How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Nair Your Own Question

Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8189
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
40004158
Type Your Dermatology Question Here...
Dr. Nair is online now
A new question is answered every 9 seconds

Can an “overdose” on nicotine cause a skin rash or joint &

Resolved Question:

Can an “overdose” on nicotine cause a skin rash or joint & tendon pain? If not, please help point me in the right direction; my dr’s are at a loss.
I quit smoking a while back but have not stopped the NTR. I probably consume upwards of 20mg of nicotine through gum and/or lozenges. I have been experiencing significant pain from what is being called plantar factitious and itchy rashes on the back of my calves top of my thighs and my shoulders which looks much like shingles. I also am experiencing whitlow-like break outs on beyond the third knuckle of my right ring finger and pinkie.
The rash flares up and then goes away in 1-2 week intervals. When it is particularly bad, the lobes and tops of my ears break out as well as other spots around my face. Sometimes, particularly on my ears, the rash oozes yellow liquid although I do not believe it’s a secondary infection; products like Neosporin do nothing.
While my diet did go in the tank over the holidays, I’ve been struggling with weight loss; I’ve been eating better and less and swimming a 500 per day (roughly; probably safer to say every other day), but my weight keeps going up. That said, there are areas of improvement in my diet; particularly in portion control…
Prednisone clears up all symptoms, immediately. However, as my wife says, I’m not that pleasant when on it.
I’ve been to two dermatologists who swear this is a contact sensitivity but the patch tests can’t find anything. I’ve been to an allergist who says this is not an allergic reaction. I’ve had several blood draws to test for things like herpes, Reiter’s syndrome, autoimmune issues, Celiac disease, allergic reactions, and lupus. All have been non-conclusive.
Overall, I am a healthy 40 year old white male of Germanic and Welch decent. I have fair blood pressure, sugars and triglycerides for someone my age. I am 5’10” and 205(ish) lbs.
Any help resolving this rash will be greatly appreciated.
Submitted: 1 year ago.
Category: Dermatology
Expert:  Dr. Nair replied 1 year ago.
Hi,

Would it be possible to take a photograph of this rash at your convenience?
Customer: replied 1 year ago.

Here's a link to a series of images:


https://docs.google.com/folder/d/0B05PuMh9ap1UNU0wTDB4TjNpMGs/edit


 


The images in the 700 series were taken in July '12 and show when the rash on my lips was quite significant. The images in the 4006-4015 range were taken today. My lips cleared up a while ago; these are just given as reference.


 


The rash, while itchy, isn't at bad at the moment as it has been. My fingers are moderately bad at the moment and the skin on the tip of my pinkie is a bit compromised; this will get worse in coming days.


 


Also, I've been nicotine free for over a week and the rash is not markedly improved.


 


Thanks.

Expert:  Dr. Nair replied 1 year ago.
Good Morning,Can't seem to view these images on my phone. Will get to a computer in 4-6 hours and take a look. Regards.
Expert:  Dr. Nair replied 1 year ago.

Thank you for the photographs. Your history and clinical picture are highly suggestive of Discoid Eczema. This is a type of Endogenous Eczema characterized by the coin/disc like patches, which may or may not become confluent and are itchy. It is often, but not always, seen in people who are prone to allergies or have other skin eczema.

Discoid Eczema is harmless per se but has considerable nuisance value because of recurrences. It has nothing to do with nicotine use. The condition ultimately burns out on its own but it is impossible to predict how long this will take. Management focuses on symptomatic relief and clearing up the patches and consists of:

1. Daily use a good moisturizer (Aveeno, Cetaphil or Jergens) - at least twice a day. Preferably three-four times a day. This is the most important measure to prevent the rash coming back again and again.

2. Flovent cream (Fluticasone propionate) twice a day till the rash disappear, then once at night for 14-28 days after that. This should be combined with Mupirocin cream in a 1:1 ratio prior to application. Once the rash has subsided I start patients on Tacrolimus 0.03% ointment or Pimecrolimus cream for a few months to prevent a recurrence.

3. Tab Atarax 25 mg two to three times a day depending on the severity of the itching

4. Soap free body wash (Nivea makes a good one) for bathing - avoid soaps as much as possible.

5. General Precautions - only use luke warm water for bathing, keep away from dust, cotton socks only, avoid any perfumed creams.

Since these are prescription drugs, I would recommend seeing your family physician or dermatologist and discussing my recommendations. Some patients need oral steroids for short bursts to get initial control after which the regimen above is continued. Oral steroids clear up the problem in a matter of days but obviously are not a long term solution, hence the need for a regimen like the one detailed above.

Till you discuss my suggestions with a dermatologist, do all the general measures I've mentioned and use a mixture of 1% Cortizone cream and Bacitracin ointment over the rash. Mix them in a 1:1 ratio. And take Claritin 10 mg twice a day in place of the Atarax.

About the joint and tendon pain - I don’t believe these are related to your skin condition - the most common skin condition that has joint and occasional tendon involvement is Psoriasis but your skin patches don't look like Psoriasis. Autoimmune conditions like Lupus can also cause skin and joint symptoms but you seem to have been worked up for these. The best person to see about your joint pain would be a Rheumatologist.

Please feel free to ask if you have any queries.

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

Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8189
Experience: MBBS, MD (Dermatology, Venereology & Leprology)
Dr. Nair and other Dermatology Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • dermdoc19

    Dermatologist

    Satisfied Customers:

    3474
    30 years practice in general and cosmetic dermatology
< Last | Next >
  • http://ww2.justanswer.com/uploads/dermdoc19/2010-09-30_160749_Photo_122807_015.JPG dermdoc19's Avatar

    dermdoc19

    Dermatologist

    Satisfied Customers:

    3474
    30 years practice in general and cosmetic dermatology
  • http://ww2.justanswer.com/uploads/AX/axedoc2010/2012-4-9_193033_DSC96671.64x64.JPG Dr. Nair's Avatar

    Dr. Nair

    Dermatologist

    Satisfied Customers:

    7176
    MBBS, MD (Dermatology, Venereology & Leprology)
  • http://ww2.justanswer.com/uploads/DR/Dr.shahzad/2013-5-28_122559_IMG2564.64x64.JPG Dr. Shahz's Avatar

    Dr. Shahz

    Dermatologist

    Satisfied Customers:

    243
    MBBS, MCPS, MD
  • http://ww2.justanswer.com/uploads/tcsatish/2009-4-14_221547_satish_pp.jpg Dr. Skinner's Avatar

    Dr. Skinner

    Dermatologist

    Satisfied Customers:

    1548
    MD , DNB ( D &V), FAAD
  • http://ww2.justanswer.com/uploads/drhanish/2008-8-5_71640_drhanish.jpg Dr. Hanish Babu, MD's Avatar

    Dr. Hanish Babu, MD

    Dermatologist

    Satisfied Customers:

    261
    MBBS; MD 26 years Experience.
  • http://ww2.justanswer.com/uploads/DR/DrVenkat/2013-11-1_14129_profile.64x64.jpg Dr. S. Attili's Avatar

    Dr. S. Attili

    Dermatologist & Dermatopathologist

    Satisfied Customers:

    4121
    MRCP (Dermatology), Int. Board Certification in Dermatopathology
  • http://ww2.justanswer.com/uploads/SK/skindoctor2000/HCM2.64x64.jpg Dr. Pravin's Avatar

    Dr. Pravin

    Dermatologist

    Satisfied Customers:

    692
    Senior Consultant MBBS DNB (DVD)
 
 
 

Related Dermatology Questions