Shot – IV

B12 Shot – IV League Nurse Concierge

You can apply hydrocortisone, a topical steroid, to weeping eczema, ideally after bathing or showering

Thyroid Hormone Replacement Therapy

Variant:5mg

Clinical: Sun sensitivity Increasingly fragile skin on back of hands and forearms Get multiple erosions and blisters This heals with scarring in the form of milia (tiny cysts) Can also get hyperpigmentation on face and neck and hypertrichosis (excess hair) Diagnosis: Skin biopsy: sub epidermal blistering All porphyrias that cause skin lesions have elevated plasma porphyrins Elevated urinary uroporphyrin (and others) and fecal porphyrins indicate PCT [Should probably do iron studies, HIV and viral hepatitis testing in these patients] (Urine may look reddish/‘tea’ coloured) Avoid unnecessary exposure to strong light  Pseudoporphyria Looks like porphyria cutanea tarda BUT porphyrin levels are normal Reaction here is to UV light and not visible light like PCT Symptoms: Photosenstivity and fragility Tense blisters at minor trauma sites (and erosions/scabs) Often on hands and feet Heal with scars and milia Usually medications: (medications react with sunlight to cause photoxic reaction in skin) · NSAIDs · Antibiotics-doxycycline · Diuretics- thiazides, furosemide, bumetanide · Retinoids- acitretin, isotretinoin · OCP Investigations: Phototesting to confirm photoxic action of the supected agent Skin biopsy of blister May check porphyrins in blood, urine and faeces to rule out PCT Management: Withdraw offending agent (usually goes away in weeks but cn persist) Sun protection Variegate porphyria: Due to protoporphyrinogen oxidase deficiency Looks exactly like PCT in skin Often presents earlier than PCT (teens) Very important to diagnose as if misdiagnose can prove fatal Variegate porphyria can cause acute, systemic internal attacks Acute porphyria signs/symptoms: AIP, Variegate porphyria, hereditary coproporphyria Can present with sudden life-threatening crisis Most patients have one or only a few attacks followed by resolution of syndrome Attacks occur rarely in childhood with incidence increasing after puberty Manifest by neurovisceral symptoms and autonomic sequelae Neuro: fatigue, confusion, seizures, motor neuropathy GI: abdominal pain, N/V, constipation Autonomic: hypertensive urgency, fever Hyponatraemia (Think in someone with unexplained neurological symptoms in someone with autonomic and/or GI symptoms and hyponatreaemia)