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dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 4124
Experience:  30 years practice in general and cosmetic dermatology
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Dear Doctor - I wonder if you can shed any light on my situation. I ha

Customer Question

Dear Doctor - I wonder if you can shed any light on my situation. I have seen 4 doctors and a dermatologist who were all unsure about what is going on with new skin lesions on my feet, elbow, calf and penis for the past 2 weeks. I normally have no skin issues or allergies other than hayfever/dust allergies.
Please see below for a full description with thanks
Submitted: 2 years ago.
Category: Dermatology
Customer: replied 2 years ago.
Dear Doctor - I wonder if you can shed any light on my situation. I have seen 4 doctors and a dermatologist who were all unsure about what is going on with new skin lesions on my feet, elbow, calf and penis for the past 2.5 weeks. I normally have no skin issues or allergies other than hayfever/dust allergies.History of onset:
20/05/2015 - I woke up with a 1.5 x 1.5cm sore circular raised area of skin on my left big toe/hallux and two smaller 0.3cm x 0.3cm lesions which were red and slightly raised on the same toe.Progression over the following two days:
Over the next two days the main lesion enlarged significantly and started to constantly burn. It was firm and quite swollen with fluid inside. I also developed a medium size similar ?vesicular fluid filled lesion on the same side just up from the inside of my left ankle. The two smaller lesions on the left hallux remained relatively similar and a similar small lesion developed on my opposite foot, next to the 1st MTP joint of my right hallux. I also noticed an area of red/slightly inflamed skin on the glans of my penis which was mild.
>I went to the emergency department, they burst the larger lesion and took bacterial & viral swabs which came back negative for HPV/ VaricellaIn the week following onset:
The skin on the glans of my penis developed two small circular indentations with what looked like a piece of dried skin in the middle and the area of surrounding skin became more obviously raised and pink looking. The penis lesions do not itch or burn, I have no issues with urination.
Also that week I developed another two lesions - one on the back of my right calf and one on my right elbow. These did not blow up as much as the initial lesion but are itchy and raised. I have no recollection of being bitten at all.
>I returned to the emergency department as instructed by the Dr. they completed FBC, ESR, CRP U&E’s – all came back as normal with only a slightly raised oesinophils (0.7).
> The ED senior Dr referred me to a dermatologist whom was unsure of the diagnosis, she was unsure and took biopsies from every site and prescribed prednisolone fatty cream to be applied to the penis 2x dailyMost recent changes:
Over the past week since the biopsies, the feet and elbow lesions have started to dry out and no new limb lesions have formed, however the penis lesion is still evolving. The area of skin change has increased in size, combining with the smaller circular lesions, with an irregular border which looks like the marking of a territory boundary on a map
> The skin biopsy results came back and the dermatologist stated “ You are a mystery” various things were identified but she was unable to give me a diagnosis, I am waiting for a full copy of the lab report but the dermatologist stated the biopsy showed Lymphocytic vasculitis in the dermis and the lower levels showed Lychenoid reaction. She was unsure where to go next and was querying multiple things right down to autoimmune issues but couldn't give anything concrete.Other relevant history:
I have no history of STD's, my current partner of 2 years is asymptomatic and neither of us have been active with anyone else over the past 2 years. I am not systemically unwell or febrile, my mouth / eyes are clear of lesions. I am english but have recently ( 4 weeks ago) travelled on holiday to Australia via singapore and have no recollection of being bitten. I have been quite fatigued over the past few weeks despite sleeping for over 8 hours per night – this is unusual for me. I have not ingested any substances out of the usual except a creatine supplement of which I took 3x about 3-4 weeks ago and stopped as they gave mild stomach upset which has resolved. I do not take any medication.Please see the attached images of the left toe, left ankle, and glans. They are taken at different dates since onset, the picture file name = the date the photo was takenThankyou in advance, your help is really appreciated... I'm a bit worried about what is happening here and this isn't sorting itself out.
Expert:  DrThomasMd replied 2 years ago.
Please type in the biopsy reports
Customer: replied 2 years ago.
Can I direct this post to Dr. Nair consultant dermatologist please? I am hoping his Dermatology speciality will be more suited to this questionI am awaiting the full copy of the biopsy report, the information given over the phone stated Lymphocytic vasculitis in the dermis and the lower levels showed Lychenoid reaction. I will hopefully receive the full report in the next few days.Thank you again
Expert:  Dr. Nair replied 2 years ago.
Thank you for requesting me. From what I have gathered so far your biopsy report is suggestive of Lymphocytic Lichenoid Vasculitis - the common causes for these are oral drugs, infections, certain inflammatory skin diseases, and connective tissue disease. It is quite likely that you may have a low grade viral infection that is causing both your systemic and skin symptoms but other causes need to be ruled out as well.
I will await your detailed biopsy reports which could throw some more light on the matter.
Customer: replied 2 years ago.
Thank you for your response Dr. Nair, just to clarify - the skin biopsies were taken only from my feet and elbow, these lesions have started to clear up after the biopsy sites have scabbed over.My main concern right now are the lesions on the glans of my penis - no biopsy has been done here, I have only applied Advantan ointment x2 daily for 2 weeks as instructed by the dermatologist but this hasnt affected it at all. The penile lesions do seem to still be changing - the two separate areas seem to be joining up into one larger area of skin change. There has been no itching/burning/urinary issues at all.Do the pictures of the penile lesions fit a the diagnosis shown in the biopsies of the other areas? I cant find anything online that looks similar to the lesions I have. I am wondering if I need to seek a biopsy of the penile lesions as I am growing a bit concerned about whether the penile lesions are something sinister such as a skin cancer.Thank you in advance for your help, it is much appreciated
Customer: replied 2 years ago.
Dear Dr. Nair, further to the above I have attached three more pictures below. The first two are from last week where there were two circular indented lesions on the glans and just on the border of the glans with a piece of dry looking skin at the centre ( these have now gone)The third image I have just taken today and is of higher quality - when I zoom in I can see multiple dark looking spots throughout the area of skin which has been affected but none of these dark spots on the other areas of skin. I hope the images might show a bit about how things have progressed after the initial set of pictures I posted above.Again, your expertise on what is happening is very much appreciated, I'm still quite worried about it and it continues to change. Thank you in advance for your help
Customer: replied 2 years ago.
I was a bit worried that this could be Bowenoid Papulosis. The link below was the thing online that looked most like it.. and that had been diagnosed as Bowenoid Papulosis.. mine doesnt look as raised, this one also has circular indented lesions.
Expert:  Dr. Nair replied 2 years ago.
Hello again,
I would put the same reason as being causative for rashes on different parts of the body as long as they appeared within few weeks of each other. Hence I think the same thing that is causing your body rash is causing your penile rash. A further biopsy from the penile rash is not required.
No don't worry this does not look like bowenoid papulosis - in practice the appearance is quite different from what you have.
Will await your biopsy reports. Regards.
Customer: replied 2 years ago.
Dr. Nair, the pathology report has finally come through (see link - justanswer wouldnt let me upload any pictures) - Also, over the past two days I have developed new different lesions. About a week or so ago I had what looked like a spot in my belly button. Over the past two days I have developed multiple small diameter 2-4mm lesions in my belly button, my abdomen and just this evening they have spread to the flexor surfaces of both my forearms which were clear this morning. There are about 5-10 lesions in each area. These lesions look very much like molluscum contagiosum which I had once when I was younger. I cant think of an obvious source for these.The dermatologist I paid over 500 australian dollars to see once has stated again that "I'm a mystery" and has said she thinks this will "likely just sort itself out in time" and has no plans to carry out any further investigations / treatment.I'm really stranded here and have no access to a dermatologist, the shorted wait to see anybody else was in excess of 2 months. I've never had any skin issues before.. and now I've had these blistering lesions, my glans skin changing and molluscum contagiosum all in 3 weeks. Please.. if you can help shed some light on what could be going on with my body and what I should be doing about it.. it would be so much appreciatedlink to report:
Customer: replied 2 years ago.
Hi Dr. Nair, Can I be updated as to the reason for the onward referral and was this to a specific person?Thank you again
Customer: replied 2 years ago.
Just a note - I have contacted support twice over the past few days and I am still awaiting connection with a new dermatologist. If anyone can diagnose my problem, it would still be very much appreciated. Thankyou
Customer: replied 2 years ago.
7 days later - I am still "waiting to be connected to another dermatologist" despite three emails to support.
Expert:  Camille-Mod replied 2 years ago.
Thank you, ***** ***** continue to look for an Expert to assist you. Please let me know if I can be of any further assistance while you wait.
Expert:  dermdoc19 replied 2 years ago.
Hello,Is it possible to send further pictures of the new lesions on the abdomen, belly button etc.Thank you.
Customer: replied 2 years ago.
Thank you for your response dermdoc, I will upload them as soon as I have access to my laptopKind regards
Expert:  dermdoc19 replied 2 years ago.
Please let me know if you are having problems sending the pictures.
Customer: replied 2 years ago.
I have been unable to connect to the internet due to changing service providers, my connection is now re-established and I will attempt to upload them thank you
Customer: replied 2 years ago.
These pictures show newly formed penile lesions and lesions which have been on my forearm and abdomen and inner thigh. They change daily. some itch but most do not.Thank you again for your help
Customer: replied 1 year ago.
I have submitted a help request as to why this post was labelled as closed and the full amount deducted from my account before an answer has been given. I have not recieved a response from just answer staff yet.I would still very much appreciate an answer from a dermatologist regarding this condition. I have attached a full history and numerous pictures as requested.Kind regards
Customer: replied 1 year ago.
I have still not received any response from staff as to why this unanswered conversation has been closed and the full amount deducted from my account.I have still not yet received an answer from a specialist for a question I asked in June, despite providing all the extra information that was requested.
Customer: replied 1 year ago.
Still no response to this. Again my account has been debited with the full amount - no answer to my question has been given. Each expert has asked for more information which I have provided. Nobody has attempted an answer yet - but I have been charged.