Chigger Bites

[KismetNJ]

Dear Doc.
My mom has been suffering from these itchy blister's that keep re-occuring now for years.  They seem very similar to chigger bites, however from what I read chigger bites don't last that long.  She has been to so many dermatologists and they never have an answer for her.  Can this be chigger bites that never went away?  If not what else could it be?  The blisters appear on her legs and underarms; she can't help but scratch them which then turns into a scab and the skin hardens around it and leaves a mark.  I really want to help her and find out what this could be caused from and hopefully get a solution.

[DrAAH]

Without seeing the lesions -- it is rather difficult to guess what may be going on.  And, one would assume that dermatologist would get to the bottom.  Having said this, though, many will follow protocols and unless they can demonstrate a mite from a scraping wouldn't necessarily make the dx.--  but presumably would have provided 'presumptive' treatment for a mite infestation (I am not thinking chiggers at this point and wouldn't see anything now - though, there is a condition in which the debris of chiggers or scabies left behind even after the active mite and their nymphs are erradicated can lead to a harden nodule that is off and on intensely itchy - and this can last for a long time -- topical and systemic antihistamines and topical steroids -- after ruling out a secondary bacterial infection would be what I would try -- and that is after giving your mother at least one real treatment for scabies -- 1% Lindane -- too much resistance to permithrins etc.).

Let's talk about burrowing mites -- best known in human experiences as human scabies (though, rodent etc. scabies can also set up house in humans).  Go to the Internet to learn all about scabies and their possible distribution on the body.  I bring up scabies because of the chronicity of your mother's situation.  The classic burrows (or tracks) caused by the female adult mite looking to lay eggs is not always easy to find -- especially if there is scratching.  And, scratching can remove the mite - making it hard to find in a scraping.  However, the eggs hatch -- the nympths find hair folicles to moult in and becoming adults continue the cycle.  Low level chronic infestations have been called 'bath tub' scabies -- because the population is kept at a low level from scrubbing and scratching.  

I would have expected that lesions would have shown up in other places by now, if this were scabies after this period of time.

It would be worth - a Kwell (1% Lindane) treatment -- at a minimum to cover her.  then patience is required and thoroughly disinfecting all environments -- clothings -- bedding etc. to prevents reinfestation.

Neem oil is worth a try too.  It may be found in different products available on-line -- (ie. Mictatin or All-stop).  It is alledged to work well -- but I cannot say -- not having had experience with it.

Your mother may also try soaking in salt (heavy amounts of sea salts added to the bath) baths to sooth the skin and perhaps reduce infections).  Sulfur creams can also act as repellants and anti-infectants at the same time.

What I am wondering from the hx now - is that she may have set up a secondary infection of common bacteria that hang out on the skin - kind of like impetigo -- but that somehow her immunity and hygiene is keeping it from spreading.

Without seeing the lesions -- as they first appear and evolve and their actual distribution -- it is hard to second guess.

I might suggest finding a more flexible thinking doctor (doesn't need to be a dermatologist necessarily) - who will pull all the pieces together and come up with something.  Healing the skin is paramount - and emu oils are great for helping on this.

You're a sweet daughter to seek help for your mom.