[AlaskaAngel]

Thanks, Jacqueline! I am exploring any possibilities and appreciate the feedback.

Prior to your post I saw the Derm NP, and asked specifically whether it would be possible to use some kind of low-dose, short-term estrogen supplement just to find out if it made any difference. Her opinion, (generalized to all patients but not specific to patients treated with chemo, radiation and antiestrogen therapy), was that there was no connection with estrogen. Specifically she said that derm docs never prescribe any hormonal drugs to any patients under any circumstances, regardless of whether the skin problem might be caused by low estrogen levels and regardless of whether the patient's history has any indications for bc.

I later obtained a copy of her clinic note of my visit with her, which noted in parenthesis her awareness of my bc dx followed immediately by her statement that there is no connection between "extreme xerosis of the skin and estrogen levels".

Her approach to my extreme dry skin problem was to prescribe cetirizine Hcl 10 mg 1 q24h, specifically Zyrtec, plus several different skin emollients applied daily to moisturize the skin. She said I might have to use it "forever". She said I could continue to use the baby oil with vitamin E and aloe in it, but only after using the emollients so that they would soak in. She said it could take up to 2 months for the cetirizine to have effect. In the meantime, she recommended cutting my fingernails (which are short to begin with), wearing gloves, and eliminating all scratching.

I asked her specifically about the numerous oval-shaped 1/2-inch "bumps" called lipomas that have arisen since the skin problem began and that are palpable under the skin in places that are especially itchy (the front part of the elbows, and on my hips) and she said there was no relationship between them and the itching. I had some other lipomas previously and those lipomas have significantly enlarged since the skin problem began. My PCP had indicated to me that perhaps the derm doc would biopsy some of them, but the NP said that if I wanted any of them biopsied they would have to be entirely removed by not a derm doc but a surgeon, and once removed then of course a biopsy of them would occur.

I have been on the citirizine, have cut my nails, have applied the skin creams, and am trying to aviod scratching. The $1/day Zyrtec helped; when I ran out, the 50 cents/day grocery store version of citirizine did not. The soothing effect of the creams lasts about 30 minutes, just in time to fall asleep (and then wake up due to itching).

I have an appt to see my PCP soon. If the recommended therapy is the only possible option, it may be necessary, but I think the question about use of low dose short-term estrogen supplementation should be explored to see if there is any validity to it, rather than taking on a band-aid approach of perpetual antihistamine and creams without even bothering to do another bx.

I am not sure what disbiosis entails and will read up on it. Since chemotherapy, radiation and anti-estrogen therapies may affect the skin and are common treatment specific to breast cancer patients, I will also be exploring whether or not something such as a sluggish gallbladder post-treatment could be a cause, since that can result in higher levels of bile salts being deposited in the skin, which causes itching. I want a bx of the skin for that, as well as possibly a bx of some lipomas (fatty deposits just under the skin).

I will post with any results.