what are these red blotches on skin

November 30, 2013 8:12 AM

My partner went hiking in Spain about a year and a half ago. She experienced some difficulties with her feet so it was a difficult hike with a fair amount of pain to complete the journey. She stayed in hostels along the way. She now has what looks like poison oak patches on her feet and arms that never seem to heal.

When she got back, she had a growing set of red blotches on her skin around her ankles and on her shoulders and arms. She has a big 4-5" blotch on one ankle and otherwise it's spread around her legs and outside of her arms kind of like you would see with poison oak that's being spread by scratching or by clothing, so not particularly something you want to show off in a bikini.
They weep, so her clothes stick to them and burn and/or itch as well. You'd think they were a form of poison ivy that lasts for months. The skin is bumpy and the worst bit, on her ankle, looks a bit crusty.

She is avowedly alternative in her medical outlook and refuses to go see a standard MD or dermatologist. I've encouraged her to do so even if only to get more information about what this could be. That's been a non-starter so far.

I don't see that her 3,4 or 5 (lost count) acupuncturists have done anything other than give her slightly varying diet suggestions, herbal stuff and needling that doesn't seem to do much. Her other ointments and dietary tweaks also have not made a difference. She thinks it's in the process of drying up. I can't see much change.

At this point, I don't know what to do to help. To me, it's irrational not to avail oneself of all available medical resources to figure out what this is and the best way to treat. it.

Whatever it is, it doesn't seem to be contagious as I have no sign of this. Is it possible she actually has poison oak that's on her clothing or it is continually being reintroduced in some way? What else could it be?

posted by diode to Health & Fitness (20 answers total)

Sounds like impetigo to me. Treatable with antibacterial cream.
posted by slkinsey at 8:23 AM on November 30, 2013

Her other ointments and dietary tweaks also have not made a difference.

What ointments has she tried? Has she tried a steroid cream? An antihistamine? An antibacterial ointment?

Is it possible she actually has poison oak that's on her clothing or it is continually being reintroduced in some way?

Seems unlikely that it's on her clothing - it would have come off in the laundry by now. And given that it's on both her ankles and her upper body, I doubt it's been continually reintroduced.

They weep, so her clothes stick to them and burn and/or itch as well. You'd think they were a form of poison ivy that lasts for months. The skin is bumpy and the worst bit, on her ankle, looks a bit crusty. She is avowedly alternative in her medical outlook and refuses to go see a standard MD or dermatologist.

Yikes. If she hasn't tried the creams/ointments I mentioned above, she should. If she has and they haven't worked, it is really, truly, time to see a medical professional of some sort. A rash so weepy that clothing sticks to it? Not good.
posted by schroedingersgirl at 8:26 AM on November 30, 2013

It also sounds like impetigo to me as well except that impetigo is very contagious. But nobody here is going to be able to give you medical advice and she really, at this point, needs to see a doctor. Are you still in Oregon? I would put a lot of effort into finding an alternative health practitioner she will agree to see who is also western medicine certified. (For example, I saw an acupuncturist who was also a certified nurse; there are doctors who practice combined medicine as well.)
posted by DarlingBri at 8:28 AM on November 30, 2013 [1 favorite]

Impetigo is contagious. If she won't see an MD after a year and a half, she's unlikely to believe a bunch of internet strangers telling her to go to an MD. But she should go to an MD.
posted by headnsouth at 8:29 AM on November 30, 2013 [6 favorites]

Could also be fungus (e.g. athlete's foot) with or without secondary bacterial infection.

If it is a fungus, steroid creams used incorrectly could make it worse. So she really needs to see a doctor who's trained in diagnosing skin conditions and applying the correct treatment.
posted by Jahaza at 8:37 AM on November 30, 2013 [1 favorite]

I have seen some skin infections that ended up needing skin grafts to fix. They started off bumpy and weepy & just got worse and worse.

A course of antibiotics or the appropriate anti-fungal cream now is far preferable to surgery in a years time.

In your place I'd point out that more information can't hurt: if she goes to a doctor or a dermatologist they can take samples and tell her whether she has a skin infection or not. Either way she can choose whether or not to follow whatever treatment they suggest herself.
posted by pharm at 8:52 AM on November 30, 2013 [1 favorite]

Would she agree to see a DO general practitioner or dermatologist rather than an MD?
posted by muddgirl at 8:54 AM on November 30, 2013

It may not be impetigo (IANAD), or you would likely have gotten it by now. It's incredibly contagious.

With open, weeping sores, she's running a serious risk of cellulitis (bad) or maybe even sepsis (very, very bad). This is not something to fool around with. What happens when you point out to her that all the non-MD practitioners she's seen have been unable to rid her of this condition?

One of you should start documenting the worst patches - take pictures weekly, maybe. She and any future practitioners need to see its progression/lack of over time. And somehow, get her to go to an actual dermatologist.
posted by rtha at 8:56 AM on November 30, 2013 [2 favorites]

"At this point, I don't know what to do to help."

Has she asked for your help? Unfortunately, you can't compel someone you love to see a dermatologist. Until this starts happening on your skin, it is her body, her choice, and just not your problem.
posted by hush at 8:56 AM on November 30, 2013

Seconding seeing a DO, but really - this unlikely to fix itself and there is no reason to avoid information from a variety of medical practitioners AND THEN get treatment options from them and make a decision at that time. Listening to an expert about something doesn't mean you have to subscribe to a different system of beliefs and accept treatment in line with those beliefs, all it does it make you better informed.
posted by iamabot at 8:58 AM on November 30, 2013 [2 favorites]

An acquaintance had some problems with his skin on his foot. Did not want to see a doctor. It turned out he had diabetes. He had to have his foot amputated. He still died. I was shocked that these things still happen in my country. It's probably not that, and sadly I agree that if she doesn't listen to you she is unlikely to listen to a bunch of internet strangers, but it would indeed be good to try to find a middle ground and a (real) health professional she does respect.
posted by blub at 9:22 AM on November 30, 2013 [1 favorite]

joint pain and patchy, weepy, itchy lesions on the outside of joints - psioratic arthritis?
posted by mwhybark at 10:49 AM on November 30, 2013 [2 favorites]

Best answer: Once, years and years ago, I got a very bad case of what I believe was poison ivy from walking through a field of it in shorts. I had very poor health insurance at the time and was on a trip far from home so I put off dealing with it, planning to wait until I could get back to see my usual physician, for weeks and weeks. (Though really I was of course hoping it would just go away on its own.)

It didn't go away but kept getting worse and worse. Once my entire lower legs were inflamed and the skin was reddened, bumpy, weeping, and firm to the touch, I couldn't stand it any more and went to an emergency room.

The emergency room doctor explained that the umbrella term for an inflammatory skin condition is cellulitis (not to be confused with cellulite, which is completely different), which can have many different causes. He said that in some cases the inflammation can become self-perpetuating, with each epidermal cell or tissue basically deciding that since all the other ones around it are inflamed, it should be inflamed too, and said that even if the rash on my legs was originally caused by poison ivy there probably wasn't any of the irritant from the plant left at that point. He prescribed some steroid cream and it cleared up shortly thereafter.
posted by XMLicious at 1:27 PM on November 30, 2013 [3 favorites]

Would she agree to see an osteopath? Osteopaths are physicians, but perhaps she would feel more comfortable with the more holistic, alternative medicine-friendly philosophy of the profession.
posted by decathecting at 2:23 PM on November 30, 2013 [1 favorite]

(Whoops, sorry, should have read the other responses more carefully. Osteopath=DO, which I now see was suggested above.)
posted by decathecting at 2:24 PM on November 30, 2013

She is avowedly alternative in her medical outlook and refuses to go see a standard MD or dermatologist.

There's a point when being stubborn passes into the land of stupidity, but that's her decision - and therefore her problem.

However, maybe she could use traditional medicine - i.e. go visit a dermatologist - to find out what's wrong with her, and then seek out alternative sources for treatment instead of just stabbing in the dark for an effective treatment?
posted by matty at 3:51 PM on November 30, 2013 [3 favorites]

I think the key point here is that these skin issues have been going on for a YEAR AND A HALF. That makes any acute infectious cause of the rash very unlikely (i.e. impetigo, cellulitis). Such infections run an acute course - either resolving spontaneously or worsening until they become sepsis and kill their host, if untreated.

Although there are many possibilities as to what could be causing these symptoms, I would consider chronic skin conditions such as psoriasis much more strongly in this case (and if it is psoriasis, it has a very characteristic appearance such that a general practitioner or dermatologist could probably get a good idea of the likely diagnosis for her with a simple glance in her direction). Consider also the possibility that this rash has nothing to do with hiking in Spain - the onset at that time could have been totally coincidental.

One approach you might take in addressing this with your girlfriend would be to ask her "what are you afraid might happen if you get this evaluated by a physician?" Tell her you understand that she doesn't want to pursue this but you'd like to discuss why so that you can also understand her concerns and her fears. In my experience, people tend to behave in the way your girlfriend is behaving because of a fear - for example, the person who refuses to seek treatment for what appears to be a growing tumor because they are terrified to be diagnosed with cancer. That's an extreme example, but many other people have hidden fears that small medical problems might turn out to be cancer or some other serious diagnosis. So much so that they avoid being evaluated until what could have been a small problem becomes a much bigger and more complicated one, or even becomes unsolvable. Other people have been failed by western medicine before (or had a relative who was failed by western medicine, either due to some horrible interaction with someone with a bad bedside manner, or a side effect to a medication, etc).

Such fears are not really based in logic and as such, you may not be able to address them with logic (i.e., the argument that "natural" remedies also contain chemicals that could harm or kill someone isn't convincing to many believers in herbal medicines, for whatever reasons). But at least you might understand further what her motivations are and explore with her what, if anything, might prompt her to change her mind about her course of action.
posted by treehorn+bunny at 4:14 PM on November 30, 2013 [4 favorites]

As a follow up, if she is defensive already after having been questioned/pressed several times on this, she may not believe that you're just broaching the topic to understand her feelings more thoroughly. In this case, I might approach her in an even less threatening way, i.e. "I see that alternative medicine is something that you very much value. Tell me about how you became interested in alternative medicine and why it appeals to you."
posted by treehorn+bunny at 4:18 PM on November 30, 2013

Response by poster: Thanks for all the comments above. They are all useful. It might be best to simply give her the link to this page and she can assess the information here and see if it changes her outlook. If not, her family is pressuring her to see a diagnostician and I've made my preferences clear as well. From that, it's really her call.
posted by diode at 8:45 PM on November 30, 2013

I wanted to say what treehorn+bunny said more knowledgeably than I could have. The travel may well have nothing to do with this; the onset could easily be a coincidence: there are a lot of conditions which have initial onset in your 20s, and your 20s is a time when a lot of people are out and about doing adventurous things.

But this could be serious - there are autoimmune disorders that present on the skin like this. I know because my SO has one. Coincidentally enough, he first noticed symptoms on a trip to France, and thought he'd picked up something temporary and local. No, when he got back home and got evaluated, he learned that he has a chronic autoimmune disorder that causes psoriasis-like eruptions on the skin, among other things, and requires lifelong management and really changes the way he makes long-term plans. Had he not had this diagnosis, he would have made some very different descisions, some of which would actually have worsened his condition.

After a year and a half of a condition not resolving, it's time to get serious about a diagnosis. It's clearly not going to go away, and it if is a serious chronic condition, it is the kind of information a person really wants to know before deciding what their treatment approaches ought to be. The difficulty with the feet thing might be important as well. An initial evaluation can help identify what is wrong. What course of medical treatment your girlfriend pursues after that is certainly up to her - and she might choose alternative therapies for the particular condition she has - but it's impossible to choose good therapies, of any kind, if you have no idea what is wrong with your body in the first place.
posted by Miko at 9:28 PM on November 30, 2013 [2 favorites]