Dermatology

Anna was readmitted to Sick kids this morning. Over the past three weeks she has developed increasingly sore and painful red, blistering, peeling raw skin on her hands and, over this weekend, on her face. As well as this, she has had extremely painful blisters and ulcers on the outside and inside of her mouth and on the tip of her tongue. Not surprisingly she has been in extreme discomfort and pain but we have tried to carry on with normal life as much as possible. At least being at nursery or out with me and Nathan temporarily takes her mind off it.

I’ve brought her in three times to be swabbed and reviewed – each time results have come back negative. She’s had three cycles of anti-virals (acyclovir) and one course of antibiotics. And I’ve been in regular contact with Ward 2. Finally this morning, I felt it was getting worse rather than better and I wasn’t managing to keep her comfortable. So we came in.

As is often the case with Anna, it is a mystery. After being admitted this morning, she was referred straight to dermatology and was seen this afternoon. Another new hospital department now involved with Anna!

The consultants here in oncology and now also in dermatology have various views. Most likely, it is a reaction to a drug, reaction to sun light or a combination of both. There was a suggestion of Stevens – Johnson syndrome but fortunately (having googled it) they seem to have decided against this.

Voriconazole, her anti-fungal treatment, can cause extreme skin & sun sensitivity. Septrin, her Monday and Tuesday antibiotic, to protect against a particular lung infection, can cause the kind of blistering and peeling response her skin is showing. She may have had cold sores and the skin condition is separate.

So, to cover all of the above, her septrin and voriconazole have been stopped. She is to have factor 50 sun cream on at least twice a day ( even in bed) and try and be covered at all times. Sunlight through a window, or even sitting in a bright sunny room can be enough to cause the reaction. We will stay in hospital until she starts to show some sign of improvement – at least until the end of the week, I think.

This is Anna when we first came in today…

And then after dermatology visit…

And then at bedtime…

The pictures show how bad her face is, even when covered in factor 50 cream in bed. Her hands are worse. She is half asleep just now but keeps waking, despite good doses of pain relief. I don’t anticipate a good nights sleep but know we are in the best place.

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