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Dr. Singh
Dr. Singh, Doctor
Category: Health
Satisfied Customers: 6496
Experience:  MBBS. General Practitioner, experienced in hospital care and primary care.
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I have a bilateral rash underneath both my arms that recently

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I have a bilateral rash underneath both my arms that recently spread to my elbows.
Some of the rashes forms a ring with the center being clear. The rash itself is not itchy but because my skin is raised so much it makes it painful. I have had to biopsy performed with the 2nd being sent to U of Pennsylvania where pathologists there are sending it out to another lab because they are unsure.

Additional info
26 Male, White with Lupus and Sjogren's Syndrome

Dr. Singh :

Hello

Dr. Singh :

Do you any other medical problems such as flu or infection at this time?

Customer:

nope

Dr. Singh :

Ok. A ring like rash with central clearing and some associated pain can be erythema multiforme.

Dr. Singh :

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001854/

Dr. Singh :

This can be caused by an allergy, including drug reactions, or an underlying medical problems such as infection or autoimmune problems. In your case, this may be related to lupus or Sjogren;s flare.

Customer:

It happens to both sides at the same time

Customer:

And recently spread to my elbows which is not a closed ring

Dr. Singh :

That does not change my impression. Generally the treatment consists of treating the underlying disease or removing any offending drug.

Customer:

Also, it is not scaley, does not look like a hive nor does it form nodules

Dr. Singh :

Hives is very different from erythema multiforme.

Customer:

Additionally the link you provided shows that a biopsy is a primary test for determining this type of reaction

Dr. Singh :

Yes, it is the only way to confirm. Many times diagnosis is made clinically and biopsy is done for complicated cases of when diagnosis is in doubt. With your history of autoimmune disease, biopsy is reasonable.

Customer:

I have had 2 biopsy performed and they are unable to determine the reaction. As it stands 14 pathologists have seen my slides

Dr. Singh :

That is quite remarkable. I wonder if your autoimmune disease history is affecting the microscopic appearance of the lesions. Have you been offered any treatment so far?

Customer:

I currently take chloroquine and ibuprofin as my primary treament

Customer:

The 2 biopsy also were not similar yet the physical appearance of the 2 rashes was identical.

Dr. Singh :

I see. You have also listed prednisone as one of the treatments in original question. Did that help?

Customer:

Yes the first time the rash appeared but not the second

Dr. Singh :

Ok. Response to steroids is typical of immune mediated rash. Erythema multiforme and lupus related rash would be my considerations.

Customer:

The last thing was I had an ANA blood test during my last outbreak and showed 1:1280 positive

Dr. Singh :

Pretty high levels. But not unusual with your lupus and Sjogren's.

Dr. Singh :

The only other thing I would add is if there was any new medication started recently or even an old one, changing or discontinuing some of your medications can be tried.

Customer:

Currently no changes in medication other than doxiclyclene as they thought it might've been lyme disease

Customer:

but I haven't had that in 4 months now and that was only given to me when I experienced the rash the first time

Dr. Singh :

The chloroquine is new?

Customer:

Nope

Customer:

Been on that for 2 years

Customer:

Dosage went from 750 to 1000mg a week about 11 months ago

Dr. Singh :

Less likely to be that, but let me look it up for a minute.

Dr. Singh :

Apparently chloroquine is known to cause erythema multiforme, although only rarely. This may be a dose related effect. Your dose is significantly higher than average dose.

Dr. Singh :

I would definitely keep this in my differential diagnosis. You can discuss this with your dermatologist.

Customer:

Hmm, alright.

Dr. Singh :

I hope this was somewhat helpful, and that you feel better soon.

Customer:

Thanks, XXXXX XXXXX the information

Dr. Singh :

You are most welcome. Please do click "accept" and rate so I get credit.

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