Open-source dermatology: allergic rash edition
October 31, 2018 9:01 PM Subscribe
I have had an itchy rash on my arms, legs, and face for three months. Three different doctors, including the head of dermatology at my local hospital, have come up more or less empty. Hope me?
1) I am one of those immuno-idiots with severe allergies, lifelong asthma, and some eczema. These dry, red, raised obviously-inflamed patches clearly have something to do with this. First doctor thought it was fungal, took those meds, it wasn't. The worst part is CRAZY evening itchiness, which often results in hideous scabbing. I know I shouldn't scratch but I have no willpower.
2) Current fancy doc swears up and down it is atopical dermatitis from the air (!) but that once my body processes it (?) I should not have this problem again. Reader, my body is not processing it. This whole thing started after I came back from a month away, caught a monsoon fever, took a Z pack, and boom, puffy raised itchy welts in my elbow-pits, around my wrists, around my mouth and eyes, and on my shins. The worst areas shift week-to-week.
3) I live in India so the dust and air pollution is real. I live next to a construction site and there is not much can really do about it. Inside my house in the evenings is actually the worst, at the office it's ok. I do all the normal stuff like washing everything regularly in hot water. I do keep the house windows open otherwise it is insanely stuffy, but can and sometimes do sleep with the ac. The rash abides either way. I have not changed my detergent, shampoo, soap, or whatever. I use only the prescribed hypoallergenic lotion. The rash abides.
4) I have been taking antihistamines more or less daily for three months and it is interfering with my sleep / productivity at work / I am afraid of the Alzheimer's risk and other side effects.
5) Steroid creams helped but now my body is used to them. Calamine lotion actually seems to work somewhat.
Does anyone have any rogue ideas or coping solutions?
1) I am one of those immuno-idiots with severe allergies, lifelong asthma, and some eczema. These dry, red, raised obviously-inflamed patches clearly have something to do with this. First doctor thought it was fungal, took those meds, it wasn't. The worst part is CRAZY evening itchiness, which often results in hideous scabbing. I know I shouldn't scratch but I have no willpower.
2) Current fancy doc swears up and down it is atopical dermatitis from the air (!) but that once my body processes it (?) I should not have this problem again. Reader, my body is not processing it. This whole thing started after I came back from a month away, caught a monsoon fever, took a Z pack, and boom, puffy raised itchy welts in my elbow-pits, around my wrists, around my mouth and eyes, and on my shins. The worst areas shift week-to-week.
3) I live in India so the dust and air pollution is real. I live next to a construction site and there is not much can really do about it. Inside my house in the evenings is actually the worst, at the office it's ok. I do all the normal stuff like washing everything regularly in hot water. I do keep the house windows open otherwise it is insanely stuffy, but can and sometimes do sleep with the ac. The rash abides either way. I have not changed my detergent, shampoo, soap, or whatever. I use only the prescribed hypoallergenic lotion. The rash abides.
4) I have been taking antihistamines more or less daily for three months and it is interfering with my sleep / productivity at work / I am afraid of the Alzheimer's risk and other side effects.
5) Steroid creams helped but now my body is used to them. Calamine lotion actually seems to work somewhat.
Does anyone have any rogue ideas or coping solutions?
IANAD IANYD These things have helped me in the past with similar skin challenges.
Your doctor might try a short-term course of prednisone in addition to an antihistamine and ibuprofen. (Ideally you would take all.) All of these have anti-inflammatory effects.
If your water is hard, try a shower head with a built in filter. The extra minerals in the water can irritate easily angered skin.
A colloid oatmeal bath or wash might help provide temporary relief before bed.
If none of this helps a rheumatologist may be in order to test you for rheumy issues as many play dirty with skin.
posted by Kalatraz at 9:58 PM on October 31, 2018
Your doctor might try a short-term course of prednisone in addition to an antihistamine and ibuprofen. (Ideally you would take all.) All of these have anti-inflammatory effects.
If your water is hard, try a shower head with a built in filter. The extra minerals in the water can irritate easily angered skin.
A colloid oatmeal bath or wash might help provide temporary relief before bed.
If none of this helps a rheumatologist may be in order to test you for rheumy issues as many play dirty with skin.
posted by Kalatraz at 9:58 PM on October 31, 2018
Sorry if this is an obvious one, but you noted haven't changed your detergent/soap/shampoo—were you already using fragrance-free products, and if not, are they available? This flare-up may have made you sensitive to irritants that weren't an problem beforehand, so if there are any you can cut out, give it a try.
Ammonium lactate lotion (supplemented by corticosteroids during bad flare-ups) keeps most my assorted skin issues under control, and also helps me resist the impulse to scratch (it stings a little if you put it on broken skin, which both satisfies the urge to scratch more, and discourages scratching in the first place). I'm guessing the antihistamine you are using is diphenhydramine; try saving it for the very worst days and taking cetirizine or loratadine instead. They're not quite as effective for itchy skin in my experience, but they help a little and they don't make you drowsy/increase alzheimer's risk. Cool showers, oatmeal baths, cold compresses (try an icepack from the freezer), etc. might all help you get through the evenings. I find icepacks helpful because the shock of the cold sort of satisfies the same impulse as scratching. Vitamin E is good for the scaly/scabbed patches while they're healing.
And yeah, if you haven't been thoroughly checked out for autoimmune diseases like celiac, definitely look into screening for other possible causes.
posted by karayel at 11:55 PM on October 31, 2018 [4 favorites]
Ammonium lactate lotion (supplemented by corticosteroids during bad flare-ups) keeps most my assorted skin issues under control, and also helps me resist the impulse to scratch (it stings a little if you put it on broken skin, which both satisfies the urge to scratch more, and discourages scratching in the first place). I'm guessing the antihistamine you are using is diphenhydramine; try saving it for the very worst days and taking cetirizine or loratadine instead. They're not quite as effective for itchy skin in my experience, but they help a little and they don't make you drowsy/increase alzheimer's risk. Cool showers, oatmeal baths, cold compresses (try an icepack from the freezer), etc. might all help you get through the evenings. I find icepacks helpful because the shock of the cold sort of satisfies the same impulse as scratching. Vitamin E is good for the scaly/scabbed patches while they're healing.
And yeah, if you haven't been thoroughly checked out for autoimmune diseases like celiac, definitely look into screening for other possible causes.
posted by karayel at 11:55 PM on October 31, 2018 [4 favorites]
Elimination diet and probiotic soap! I followed a lot of the recommendations in the book The Beauty of Dirty Skin and saw a huuuge difference in nighttime itchiness, after lots of medications, creams etc. didn’t help and doctors were useless.
posted by stellaluna at 7:44 AM on November 1, 2018
posted by stellaluna at 7:44 AM on November 1, 2018
Fungal skin conditions often respond better to topicals, like a ketoconazole cream. The armpit issue sounds fungal, only because they tend to occur in damp-ish areas and joints like armpits, groin/upper thigh, etc.
It also may be that you have more than one skin condition occurring. It could be atopic dermatitis, though that doctor saying it should 'run its course' sounds odd to me as it is generally chronic but can be reduced if you locate the trigger, which really can be anything. You can work to find it, but also work to treat the symptoms.
I've had a whole host of different and fun skin conditions over the years (eczema, atopic dermatitis, fungal infections, seborrheic dermatitis) and here is what I do to try and keep my skin happy:
- Keep shower temps warm but not boiling hot (hot water dries out skin and dry skin is itchy skin)
- Moisturize immediately post-shower with a mild, unscented moisturizer
- Wash bedding at least 1x/week, 2x is better
- Vacuum as often as is possible
- Think carefully about what you could wear to bed to stop nighttime itching. I will usually do long sleeves and long pants (whatever covers itchy patches), sometimes paired with gloves or even oven mitts to stop scratching elsewhere. I have gone to the extreme of immobilizing my arms (basically soft-splinted at the elbow so I couldn't bend my arm) which stopped the scratching entirely. But it wasn't easy to sleep like that.
Wishing you luck.
posted by rachaelfaith at 7:52 AM on November 1, 2018
It also may be that you have more than one skin condition occurring. It could be atopic dermatitis, though that doctor saying it should 'run its course' sounds odd to me as it is generally chronic but can be reduced if you locate the trigger, which really can be anything. You can work to find it, but also work to treat the symptoms.
I've had a whole host of different and fun skin conditions over the years (eczema, atopic dermatitis, fungal infections, seborrheic dermatitis) and here is what I do to try and keep my skin happy:
- Keep shower temps warm but not boiling hot (hot water dries out skin and dry skin is itchy skin)
- Moisturize immediately post-shower with a mild, unscented moisturizer
- Wash bedding at least 1x/week, 2x is better
- Vacuum as often as is possible
- Think carefully about what you could wear to bed to stop nighttime itching. I will usually do long sleeves and long pants (whatever covers itchy patches), sometimes paired with gloves or even oven mitts to stop scratching elsewhere. I have gone to the extreme of immobilizing my arms (basically soft-splinted at the elbow so I couldn't bend my arm) which stopped the scratching entirely. But it wasn't easy to sleep like that.
Wishing you luck.
posted by rachaelfaith at 7:52 AM on November 1, 2018
To add to the person above talking about detergent/soap/shampoo--manufacturers often change the formulations without announcing it. I know someone with a contact allergy to citrus who has to read the ingredients on the bottle of cleaning products that touch his skin (detergent, shampoo, etc) every single time he buys them because he's found that citrus can show up in the ingredients unexpectedly.
posted by telophase at 8:30 AM on November 1, 2018
posted by telophase at 8:30 AM on November 1, 2018
Like rachelfaith, I've had skin/rash problems all my life: been diagnosed with eczema, dermatitis seborrhea, etc. Rashes show up sporadically and my scalp needs constant care. Here's what works for me: 2.5% cortisone cream as needed, at least 2x/day (do not apply to scratched areas or open sores, it'll make it worse, so don't scratch), head & shoulders dandruff shampoo, which has an ingredient not in other dandruff shampoos; also, a anti-fungal liquid to use on wet scalp after shampoo. Oil of Olay lotion after bath and whenever skin feels dry. Drink lots of water. An oatmeal bath should help with itchiness, and when skin is dry, apply cortisone cream liberally. I had been on 1% cortisone cream for a long time but got upgraded to 2.5% last year (Rx only). Best of luck to you.
posted by MovableBookLady at 11:03 AM on November 1, 2018
posted by MovableBookLady at 11:03 AM on November 1, 2018
Air filters for the house (in case your doctors are right, and the dusty air is why the rash troubles you more at home than in the office). Photosensitivity/sun allergy?
posted by Iris Gambol at 11:47 AM on November 1, 2018
posted by Iris Gambol at 11:47 AM on November 1, 2018
I hada problem like this once, after taking some thorough antibiotics. If that's what a Z pack is, have they checked you for opportunistic infections? I managed to have two things pop up that required new kinds of antibiotics. Good luck.
posted by Margalo Epps at 1:53 PM on November 12, 2018
posted by Margalo Epps at 1:53 PM on November 12, 2018
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posted by octopodiatrist at 9:27 PM on October 31, 2018 [1 favorite]