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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8387
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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I have dry itchy skin on hands, itchy sore scalp and a red sore rash in underarms. Doctors

Resolved Question:

I have dry itchy skin on hands, itchy sore scalp and a red sore rash in underarms. Doctors all say excema, but if so, what is the underlying cause? There must be a cause and a solution. This has been going on for 5 years.
Submitted: 2 years ago.
Category: Dermatology
Expert:  Dr. Nair replied 2 years ago.
Hi,

Eczema is of two types - exogenous (having an external cause) and endogenous (not having an external cause). Your eczema sounds endogenous - this is because of an internal disturbance of the body's immune function. The tendency for this is inborn and I'm afraid there is no cure. However symptoms can be controlled with appropriate treatment. Would you like me to take a look and confirm whether your rash looks like eczema? I'd be happy to if you can take a photograph of the affected areas at your convenience.
Customer: replied 2 years ago.

I suspected that this is caused internally because I take great care to use hypoallergenic soaps etc. so that I do not subject my skin to harsh chemicals. I don't like to hear there is no cure. Something is upsetting the immune system. Could it be diet related and how could I isolate a cause. Are there particular foods that could lead to these problems? I could take pictures of my hands and underarms but I don't see any way to link the photos to this reponse form.


Thanks for your quick response.


John

Expert:  Dr. Nair replied 2 years ago.
Sure I'd be happy to take a look - the fastest way to get a picture to me is to upload it to the question box by clicking on the paper clip or tree icon in the question box toolbar. This toolbar does not display in google chrome and safari so an alternate browser may be required. You can also upload them to any free photo hosting site like picasa or photobucket and send me the link if you prefer.

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Or you can email the photographs to experts@pearl.com with my name (For Dr Nair dermatology expert) in the subject line but they usually take a few hours to forward these to me. If you choose this option please make sure you ask for an acknowledgment from JustAnswer that they have received your mail, and let me know that you have sent it.
Customer: replied 2 years ago.

I am attaching 2 images, 1 of the rash under my arm, which is not too bad right now because I have been using a prescription cream from the doctor. This rash started for the first time this summer. The second is my hand which also is not too bad right now but you can see the small blisters between my fingers. These will eventually break, bleed and the outer layers of skin will die and fall off. the hand will eventually heal and the process then repeats itself. All summer the problem was on the bottom of my fingers but it now seems to be moving inside the fingers and to the top of the hand.


Expert:  Dr. Nair replied 2 years ago.
Thank you for the photographs. Has a skin scraping been done from the underarm rash to rule out fungal infection?

Do you have diabetes by any chance?

Any other medical problems?
Customer: replied 2 years ago.

I have no medical conditions I am aware of and I have a physical every year. My doctor just says i have excema and there is no cure just treatment with creams. he prescribed Betamethasone Valerate 0.1% for my hands and underarms and Betamethasone 17-Valerate 0.1% for my itchy scalp. he never suggested a skin scraping for fungal infection. I don't like using these medications when I read the side effects such as skin thinning etc.


This has been driving me crazy for the last 5 years and I've tried cutting different foods to see if it makes a difference. I just can't believe that auto immune problems don't have a cause that can be identified and treated.


There must be some way we can identify the root cause here.


thanks


john

Expert:  Dr. Nair replied 2 years ago.
Thank you for the photographs. Yes this could well be flexural eczema, in particular seborrheic dermatitis. This is a condition where the body loses tolerance for a yeast called Malassezia (which is present normally on all our skin and never causes problems for most people) and starts attacking it leading to symptoms. Itching is variable but can be severe. The head & neck region and body flexures are the most affected areas though virtually any part can be involved. Other possibilities would be Psoriasis Vulgaris and Cutaneous Candidiasis, however they are much less likely. Since your symptoms have persisted for so long it will be best if you get a skin biopsy done by a dermatologist to confirm the diagnosis.

Treatment wise here is what works best for Seborrheic Dermatitis:

Cap Itraconazole 100 mg twice a day for 7 days followed by twice a day on the first two days of every month for 11 months. The capsule is to be taken after breakfast and dinner with half a glass of coke/sprite (the aerated drink improves the absorption of this drug into the blood).

Mometasone cream + Terbinafine cream: to be mixed in equal parts and applied on the affected areas (not the scalp) twice a day for 14 days followed by once at night for 2 weeks and alternate night for 2 weeks more. These molecules are available in lotion forms as well, which is what should be used on the scalp.

Nizoral-AD shampoo: apply and leave for 5 minutes on the scalp after working up a lather. Also use this in the armpits and groins leaving the lather on for only 30-60 seconds though. Do this every alternate day. (e.g Mon-Wed-Fri). Use regularly for 4-6 weeks then start decreasing the frequency of application gradually till you reach once a week and maintain.

Tab Claritin 10 mg once or twice a day depending on the intensity of the itching for as long as required.

Treatment as detailed above is usually very successful in clearing up the rash but the yeast will eventually always recolonize the skin since it is present everywhere in the environment - symptoms can then recur. So Nizoral-AD shampoo should be continued at the lowest frequency which keeps the symptoms from coming back. For some patients this is as infrequent as once every two weeks.

Please feel free to ask if you have any queries.

Please remember to only rate my answer when you are satisfied. If you have any queries, please respond via the REPLY button and I will be happy to continue further and do everything I can to provide you with the service you seek.
Customer: replied 2 years ago.

Thank you for the information. Is the Nizoral AD shampoo a prescription product?


John

Expert:  Dr. Nair replied 2 years ago.
You're most welcome! No Nizoral-AD shampoo is not a prescription product, you can buy it over the counter. Regards.
Customer: replied 2 years ago.

I was only able to find Nizoral, not Nizoral-AD. Is there a difference and should I keep looking?


Thanks

Expert:  Dr. Nair replied 2 years ago.
That's fine, Nizoral is the same thing. You can go ahead and use it as directed. Regards.
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8387
Experience: MBBS, MD (Dermatology, Venereology & Leprology)
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MBBS, MD (Dermatology, Venereology & Leprology)