Adventures in the skin trade
May 15, 2014 9:20 AM   Subscribe

I have a rash I have been dealing with unsuccessfully for the last four months, and need deciding how to proceed. General interest (well, if you're interested in rashes and bug bites and other matters dermatological), but people who know the Baltimore medical scene are particularly invited to read on. Red, blotchy snowflakes inside.

I went to Caicos last December for a week. Near the beginning of my trip, I noticed some minor itching under my beard, but I get that sometimes, and ignored it. But the itching persisted, and then on the 4th day i noticed three little bites on my arm. The next day I noticed three little bites on my chest. I went to the nurse, who said "sand flies."

I returned home, thinking everything would subside. It did not. The itching under my beard continued. A rash started to appear where the chest bites were. Things got worse. Periodically, new clusters of bites appeared.

I went to see my dermatologist. She said they were NOT bites, and that the chest/abdomen stuff was not the same as the beard stuff. The beard stuff, she said, was dandruff, and she prescribed daily anti-dandruff shampoo. She didn't know what the other stuff was, but she prescribed a strong steroidal cream and said it would go away.

Neither helped. I religiously shampooed my beard daily for two weeks with no change. The cream didn't seem to help either, so she switched me to a foam which helped, but didn't actually make anything go away -- and as soon as i stopped applying the foam, the rash came back.

The dermatologist took two biopsies, which came back "spongiform folliculitis (probably allergy)." I have no known allergies and there's nothing in my environment which seems to have changed in the appropriate time period. The dermatologist thought maybe it was eczema, which seemed to me to be grasping at straws, but i tried the moisturizer she gave me with no results. I decided to see another dermatologist.

This dermatologist took one look at the latest outbreak of bites and said bedbugs. He told me other things which fit with that theory. He said get rid of the bedbugs and the rest of the rash would go away. So I had exterminators in. They found nothing. They said I may have brought back one or two with me from the islands, but they couldn't do anything about just one.

So what should I do now? I think my old dermatologist probably doesn't have anything new to contribute, and I don't think going back to the other one will change his mind. I've been sleeping on a couch two rooms away from my bedroom for the last two nights, and there have been no new outbreaks. Should I keep doing that for a few weeks and see if the problem goes away? Should I see a third dermatologist? The new one lost interest once he diagnosed bedbugs, but I still think I might have more than one thing going on. Other ideas?

If you think I should see a third dermatologist, got any recommendations? I'm in Baltimore, and so is Johns Hopkins, so I can pick one of their dermatologists out of a hat, but if I'm going to see a third doctor I'd really like to make sure it's a wonder-doc.

All suggestions and advice welcomed.
posted by ubiquity to Health & Fitness (8 answers total)
First, so sorry you're dealing with this. It sounds awful. Hope you find a diagnosis and treatment soon! I don't know how helpful the below will be, but here are some thoughts:

I've been sleeping on a couch two rooms away from my bedroom for the last two nights, and there have been no new outbreaks. Should I keep doing that for a few weeks and see if the problem goes away?

Well, if it is bedbugs - and I'm not convinced it is, honestly, the "1-2 came back with you from Caicos and never procreated" idea is pretty weak IMO - they will eventually figure out that you're sleeping in another room, and they will start biting you on the couch instead of in bed. Just something to think about.

If you think I should see a third dermatologist, got any recommendations?

I'm inclined to say yes - it can't hurt, right? Unfortunately I don't have any good recs for Baltimore derms, hopefully another MeFite will. I will say that I've had similarly poor experiences getting diagnoses from dermatologists - skin issues seem incredibly hard to identify. Whenever I'm having a hard time with a weird medical issue, I do try to choose doctors that also teach at the nearby med school...if you can find a derm that also teaches at Hopkins Med I think you'll be in decent shape.

Sorry not to have been more helpful, and best of luck!
posted by schroedingersgirl at 9:52 AM on May 15, 2014 [1 favorite]

Don't rule out allergies just because nothing in your environment has changed (as far as you know).

I spontaneously developed contact dermatitis allergies last year. The first few incidents were minor and misdiagnosed several times. It was only when I had a full blown skin swelling, turning red, oozing and peeling off incident that I got referred to a contact dermatitis specialist.

Through patch testing, she determined I had developed an allergy to several common preservatives that are found in a lot of products (even ones that are billed as "natural" or "eco-friendly"). I had to throw out a bunch of cleansers, cosmetics, and household products that I'd previously used for years without issues.
posted by superna at 9:57 AM on May 15, 2014

I'd also add, if you do pursue that angle, look for a contact dermatitis specialist. A typical dermatologist will use the T.R.U.E. premade patch test which covers the 20 or so most common contact dermatitis allergens. A specialist's office can make up additional tests and also test with products you bring in from home.

My docto had me bring a rolling suitcase full of all soaps, medications, cosmetics, detergents, lotions, cleansers that I was currently using or had quit using because I thought they might be an issue. After she evaluated them, I was tested with about 90 allergens and 30 items I had brought in. Several of the allergens that turned out to be a problem would not have been covered by the T.R.U.E. test.
posted by superna at 10:05 AM on May 15, 2014

Talk to an allergist. Dermatologists are the rash specialists, but don't always know what's causing the rash.

Meaning, bedbug bite reactions are often reactions to an allergy to bedbugs. You could have an allergy to any number of things including your detergent. Allergies come and go mysteriously.
posted by the young rope-rider at 10:05 AM on May 15, 2014

FWIW I think this sounds like it might be scabies, but a dermatologist should have been able to diagnose that, especially with a biopsy.
posted by amaire at 10:42 AM on May 15, 2014

The next day I noticed three little bites on my chest. I went to the nurse, who said "sand flies."

Sounds like you could have picked up Leishmaniasis from the sand flies:
Leishmaniasis: The Sand Fly's Bug

Leishmaniasis is a parasitic disease caused by a protozoan that initially lives in the sand fly and is transmitted to people through sand fly bites. The organism develops and multiplies in the gut of the fly and is introduced into the bloodstream of humans after a bite. It can cause a skin infection or a more serious systemic infection. The skin infection, which consists of sores, develops weeks or months after a sand fly bite. The more serious infection, which consists of fever, enlargement of the liver and spleen, and anemia, can take months or even years to develop.

The disease is found in 90 tropical and subtropical countries around the world. More than 90 percent of the systemic cases occur in Bangladesh, Brazil, India, Nepal, and Sudan. The disease is rare, but not unheard of, in the United States.
posted by jamjam at 10:46 AM on May 15, 2014 [3 favorites]

Seconding a patch test to determine whether you have contact allergies. They come and go, potentially, so just because you weren't allergic to anything yesterday doesn't necessarily mean you're not going to be allergic to anything today.
posted by lydhre at 11:29 AM on May 15, 2014

It might be worthwhile to see an infectious disease specialist.
posted by SyraCarol at 7:53 PM on May 15, 2014

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