What's up with my skin?
May 4, 2013 1:37 PM   Subscribe

I've had a mysterious rash for the past 8 months, starting 2 weeks after my first child was born. Two different dermatologists say probably eczema, and I probably just have to live with it. Should I give up and live with it, or try to do something else?

I had eczema on my wrists (and only on my wrists) when I was about 8. I put some sort of cream on it and eventually it went away completely for 22 years. Then 2 weeks after my kid is born, some itchy redness shows up on the backs of my hands.

At first it was just on the backs of my hands, and in these small circles sort of like ringworm. I was sleep-deprived and stressed out (the early weeks were difficult). We used disposable diapers in the first two weeks or so, then switched to cloth diapers. I was washing my hands a lot after changing diapers, and there was the new cloth-diaper-safe detergent (Rockin green). Neither my wife nor son have had any symptoms.

I tried over-the-counter cortisone stuff, moisturizer, anti-fungal stuff, and doing nothing on the various spots, but I couldn't determine any difference between the treatments. The one spot that improved the most was a cortisone-treated spot, but so was the one spot that got worse the most. My wife took over the bulk of diaper duty, we tried changing detergents (All, free and clear), we tried running a load of rags with bleach before doing adult laundry, and my stress levels went down naturally, but nothing seemed to matter.

My hands were a little dry, but not the driest they've been since I was 8. Occasionally the backs of my hands have gotten chapped when I spent too much time outside without gloves in the winter, and I never needed anything more than some moisturizer to heal it.

The spots on the backs of my hands got pretty bad, and I also started getting some spots on my upper arms and on my legs, so I went to a dermatologist. She did a scraping and said it wasn't ringworm. She said it could be a handful of things, but it didn't really matter because the treatment would be the same - topical steroid ointment, fluocinonide 0.05%. I put that on for two weeks and the spots got a lot better, but didn't totally go away. She did another scraping and sent it to a lab to look for bacteria, and there was some, so she gave me an antiobiotic and told me to continue for another two weeks. When I asked her if there was any way to determine the cause of this rash, she said I could get a biopsy, but it probably wouldn't tell us much.

The spots would go away completely, but once I stopped putting the steroid on them, some of them would come back. I would randomly get new spots on my arms, legs, backs of my fingers, and tops of my feet. I didn't get warm fuzzy feelings that the first dermatologist was going to solve this for me, so I decided to get a second opinion. The second dermatologist said it's definitely eczema, and I just have to live with it, moisturizing as much as possible, treating with steroids for two weeks, taking a break from steroids for a week, and repeating. She also gave me a "stronger" steroid cream, triamcinolone acetonide 0.1%.

I used the "stronger" cream for two weeks, but it didn't work as well as the ointment, which I'm able to leave as a layer of greasiness on the backs of my hands for most of the day -- I very carefully wash just the fronts of my hands when I have this stuff on, and I punch a keyboard all day.

So now I'm using the ointment for two weeks, taking a break, and repeating. During the break I put the greasiest Eucerin you can find on my skin instead of the ointment - Original Healing Soothing Repair Cream With Rich Emollients, Maximum Richness. By the end of the two weeks of ointment I'm in pretty good shape, but then by the end of the week break it's all itchy, red, sensitive, and slightly inflamed again. That's where I'm at now - finger, back of my upper arm.

I'm tired of putting this stuff on my skin every day, and the explanations don't make any sense to me. It's May now and my skin isn't dry at all. I'm getting decent sleep, and I'm not stressed. The second dermatologist also said my past eczema plus my other allergies (cat hair, dust, pollen) point to eczema, but most of this rashy time has been pollen-free winter.

So what is going on? Should I see another dermatologist? Should I suck it up and continue with the steroids? Should I get a biopsy? Neither dermatologist gave many details about what sort of biopsy they'd do or what they might be looking for.
posted by Vampire Cat to Health & Fitness (15 answers total) 6 users marked this as a favorite
Best answer: You should ask your dermatologist to give you a contact-allergy patch test; if they won't, or if they do and don't find anything, you should go to an allergist, who can administer a different set of patch tests and/or prick tests to see whether there's something in your environment or any of the products you're using that you're allergic to.

Last winter, I got to the point where I was so itchy, I was bruising all over from trying to relieve the itching with my fingertips, and ultimately, after a dermatologist's patch test and an allergist's prick test, I was diagnosed with a formaldehyde allergy, plus dermatographism (basically, a condition where scratching makes me itch more). The formaldehyde allergy has ruled out a lot of moisturizers, beauty products, and even clothing (e.g., corduroys) for me, but it's also given me a lot of direction to go in in terms of avoidance and treatment. And getting those tests also helped me know what I wasn't allergic to (pretty much everything else), so I could stop guessing. I'm rarely itchy anymore.

Along those lines, in the meantime, I would consider ditching the Eucerin in favor of an all-natural moisturizer with few ingredients, like pure jojoba oil or a lotion from Jason cosmetics; the Eucerin could have something in it that you're sensitive to. When my primary doctor still thought I had eczema, before I saw the specialists, she prescribed triamcinolone acetonide cream, and I also tried all the things people on here recommend for itchy skin: Aveeno oatmeal lotion for eczema, Cetaphil, etc. Ultimately, most of the products I tried turned out to have been making things worse, because they contained formaldehyde-releasing preservatives.

Anyway, I hope you get this figured out! It's awful being itchy all the time.
posted by limeonaire at 1:53 PM on May 4, 2013 [3 favorites]

Is it postpartum PUPP?

There are lots of autoimmune problems that happen to women who have been pregnant, and equally interesting theories as to why. I remembering hearing an interview on Fresh Air about it

Here's a study that got funded in 2007 on the topic. My phone's about to die so I can't google to see if there are results but the Fresh Air interview I heard in the last two years. (May have been Radiolab actually.)
posted by discopolo at 2:28 PM on May 4, 2013

Definitely go to an allergist/immunologist. I got a crazy heat rash one summer because I stopped treating my allergies and she was the only one who could recognize what it was and explain why I needed to take allergy pills everyday. She was great.
posted by discopolo at 2:36 PM on May 4, 2013

Response by poster: Interesting answers so far -- an allergist sounds like a great suggestion, and I think I will try ditching the Eucerin. Also, the talk of allergists reminds me I should add Benadryl and Claritin D to the list of things I tried that haven't made any difference -- I tried Benadryl early on, and I've been taking Claritin D lately since trees have started pollinating.

Also, I should clarify that I'm the father, so probably not postpartum PUPP.
posted by Vampire Cat at 3:28 PM on May 4, 2013

Try extra virgin coconut oil for one week. Keep the steroid cream if you want, but ditch the Eucerin.

This worked for me on one weird weird little spot that would not heal.

I swear by the stuff now!

Bonus? No other ingredients that might be exacerbating allergies and similar.
posted by jbenben at 3:47 PM on May 4, 2013

Has your diet changed at all post-baby? It may be that you're eating a lot more of something now that you tolerate in modest quantities but can't handle more of. Like, say, cheese in burgers and burritos and casseroles you might be eating in the stressed-out-newborn period.

My daughter's eczema is very directly linked to how much dairy she eats. A small baseline level is OK, but if she has multiple servings of cow milk and cheese and ice cream in a day, she gets a horrible itchy rash inside her elbows, behind her knees, and if it gets bad enough, even on her eyelids.
posted by Andrhia at 4:04 PM on May 4, 2013 [2 favorites]

Best answer: I highly recommend CeraVe products for skin problems. My dermatologist recommended them to me when I was first diagnosed with guttate psoriasis, and I'll never use anything else. The cream is a bit pricey ($15-20) but there are coupons available at the CeraVe website. It's available at CVS (and Walgreens, I think). Please do try it; it's been a miracle product for me. Eucerin, even the anti-itch formula, never helped me enough, FWIW.

Next thing: here is a chart of topical steroid potency. Your derm hasn't busted out the big guns yet - triamcinolone acetonide is a "mid-strength" formula. I have Clobex spray (superpotent) and let me tell you, it does the trick. Of course, you'll want to ask your derm and read up about the effects of long-term topical steroid use; it's not ideal to be putting steroids on your skin for long periods of time, and at least with my type of skin condition, can trigger a flare-up if you suddenly discontinue the product.

Another option to make this flare-up go away is light therapy. Here is a serviceable introduction to (not a comprehensive view of) the topic. When I had a flare over 90% of my body, Narrowband UVB therapy was the only thing that ultimately resolved it. (At that time, steroids did nothing for me; I use them now only for little spots that crop up on occasion.)

If you are looking for a potential quick fix, you could also try visiting a tanning salon or other place where you have access to a tanning bed and trying that for a few sessions. There is, however, a great deal of disagreement as to whether tanning as opposed to in-office light treatment is efficacious, with some people reporting amazing results and others, nothing. I have exactly zero interest in "getting a tan," but I tan once every two weeks for 8 minutes in order to keep flare-ups at bay.

Personally, if I were you: if neither of the derms you have seen offer broadband or narrowband light treatment services in their offices, find one that does. I'm skeptical of these wishy-washy diagnoses you have received. A place that has light treatment services (also called "phototherapy") will be very familiar with eczema/psoriasis and will thus be able to serve you better. Here is a resource that will allow you to search for providers by treatments provided in your area.

Hope this helps - I know exactly how frustrating this crap is! Good luck.
posted by sevensnowflakes at 4:41 PM on May 4, 2013 [1 favorite]

Best answer: Seconding CeraVe or a similar cream. The "magic" ingredient is the mix of lipids, especially ceramides. The prescription ceramide cream (Epiceram) we use for my son's eczema has allowed us to greatly reduce the amount of steroid we use. It's definitely expensive but has worked great for us. See if your derm has sample tubes of Epiceram or similar you can try. A little goes a long way.
posted by girlhacker at 5:46 PM on May 4, 2013

Best answer: I have a lot of eczema and I am actually quite surprised with the responses that you received from your dermatologists -- I have never once had a dermatologist say that I just had to "live with it".

Cerave cream is my preferred moisturizer too, and coconut oil is really nice on dry skin. But really, none of them is going to make the eczema go away. Make them kind-of-bearable, yes. But not go away.

I have had eczema on my hands almost identical to those in your finger picture, and successfully treated them with a topical corticosteroid (I was prescribed mometasone furoate/Elocon which seems to be of similar potency to the one you received). It definitely took more than two weeks for the eczema to go away completely, though -- perhaps three to four. However, "going away" meant that I didn't need to use the steroids again for months or years.

I've found that being vigilant about what I use for washing my hands make a huge difference in terms of preventing flare-ups: anything remotely soapy (including stuff like Cetaphil) definitely won't do it. The "purpose gentle cleansing wash" (yes, it's expensive) happens to work for me. You may need to go so far as to carry your favorite cleansing product with you to avoid "soapy" soap in public restrooms. And yeah, no washing dishes by hand (with or without gloves), ever.

In my unprofessional opinion, you may want to give allergy testing a shot. If they find that you have no specific allergy, there are higher-potency steroids. If steroids are too risky, there are non-steroid eczema treatments (I use pimocrolimus/Elidel for eczema on my face -- skin atrophy high risk area, apparently).

Overall, I think it's way too early to declare that you just have to "live with it" (sure, it's a chronic "illness", but you can definitely treat its symptoms!). If your current doctor(s) has no interest in helping you sort this out, I really think you should look for a different one.
posted by yonglin at 7:55 PM on May 4, 2013

If it were me I would be interested in the allergy testing, for sure. But I also wanted to recommend this soap called Noble Formula. I have persistent seborrheic dermatitis (a red itchy flaky skin condition exacerbated by stress) and that soap works gentle magic on it. It has done the same for my mom and uncle who both have web deem too. (This is after trying all sorts of stuff including dermatologist-prescribed cortisone.) It is supposed to be good for eczema too, give it a look: www.amazon.com/Noble-Formula-Pyrithione-Zinc-Soap/dp/B004R3TBEC
posted by feets at 8:16 PM on May 4, 2013

"Web deem" = seborrheic dermatitis
posted by feets at 8:31 PM on May 4, 2013 [1 favorite]

I manage (mostly) to keep my eczema at bay, but it takes quite a bit of work, and periodic steroid cream (the level of eczema on your finger would require steroid cream to reduce if it were on my finger; Elocon helped me quite a bit). I was tested and get allergy shots, which definitely helps. I switched to using fragrance free and hypoallergenic in all products, from laundry detergent to soap (Dove sensitive unscented works for me), to deodorant. If you are changing the baby and getting things used on the baby on you, then switch to these types of products for the baby as well. Be careful about getting cleaning products on your hands. Rubber gloves will protect you but sweating in them can make the eczema worse. I wear cotton gloves inside rubber gloves to help with that. If your hands get wet, like during baby changing, then dry them after and apply cream. In the daytime, a non greasy cream can help, like Aveeno Intense Relief Hand Cream. I've tried multitudes of creams, and currently the thing that helps me the most is putting on Cocoa Butter Body Butter religiously at night on places with issues (The Body Shop makes a nice one). CeraVe sometimes works for me as well. You will need to try different things and see what works for you.

I do agree that the dermatologists you have consulted don't seem to be taking this as seriously as they should, and you may need to keep going to different ones till you find someone who will work with you on a solution.
posted by gudrun at 6:59 PM on May 5, 2013

I would also keep in mind that this could be a type of irritant contact dermatitis and a non-allergic reaction to something you're using on your skin. It's interesting that you're getting it primarily on your hands, which probably get more washing than the rest of you and are also exposed to things like dishwashing soap. You might try washing your hands with a soap that doesn't contain sodium lauryl sulfate, which many people are sensitive to. You can ask at your local health food store; look for things that say "SLS free" on the label. I'm thinking it's probably not a reaction to something you're using to do laundry, simply because of where it's located.
posted by WorkingMyWayHome at 7:57 PM on May 5, 2013

Response by poster: Thank you all for your answers! I've got quite a list of things to try now... hopefully something works :)
posted by Vampire Cat at 10:16 PM on May 9, 2013

Response by poster: This CeraVe cream is pretty awesome. It is much more pleasant to wear than the Eucerin, and it's very effective. It does seem that the Eucerin was aggravating my skin - things have improved somewhat since I've switched to CeraVe.
posted by Vampire Cat at 4:51 PM on June 8, 2013

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