Treatment: If a pancreatic or liver tumor is identified and able to be surgically excised, the skin lesions may normalize for an extended period of time, but because these tumors metastasize (spread to other areas of the body) quickly, surgery is not curative. In cases of end stage liver disease, surgery is not possible, and the goal of therapy is to increase quality of life and decrease uncomfortable skin lesions with supportive care and addressing the nutritional abnormalities. Supportive care includes supplementing protein and necessary minerals and enzymes through the diet and oral supplements or by weekly intravenous amino acid infusions that are performed in the hospital on an outpatient basis until improvement in the skin is noted. Unfortunately, despite the supportive care, the disease will progress.
While it would be absurd to suggest that family doctors should be aware of the more obscure side effects of all the drugs they prescribe, this situation is rather different. Bendroflumethiazide is one of the commoner drugs prescribed for raised blood pressure and it is well known to cause diabetes in almost 10 per cent of those taking it. So for her family doctor to fail to make the connection is definitely a bit odd. She did the sensible thing and binned her pills. Gratifyingly, her “diabetes” has since cured itself, and for good measure, her blood pressure has also remained satisfactory.