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dermdoc19
dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 3731
Experience:  30 years practice in general and cosmetic dermatology
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How to cure Spongiotic Dermatitis? For the last year, I have

Customer Question

How to cure Spongiotic Dermatitis? For the last year, I have suffered from a variety of skin conditions and have been to two different Dermatologists a collective total of 5 times. My last and current Dermatologist performed a skin patch test as well as extracted a patch of skin to test / examine under the microscope. Her diagnosis contains several parts. She believes I have Spongiotic Dermatitis and that I am prone to having "Id Reactions" where other parts of my body react / over-react to the initial reaction to an allergen. The skin patch test revealed that I am allergic to colophony and that specifically, I am allergic to methylchloroisothiazolinone (commercial name "Kathon CG"). I've been using the same laundry detergent, shampoo, and body soap that I have been using for years with no prior reaction prior to this past year, so I'm not sure what new substance I may have come in contact with that would trigger my dermatitis outbreaks. I've not contacted the personal care products manufacturer I use most (Melaleuca International / Idaho Falls, ID) to see if they have altered the formulation of their laundry soap / dryer sheets, body soap, or shampoo / conditioner, however their entire company is based on using safe, natural ingredients that are hypoallergenic and not supposed to trigger allergies. I will follow through with them to see if they've started to incorporate Kathon CG in any of their body and wash care products.

While spongiotic dermatitiis may typically affect abdomen and buttocks, the outbreaks I have are most severe along the front of my shins as I wear shorts most every day in this hot, humid, subtropical climate of south Texas where it never snows. And the outbreaks on my shins appear much like insect bites at times, then at others along my abdomin sides and outer thighs like a hazy rash. Then at other times, the symptoms come on suddenly like patches of hives, particularly around my belly, lower back and outer thighs.

And then I have also suffered off and on from tinea cruris in the perianal region -- a problem I cannot seem to get to go away permanently but have achieved some progress lately with over-the-counter powder sprays (Lotrimin).

I bathe regularly and sometimes perhaps too often when the itching becomes so intense, I cannot sleep and the only thing to stop the itching (at least for about 3 hours) is a bath soaking in wather with natural oils as an additive. I've alternated between Melaleuca bath oil to Mineral Oil, Baby Oil, and a combination of natural oils including Neem oil to treat a case of scabies that I suffered from (and finally beat) about 6 months ago. But even bathing with natural oil additives to the water and applying anti-itch lotion with menthol or oatmeal added, my skin will dry out and then the dermatitis itching gets combined with dry skin itching, prompting me to bath no more than once a day to let my skin's natural ph and oil balance return, and then just go without sleep when the itching at night becomes the worst when laying still under the covers. But then lack of sleep leads to other health problems I won't get into here at present.

I've been through the gauntlet of corticosteriod creams beginning with triamcinalone, then ketoconasole, and am currently applying the highest potency corticosteroid clobetasol under my Dermatologist's supervision. She also gave me a 1 week supply of oral Prednisone which provided the most healing relief I've experienced thus far, but of course one should not take Prednisone on a long term maintenance or prophylactic basis due to the complications with this steriod (risk of cancer, I believe). And after the initial healing from the first Prednisone 1 week dosage, the dermatitis and itching returned in the following weeks, much as my Dermatologist predicted.

My health care is through the VA and there are special procedures I must follow to get to see my Dermatologist (a specialist) which usually involve delays of 1 to 3 months (e.g. must see my regular primary care physician first for specialist approval which itself involves a 1 to 3 month wait for an appointment.) So I am looking for some other treatment and hopefully cure for my Spongiatic Dermatitis beyond just continuing to apply Clobetasol and going back and forth intermittently to hopefully get approved for another week's worth of Prednisone.

Any suggestions?
Submitted: 2 years ago.
Category: Dermatology
Expert:  dermdoc19 replied 2 years ago.

dermdoc19 :

Hello

dermdoc19 :

Would you be able to forward a photograph?

Customer :

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.

Customer :

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.

dermdoc19 :

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 experts@justanswer and ask them to forward the photo to me. Thank you. I have some ideas but will wait for the photographs.

Customer :

Thank you. Will take photos over next 24 hours and send. Update coming.

dermdoc19 :

Good. They help a lot for us since dermatology is such a visual specialty.

Customer :

Skin condition on left shin / calf
Full Size Image

Customer :

Skin condition on right outer thigh
Full Size Image

Customer :

Full Size Image

Customer :

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.

Customer :

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?

dermdoc19 :

Hi again,

dermdoc19 :

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.

dermdoc19 :

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.

dermdoc19 :

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.

dermdoc19 :

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.

dermdoc19 :

Try to use ointments instead of creams. Less chemicals and they will lubricate better.

dermdoc19 :

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.

dermdoc19 :

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).

dermdoc19 :

A couple of other treatments which I have found successful in cases such as yours:

dermdoc19 :

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.

dermdoc19 :

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.

dermdoc19 :

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.

dermdoc19 :

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.

dermdoc19 :

Happy to continue the discussion tomorrow as it is late here on the east coast.

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