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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 9190
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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i have red spots on my back, chest neck and genitals. It itches

Resolved Question:

i have red spots on my back, chest neck and genitals. It itches terribly. My dermatologist said it was eczema and gave me a shot of Prednisone and then an oral Prednisone for 10 days after that. It did not work. I visited my primary and he thought it could be a staph infection of the follicles. He prescribed me Doxycycline but after 5 days I am not noticing a difference what so ever.

I've read about folliculitis but there are several varieties. Is it possible it is being misdiagnosed?
Submitted: 5 years ago.
Category: Dermatology
Expert:  Dr. Nair replied 5 years ago.
Hi,

Would it be possible to take a photograph of the affected area at your convenience?
Customer: replied 5 years ago.
not at this time I'm at work
Customer: replied 5 years ago.
I've taken 2 photos, how can I send them to you?
Expert:  Dr. Nair replied 5 years ago.
Great! Can you see a paper clip icon in the question box toolbar?
Customer: replied 5 years ago.
PIC 1No I do not. My box is blank.
Customer: replied 5 years ago.
Figured it out....please forgive my ignorance.
Expert:  Dr. Nair replied 5 years ago.
No problem, my internet is giving me trouble and that is why I am taking some time to respond. Thank you for the photographs. Tell me is are these spots raised or flat?

Do they ever ooze or develop a crust?

How long have you had them?
Customer: replied 5 years ago.
They're raised. These are two of about 15 total. Only 1 or two of them have oozed, the rest just stay red and itch. I've had these 2 for about a month now. The ones I my genitals and inner thigh just showed up after one oozed the other day ...presumably spreading? My back is primarily little red bumps as is my chest and armpits and kneck --- no large bumps like the pictures.
Expert:  Dr. Nair replied 5 years ago.
Typing out your answer. Please give me a few minutes.
Expert:  Dr. Nair replied 5 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Thank you for the information. At first glance I would have considered your bumps to be either because of a persistent insect bite reaction (Pseudolymphoma) or a furuncle or a fungal infection like a Majocchi granuloma. These might still be a possibility but since some lesions have lasted 2 months a possibility of either Sarcoidosis or Eruptive Xanthomas will need to be considered. Sarcoidosis is an auto-inflammatory condition of unknown cause wheres Xanthomas are because of fat deposits in the skin. Rarer possibilites include Follicular Psoriasis or Lichen Planus.

Your require a skin biopsy with special stains for bacteria and fungus to determine the cause of these bumps. Only then can appropriate treatment be decided.

I would recommend discussing all of these possibilties with your doctor and requesting a skin biopsy.
Customer: replied 5 years ago.
What about hot tub folliculitis? I was in one just prior to the onset of this condition. Never had issues like this my entire life. Could that explain the infected follicles?
Expert:  Dr. Nair replied 5 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Well yes hot tub folliculitis could be a possibility but unless you have continued to use the tub over the last 2 months the folliculitis should have cleared up on its own. Also lesions are more common in covered areas like the buttocks than on the trunk. Otherwise based on just the clinical appearance it is a possibility. You could discuss changing your antibiotic to Ciprofloxacin 500 mg two times a day in place of the Doxycycline and seeing if this helps, since Doxy often doesn't work against Pseudomonas - the bacteria that causes hot tub folliculitis.
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Customer: replied 5 years ago.
I do have lesions on the inner crack of my buttocks and at the base of the buttocks as well as the part of skin between the anus and genitals.
Expert:  Dr. Nair replied 5 years ago.
Well then you should definitely give Ciprofloxacin a shot before considering the other possibilities I had mentioned. I am calling it a night as it is nearly 4 am in my part of the world. Will be happy to answer any further queries in the morning. Regards.
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