Dermatology Questions? Ask an Online Dermatologist.
Would you be able to forward a photograph?
I have a camera that downloads pictures in .jpeg format, so yes I can send a picture although I have not taken one nor do I have one on file as I write this. I can take two or three pictures based on how the various conditions look different in different places. But this is my first month with JustAnswer.com such that I've yet to download any pictures yet. I download to others all the time so I am happy to do if you or other will advise on where to do that, i.e. over this website? Or via separate email? etc.
Also, I might like to do that tomorrow in that I am running into a prior time commitment at present. Might we resume either later tonight or perhaps tomorrow with the photos? Note, my handheld camera has no flash so waiting for daylight would improve the picture quality but is not essential.
Try to send the pictures via this website by clicking on the paper clip icon and downloading. If you have trouble you can e mail [email protected]
Thank you. Will take photos over next 24 hours and send. Update coming.
Good. They help a lot for us since dermatology is such a visual specialty.
To DermDoc19: Uploaded are three areas of my body where I have the skin condition which I believe is Spongiotic Dermatitis based on the diagnosis my Dermatologist gave me two months ago. When I met with her, she gave me Prednisone for a week and that helped clear it up but it did not go away entirely. Since then, the condition has gotten bad again. I continue to apply Clobetasol Propionate but don't have any more Prednisone and am looking for suggestions on any treatments I can use and hopefully not the same ones I've already tried (see history) which don't work well except the Prednisone.
The first picture above is my left shin / calf. The second picture above is my right outer thigh. The third picture is my belly which has fewer distinctive lesions but has a hazy type rash that itches. I have that same hazy red rash on the front part of my shoulders and at least half of the underside of my arms. What do you think this is and what can I do to treat it?
Thank you for the photographs. They are typical of some of the most difficult cases we have in dermatology. I can offer a few suggestions.
1) I would contact the manufacturer of the products to see if they are using anything related to your allergen ( Kathon CG). They may have changed formulations. Just because they use less allergenic ingredients does not necessarily mean that they do not have an ingredient such as Kathon CG or one related to it. So, I would continue your pursuit.
2) Since your dermatologist feels that an "id" reaction might be involved, I would aggressively treat the numero uno cause of i"id" reactions: fungus. I would add Diflucan 150 mg. twice a week ( be sure you are not on another drug that interacts such as a statin drug). I would continue a topical medication but would switch to one in the allymine family such as Naftin or Loprox.
3) I would actually decrease all those oils that are so popular on the internet: neem oil, melaleuca etc. Do not muddy the waters. Keep things simple. They are not bad products per se, but the less exposure to various things your skin has the better. You are not treating dry skin but a rash.
Try to use ointments instead of creams. Less chemicals and they will lubricate better.
Burst of Prednisone is fine and a good idea. Cancer is one of the least worries with steroids...I am not even sure it causes cancer. We are worried about ulcers, cataracts, aseptic necrosis of the hip, diabetes, osteoporosis...many things before we worry about cancer. So, I agree, we should limit oral steroids, but they can provide relief.
Clarification: Spongiotic dermatitis is not a disease or skin condition, but a histopathologic term: usually meaning things like a possible contact dermatitis, id reaction, nummular ezceam ( which you do not have).
A couple of other treatments which I have found successful in cases such as yours:
Treat for scabies with Ivermectin. Scabies can be a very tricky diagnosis and is often missed. Since you had a case of it, I would treat with oral Ivermectin. Higher success rate than topicals. Off label but WHO approved.
Repet a biopsy with immunoflorescence to rule out something such as IgA dermatosis or Dermatitis Herpetiformis. Unlikely, but at this stage the likely stuff would have been diagnosed.
Go on a gluten free diet. I have found this to work in a couple of patients such as yours. This was written up in Cutis as a possible treatment for a persistent pruritic eruption like yours. It is safe and inexpensive.
With scabies: make sure that all were treated in the family.You should once again take Ivermectin but the others in your family should use permethrin. I am thinking that scabies might have bounced back to you. So that is the reason to repeat Ivermectin.
Happy to continue the discussion tomorrow as it is late here on the east coast.