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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8492
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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For the past 3 weeks my hands Red, Swollen, Itchy

Resolved Question:

For the past 3 weeks my hands have encountered episodes of getting swollen, red and itchy. Additionally, seems to be focused on pointing finger and thumb and between these fingers of both hands. They swell, get red and very itchy. These fingers feel stiff and joints of these fingers hurt. Then if I stop itching hands go back to normal somewhat after several hours or next morning. Went to doctor and they gave me Zyrtec 10 mg and cortisone cream. I take the Zyrtec in the morning and hands and fingers seem fine shortly after taking meds. However in the evening, my hands begin to turn red, hot and there seems to be pockets of swollen marks on palms of hands and they are itchy and very hot, seem like little pillows of water retention ( when I stretch hands/skin the swollen spots show up as white among the red skin). When you wash hands under warm water hands burn slightly. When I go to sleep and wake up in the morning hands do get a bit better, but when I take the Zyrtec they get back to normal somewhat, not swollen, but still have a slight red and stiff feeling, but no longer localized to pointer finger or thumb, but not very itchy. But the concern I have is when the Zyrtec wears off then it starts the cycle again. I do take lipitor and have not had my liver enzyme test for a while, wondering if lipitor is causing this? Been taking it for years with no problem. Also wondering since my feet do get slightly swollen wondering if this could be signs of congestive heart failure, the doctor did not think that was the case. Thought since I am a big guy on his feet a lot, its normal, and watch salt and keep feet up.  I have been trying to avoid things to see where it is coming from, but no luck yet.  Thoughts?
Submitted: 3 years ago.
Category: Dermatology
Expert:  Dr. Nair replied 3 years ago.
Hi,

Would it be possible to take a photograph of the affected area at your convenience?
Customer: replied 3 years ago.
Attached are 3 pictures of my hands with zrytec 10 mg once a day. hands are not completely affected now however you can see the red and a focus shot of the white pigment area( does not itch nor swell). later in the day when zrytec no longer works then it will increase in redness, itchiness and swell slightly in spots on palm. Normally the whiter areas itch more, turns red when I do not stretch skin. Before zrytec two fingers only pointer and thumb on each hand would turn red, swell, get very itchy only. swell nearly 1/2 size bigger not pal etc. thoughts?
Customer: replied 3 years ago.
http://www.flickr.com/photos/66915106@N04/6090023617/in/photostream/

http://www.flickr.com/photos/66915106@N04/6090022865/in/photostream/

http://www.flickr.com/photos/66915106@N04/6090566432/in/photostream/

corrections from previous reply. The pictures attached are while on zrytec 10 mg. take in the morning, picture was taken at 5pm. The red areas (not white) are the itchy areas that get worse as zrytec affect decreases. Additionally, the areas swell and itch increases and feel it between fingers. As mentioned take Zrytec once a day. Before taking Zrytec, it only affected pointer and thumb fingers on both hands. Symptoms, swell, itchy and red. Could swell 1/2 size. Could be one hand, or both.. Now since taking zrytec affects only surface of hand. Feeling again is warm, itchy and when rinse hands in warm water, hand feel burny. Thoughts? I am on holiday in Aruba now saw a doctor who gave me meds. Perhaps take zrytec twice a day until I return back to USA and see doctor.
Customer: replied 3 years ago.
Since sending you the pictures and further detail, I took a zrytec 10 mg at 6pm thinking it would help and hands still itchy and red. and at the base of two fingers it is swelling and feels stiff and between these fingers feels itchy. look forward to your response
Expert:  Dr. Nair replied 3 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Good Afternoon,

Your symptoms are suggestive of Acute Urticaria. This is usually caused by either intake of a new prescription drug like penicillin or an OTC drug like aspirin, systemic infection (either bacterial or viral), food additives or seafood or intestinal worms. The last is usually only of significance in children. Stress is also a major cause of an outbreak. There are numerous rarer causes, however if all of the above are ruled out then I always get a patients thyroid function test done as hypothyroidism is often a cause.

Many times it is not possible to find out the cause, however most episodes of acute urticaria are self limited, usually within 6 weeks of onset of symptoms. So I would recommend taking Tab Zyrtec 10 mg twice a day for 2 weeks + calamine lotion over the affected area whenever symptoms occur and seeing whether the they recur on stopping the medicine after 2 weeks. If they do then you will need to see a doctor in person to get the appropriate blood tests. Also keep your skin as well moisturized as possible and use a soap free body wash instead of a soap for bathing.

Hope this information is useful, please feel free to ask if you have any queries.

NOTE: Sorry about the delayed reply. It was around 3 am in my part of the world by the time your reply came and I was fast asleep. Regards.
Customer: replied 3 years ago.
Thanks for your response> would acute urticaria also cause swelling of fingers? as mentioned it affects them and they swell up to knuckle and get swollen, stiff and painful to touch, like they are filled up. Before taking Zrytec would be entire finger. Stress is playing a major role I think. I was looking at internet and thought maybe it could be CHF but that would affect the entire hands and swell up very big. I am not tired or lose breath etc. Please confirm if the symptoms I described would not sound like CHF. I am noticing looking at internet is not a good thing and self diagnosing.
Customer: replied 3 years ago.
Thanks for your response> would acute urticaria also cause swelling of fingers? as mentioned it affects them and they swell up to knuckle and get swollen, stiff and painful to touch, like they are filled up. Before taking Zrytec would be entire finger. Stress is playing a major role I think. I was looking at internet and thought maybe it could be CHF but that would affect the entire hands and swell up very big. I am not tired or lose breath etc. Please confirm if the symptoms I described would not sound like CHF. I am noticing looking at internet is not a good thing and self diagnosing. Again would this cause swelling and stiffness feeling in parts of hands and fingers and itching?
Expert:  Dr. Nair replied 3 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Yes absolutely - Acute Urticaria can cause considerable swelling of the hands. Congestive heart failure (CHF) has numerous systemic symptoms like dyspnea (trouble breathing), easy fatiguability and the first body part to become swollen are the lower legs. Hands only get swollen in advanced disease as a part of generalized body swelling (Anasarca) and this swelling does not respond to antihistamines like Zyrtec. So CHF is not a possibility in your case. Hope this reassures you a little bit :)
Customer: replied 3 years ago.
Just for clarity, hopefully this will be my last question. I will be going to the doctor. But as I have focused on the symptoms, this is what happens.
1) Palms turn red, can alternate between hands.
2) Then one or more fingers swell and become stiff and I know this sounds weird, but different fingers can be affected, a finger that was affected during the day can improve and then moves to another finger on the same hand! Causing it to swell and feel stiff and when you squeeze it the finger feels almost like pushing on a bruise. Then it can move to the other hand, with same symptoms alternating fingers. Or it can be both hands, with only 2 or 3 fingers being affected and on the other hand one finger. This is crazy. Typically the finger is swollen at the base below the knuckle. Hands turn red and itchy. The antihistamines make it a bit better but has not cured the situation. What is making me concerned is alternating hands, fingers or both hands are affected. Never the same except when it happens itchy, red and the affected fingers feel heavy, swollen, itch and painful if you squeeze them. Typical? Based on your info on CHF, I don't have that so thanks for peace of mind. Will await your answer or if you initial diagnosis stays the same. Also, if I have been tested before for Diabetes 2 before and all negative, coming up for my annual exam, was reading internet, could this be caused by onset of diabetes? Probably should not read internet, you can think you have every symptom lol, anyway will await your reply. thank you for your help
Expert:  Dr. Nair replied 3 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Good Afternoon,

You're most welcome! Yes urticaria lesions usually occur in random areas and hardly ever recurrently in the same spot. So your history is still typical of acute urticaria. Regarding Diabetes, no it does not cause urticaria. Please start the treatment I have suggested till you can see your doctor. If there is insufficient relief he or she may decide to start you on a short course of tapering oral steroids which should take care of the problem.

Oh and I wouldn't recommend any more net surfing, since it will just lead to anxiety :). Regards.
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8492
Experience: MBBS, MD (Dermatology, Venereology & Leprology)
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