Who would pick up a hitchhiker with this thumb?

December 5, 2007 5:02 PM

Gumshoe dermatologists: What is going on with my hand and what can I do to fix it?

This is not very pretty--although not as shocking as a previous question--so if you are queasy around skin ailments, perhaps you'd like to move onto another question...

For the past few months, the skin around my thumb on my right hand has been acting pretty strange.

First, there was a cut/crack in it that wouldn't heal--no matter the amount of moisture or band aids I put on it. That went away--eventually (a month or two after appearing)--but then the skin on the same thumb a little above where the cut was located began forming a rash. Or at least I thought it was a rash. Again, no amount of moisturizer can help it; though Keefe's did seem to help outward appearances for a bit, but it never cured it. The skin in the affected area is red, flaky, kinda burns a bit, and just a wee bit juicy which is pretty gross. When I stick it under hot water it almost feels orgasmic, but then it just flakes more and more.

A sort of blurry picture of my unfortunate thumb is in this link.

I'm stubborn and can't really afford going to a doctor right now, which is why I've avoided professional help. But now I'm starting to think that the irritation is about to spread and sort of am freaking out.

And FYI, I don't eat fish or meat, in case you think it may be tied into diet.

Any help would be greatly appreciated.

posted by mwachs to health & fitness (21 comments total)

Looks like fungus, like maybe ringworm. Go buy some athelte's foot creme and see if that helps (but put it on your thumb, not your foot :) ). And if it doesn't, doctor.
posted by Eringatang at 5:08 PM on December 5, 2007

Eczema? Fungus? It's hard to tell, but a doc could figure it out right quick.

Having been poor and stubborn and prone to weird rashes, my usual way to deal is to get some anti-fungal cream and some over-the-counter hydrocortisone cream. DON'T USE BOTH AT THE SAME TIME. Apply one cream for a week or two solo. If the hydro clears it up, it's eczema; if the anti-fungal does, it's fungus. I've never had this regime hurt me-- putting anti-fungal cream on eczema doesn't make it worse, and putting hydro on fungus won't make it worse.
posted by holyrood at 5:23 PM on December 5, 2007

If holyrood's method doesn't work, perhaps it's some type of general topical dermatitis? In which case, aloe vera gel (applied topically, not the liquid kind to drink) might help.
posted by scody at 5:25 PM on December 5, 2007

Are there any other patches on other parts of your body? It looks like it could be psoriasis, but psoriasis usually comes in several spots (often bilateral -- i.e. both thumbs, or whatever) at once. One spot by itself is not usually what psoriasis does. If it's one spot by itself, I vote fungus.
posted by ClaudiaCenter at 5:27 PM on December 5, 2007

the "plating" looks like psoriasis, but I've never seen it that localized.

However, the "bubbling" on the upper part of your thumb looks just like the early stage of hypo-aquatic eczema on thick skin like hands (I know from experience). And the dry patches around the plating look like eczema as well. And the "cut" is typical-- your skin gets so dry it splits and won't heal.

When it's that bad, you often need prescription steroid creme to beat it effectively. But you might have good luck with OTC 1% hydrocortisone creme (twice a day) and Eucerin creme (or the generic equivalent-- make sure it has urea in it) as needed. That's what I do, but I haven't let a patch get to a state like that in years.

In my case, it's generally dust that causes it. You might be different, or you might try putting on some winter gloves and dusting your bedroom, bathroom and living room thoroughly.
posted by Mayor Curley at 5:41 PM on December 5, 2007

That blistering looks exactly like the weird Index Finger Disease I had that went away with Tinactin. The rough spots look like the under-the-cheap-Overstock-wedding-ring funk I have that has not responded to hydrocortisone and I haven't tried Tinactin on yet.
posted by Lyn Never at 5:57 PM on December 5, 2007

Check out 'dyshidrotic eczema' -- I'd bet dollars to donuts that's what you have. Topical steroid cream or ointment, OTC or prescribed, may help you some but won't touch the underlying cause, which varies wildly from person to person. Could be something in your environment you're contacting, could be something you eat, could be stress, could be weather. No way to tell, really, as no dermatologists consider it 'important' enough to do real research on.

Aquaphor ointment or Eucerin cream might help you, but it may take a fair bit of trial and error to see what non-steroidal preps help you. It's best to stay away from topical steroids for long-term use, as they thin the skin over time.

I wish you luck if that's what you have... and if it is, I pray it doesn't spread further than that thumb, as having it all over both feet and both hands at various times is something I wouldn't wish on my worst enemy.
posted by seancake at 6:02 PM on December 5, 2007

The timing of the cut previous to the rash, the picture, and your description all make me think impetigo (yes, it's usually a children's ailment, but adults can get it, too). If it is, you'll need to get an antibiotic cream from the doc. I'd say, since you don't want to go the doctor route unless you have to, try all the other over-the-counter stuff first (anti-fungal, hydrocortisone, etc.) and see what happens. If it was me, though, I'd head off to the doctor.
posted by cooker girl at 6:02 PM on December 5, 2007

Either eczema or a fungus. That tinactin is wonderous stuff.

And let us not forget the miracle that is Rescue Remedy cream! I'm allergic to poison ivy et al, and this is the stuff that has saved my sanity before. Whenever I travel, I keep some with me.
posted by humannaire at 6:02 PM on December 5, 2007

Looks like a lot of things, including possibly psoriasis, which I have. And I do have it spots that are even more localized. For what it's worth, psoriasis often starts after an injury, in the site of the injury, like say a cut or scratch, and can include pustules as well as flakes. If it is psoriasis, the *only* thing that will even remotely help over-the-counter is coal-tar soap or shampoo (and know that it's mildly carcinogenic). Stay away from the acid-based crap marketed for psoriasis--it peels off the flakes, but I find it irritates the area more. Exposure to some good sunshine(without burning) can also temporarily clear an area. However, the only thing that makes a major difference is prescription medication, particularly steroid creams.

However, a lot of skin diseases look a lot alike, especially to the untrained eye.

Point in case--my father has a creeping skin disease that started in his hand, which turned out to be some exotic fungus he picked up in a lab where he worked installing lab equipment. He was pulling out a sink, and some liquid was caught in the trap, which spilled over his hand and a recent cut. A few weeks later, something that looks almost exactly like severe psoriasis showed up. He can no longer play the violin, as his entire hand cracks and bleeds on a regular basis. It's been diagnosed as something exotic I can't remember and is practically incurable--although catching it earlier would have made the odds better.

See a doctor as soon as you can afford to. I know about the money, I really do. Good luck.
posted by tejolote at 6:09 PM on December 5, 2007

Holyrood's wrong; hydrocortisone will make a fungal infection worse, because it inhibits exactly the kind of immune response required to keep the fungus from spreading. Also, it will reduce the visible inflammation from a fungal infection, so it will look like it's getting better when in fact it's getting worse. So don't use that method.

Docs often prescribe Lotrisone, which is an anti-fungal and cortisone together, for rashes, for just this reason. (If the fungal infection is widespread, though, you can kill someone amazingly quickly by giving them systemic steroids.)

I don't know what that is there that you have taken a picture of, but I can think of at least 10 possibilities offhand. If something like that was bothering me I'd head to a dermatologist, unless I didn't really care whether it got better or not.
posted by ikkyu2 at 6:20 PM on December 5, 2007

it looks like fingertip eczema to me, although as lots of people mentioned rashes are tricky to dx. i had thumb eczema all summer. mine went away with rx coritsone cream and over-the-counter tar gel (i think the brand is psoriasin). you could try just the tar gel for a week, if you can't get to a doctor, and see if it helps.
posted by nevers at 7:17 PM on December 5, 2007

I've had similar, 90% chance your initial doctor visit will be some prescription hydrocortisome cream. And the "Athelete's foot" antifungal. I've had occasional little bumps on my fingers that no doctor has ever been able to tell me what they were. One tried to tell my that they were Scabies but he was a moron. Try the aniti-fungal and the hydrocortisone. If it doesn't go away seek a Dermetologist.
posted by zengargoyle at 8:30 PM on December 5, 2007

Looks like you have developed a secondary allergic reaction to something you've been applying. That weepy rash is classic contact derm, also seen with exposure to urushiol and other plant oils, and nickel- do any of the products you are using contain neomycin? Many people apply neosporin to skin stuff and then get a secondary topical reaction. The tip to me is your comment about hot water making it 'orgasmic'.
posted by docpops at 10:11 PM on December 5, 2007

Welcome to the wonderful world of Ezcema.

IANAD, but I've had lifelong, chronic ezcema in some form or another. It's *AWESOME*.

*stare*

Seriously, though you may not have ezcema outright, it looks an awful lot like any of the patches I've developed; specifically one like that on the right side of my hand that would bleed all over the place. Not cool.

Start by trying Aquaphor Healing Ointment.
It's really primarily for "dry skin," but it does an exception job of locking moisture in and letting your skin repair itself. AND it doesn't burn on open sores.

(Which, I *assure* you is not the case with steroid creams.)

I'm on Elocon and Beta Val. Elocon is a hydrocorticol steroid cream that I use, unfortunately, on my eyelids, forehead, back of ears, and a few other random patches. Beta Val is an alcohol-based ointment, which I use on my scalp. (The alcohol vehicle is wonderful.)

These are things you may be prescribed if it doesn't go away on its own and is determined to be eczema/psoriasis. I wouldn't settle for the new non-steroidal creams. These are in such low concentrations and quantities that the typical negative steroid qualities don't present much, and it's *much* more effective. It also works instantly at relief. (Though Elocon in your eye is one of the worst feelings, ever. Second only to intense burning and itching on a massive rash that's taken over your entire body... doused in calomine, before we knew better. *shudder*)

Winter's here, and my terrible skin flairs into something vicious that, when it *isn't* ezcema proper, still cracks and bleeds. And for that, Aquaphor is a life saver. It's expensive, but it was WAY more effective for me than Eucerin, and I just applied it at night. (Since it's a bit like vaseline and doesn't do well going "out.")

Good luck and try that, then move on to a dermatologist to get a proper diagnosis if that doesn't take care of it. In the mean time, stop scratching.
No, seriously, stop scratching. :-)

Also, I'll second that "scabies" is a moron diagnosis. And the test for that is ridiculous, but the treatment is wicked retarded. (You basically mummify yourself with lotion or some shit.)
posted by disillusioned at 1:56 AM on December 6, 2007

That's not eczema, folks. That golden crusting is pretty specific. Remember, dermatology is an entire field devoted to little more than variations on the theme of reddened skin. There's more out there to this than atopy.
posted by docpops at 6:23 AM on December 6, 2007

You're going to have to visit a dermatologist. Nobody here can definitively diagnose it by remote. My guess is psoriasis, but that's worth exactly what you paid for it.
posted by Kirth Gerson at 7:13 AM on December 6, 2007

I note from a previous question that you spilled gas in your car early this year, which is a classic 'sensitizing' scenario for reactions to volatile organic compounds (VOCs).

I suggest attempting to observe whether your thumb worsens and improves according to your exposure to sources of VOCs, such as varnish, BBQ lighter fluid, acetone, paint thinner, many paints, etcetera. If you find a correlation, try avoiding those things for awhile to give things a chance to cool off a bit.
posted by jamjam at 9:08 AM on December 6, 2007

i used to get something that looked just like that on my cheeks. I thought psoriasis or eczema, and had some relief from a roll-on i think called psoriasin, and from hydrocortisone creams, but nothing solved the problem... i finally looked externally to what could be causing this. I figured out i was getting the rash especially bad after talking on my cell phone for long periods of time. It turns out i think that the metal in the cellphone frame was exacerbating it badly. I found a phone that didn't touch that area when i talked on it, and have never had a recurrence.
what is your thumb coming into contact with regularly, for extended periods of time, and could you be allergic to that thing?
posted by Soulbee at 11:00 AM on December 6, 2007

I am certain that is dermatitis. It's cause is either something you're using now (a handwash, a hand cream, dishwashing liquid) or something that happened a while back (illness). Shea butter or medical grade lanolin (assuming you're not allergic to it) will help stop the cracking and let it heal.
posted by gatchaman at 3:15 PM on December 6, 2007

Don't be a dumbass. Gather whatever CASH you can, go to the nearest dermatologist, and tell them you are paying cash for a consultation. You'll likely get in, won't cost you as much as they charge the insurance covered patients. See, they'll charge $300 to insurance but get paid $100 because the insurance companies are bastards. You pay them $100 cash and all is fair.
posted by Bob Dobbs at 5:35 AM on December 10, 2007