What kind of doctor do I need?

March 19, 2009 8:21 PM

I have a rash. I've been on two different courses of antibiotics and it keeps coming back. What do I do?

At the tail end of January, I started developing a rash. Red sores started appearing all over my body, and they were crusting over with a brown fluid. I went to a walk-in clinic, was diagnosed with impetigo and given a 10-day course of antibiotics (clindamycin). It started going away and I was relieved. After the antibiotics were gone, it came back. I went back to the clinic, and the doctor and I agreed that I just needed more antibiotics. I was prescribed prednisone to get rid of some of the skin irritation and a 14 day course of clindamycin. It was almost completely gone, but now it's come back again.

So what do I do now? Should I go back to the walk-in clinic? I guess it's possible that the doctor misdiagnosed me. Or should I go see a "real" doctor? Or maybe a dermatologist?

I'll admit I've been doing a lot of "research" on the internet and I am freaking myself out. Maybe it's shingles, scabies, bedbug bites, the plague, an allergic reaction, etc.

I just don't know what to do. I don't have a lot of experience going to doctors, mostly because I haven't had insurance for most of my adult life. For example, I have this vague notion that I can't just make an appointment with a dermatologist; I need to get a referral, and it will take weeks to get an appointment. I don't have a regular doctor. Oh, also, I am unemployed and don't have a lot of money. That was why I chose the walk-in clinic in the first place.

I'm not looking to get diagnosed by strangers on the internet. I know I need a doctor. I just don't know where to go.

I need to start living my life again! This sucks!

posted by kpmcguire to health & fitness (16 comments total)

Did anyone at any point take a culture? If so, what were the results?
posted by Cool Papa Bell at 8:25 PM on March 19

I know maybe this is a bit gross, but since you didn't go into detail: how scrupulous have you been about hygiene? As a kid, I used to get it around my nose pretty often, and I think my mom would have me scrub it with hydrogen peroxide. But I never got it on any other part of my body.

Later on, as a camp counselor, I got to encounter some pretty horrific examples of it on some of my kids (like, huge patches on their backs)...apparently because they didn't wash enough. Now, I was not the cleanest of guys as a teen but I never got impetigo. Maybe I was just lucky, but I get a feeling you have to be sort of enthusiastically dirty to get impetigo.

This may not be the case, but unless you have reason to believe that getting impetigo would be likely, I suspect the rash has a different source.
posted by Deathalicious at 8:31 PM on March 19

No cultures. It was diagnosed by the clinic doc purely on sight.

I have always been a pretty clean person. I shower daily, and I've been pretty diligent about laundering my clothes and sheets and towels since this has been happening. I keep thinking that maybe I got re-infected because I didn't clean my things enough. But man, do I have to go all Velveteen Rabbit and burn everything I own?
posted by kpmcguire at 8:37 PM on March 19

See a dermatologist and get them to take cultures.

But more immediately: hygiene is a big factor, as Deathalicious suggests. Use a good body wash instead of a soap, because soap dries your skin out and can cause itching and rashes.

It could be something in your envronment. Any new clothes recently? New bedding? A new couch or armchair? New carpet? A pet? New laundry detergent? Any changes in your diet? You say you are unemployed - could it be caused by stress?
posted by turgid dahlia at 8:38 PM on March 19

Oh, and has your local council made any changes to the water supply recently? It's a long shot but it can happen.
posted by turgid dahlia at 8:40 PM on March 19

There should be no shortage of dermatologists in Chicago, and you don't need a referral to make an appointment--just look them up and book a time. I seriously doubt it would be more than a few days wait if you call around. Be prepared to drop a few hundred dollars on the office visit and then the same on a good schedule of ointment/antibiotics if you're not using insurance.
posted by Burhanistan at 8:40 PM on March 19

List of dermatologists in Chicago (going off your profile location).
posted by Burhanistan at 8:42 PM on March 19

I once had a horrendous recurring rash that was treated first as a fungal infection, then as a bacterial infection and turned out to be an awful allergic reaction. Go and get your referral to a dermatologist (count yourself lucky, I had to wait 6 agonizing months for mine), and also one for an allergist, which may be a shorter wait. You may want to look into natural treatments like oil of oregano (to ingest), to try while you're in wait without another course of antibiotics.

I'm not terribly familiar with lack of universal health care, so the financial strain of that may suck more than I can imagine, but what I do understand is what kind of havoc stuff like this can wreak on your everyday life. Do what you can, and hopefully you will find an answer sooner rather than later. Heck, you might try calling some dermatologist/allergists offices and asking them whether you need a referral. If you don't, awesome! If you do, like I did, this is something your walk-in should be able to arrange for you.

Best of luck. I've been there and it was some of the worst months (2 years actually, on and off) of my life. I thought I'd never get to the bottom of it, and I finally did- with a combination of my own guesswork and the guidance of professionals. Don't read the internet med-sites, they just increased my anxiety, and that's no good for an already weakened immune system. Do yourself the favour of avoiding it.
posted by sunshinesky at 8:45 PM on March 19

I have this vague notion that I can't just make an appointment with a dermatologist; I need to get a referral, and it will take weeks to get an appointment.

This is true if you are on some forms of insurance. If you aren't insured, you might as well go straight to the dermatologist. I would expect the office visit to cost $200-$300. If they need to run tests that will probably be another couple hundred dollars. Those are not small sums, but consider that if you don't get treated it might get worse and be even more expensive. Call and see if you can get a discount for paying up front.
posted by grouse at 8:53 PM on March 19

I think I'm going to start calling dermatologists tomorrow. Although I don't have the money now, a check is in the mail, hopefully it will come in time for the appointment. And hopefully it will be enough to cover it.

sunshinesky, thanks. I think the psychological aspect of this whole situation has probably been the worst part.
posted by kpmcguire at 8:55 PM on March 19

Have you been tested for MRSA? If it's positive, you will have to do lots of fun things like Bactroban cream up the nose and Hibiclens washes and all that fun gunk. MRSA recurs nice and frequently. And yes, wash everything in hot water and wash your hands often.
posted by crazycanuck at 9:04 PM on March 19

Shingles aren't something that happens all over. If you read the wikipedia page on the subject, you'll see that it comes out in specific bands, along nerve lines (my partner just had this last fall). It is from chickenpox, that you'd had to have had previously.

It doesn't sound to me like something that should require a dermatologist, but then, the guy you've seen has failed to rid you of the problem, and now whatever it is has been learning how to resist the clindamyacin, most likely. (for good measure, it wouldn't hurt and would likely be a good idea to take some intestinal probiotics. In Switzerland, they prescribe this any time antibiotics are used).

My sympathies on the hit to your budget. American health care is the pits.
posted by Goofyy at 9:33 PM on March 19

I kinda figured it wasn't shingles based on my crazed internet research, but it certainly crossed my mind early on.

American Health care is indeed the pits. They sound so nice in Switzerland - I didn't get a single mention of any of that probiotics info either time I was prescribed the clindamycin, which is apparently particularly prone to screwing up your intestinal flora.
posted by kpmcguire at 9:46 PM on March 19

I had a strange rash that was missed by 2 doctors...turned out to be Hot Tub Folliculitis. There were similar symptoms to what you descibed. My Doc talked about taking Prednisone, but suggested that I first try washing with Hibiclens, It helped a lot, was over the counter and cheap, and worked after a week or so. If nothing else, it might give you some relief. But as always, IANAD.
posted by lobstah at 3:00 AM on March 20

Wherever you go, always ask about discounts for the uninsured. Plead for it and you might get it. Doctors are sometimes the sympathetic sort. :)
posted by GPF at 5:10 AM on March 20

Good luck with the dermatologist - I have a rash that my PCP misdiagnosed as an allergic reaction. When it didn't go away, I went to a dermatologist. Turns out it's a viral thing called pityriasis rosea. Doesn't sound like that's what you have, but a dermatologist will know.
posted by roomthreeseventeen at 6:11 AM on March 20