Desperate for help! Extreme unknown rash 1 year - Very painful

[CoderJo]

A friend has had a skin problem for almost 2 years.  It started after he changed the oil in his car. He had swelling, redness & heat in his wrist.  The next day, it moved to the other wrist.  Since then it comes and goes.  Prednisone works, but after a month, it comes back in more areas and now covers his entire body.  It is redness, blistering, swelling with oozing from split skin.  There is scaliness. His face swells to the point his eyes are swollen shut.  He's had periodic blepheritis.  
   He's been tested for Lupus - negative. He's had allergy testing for all skin care products and has stopped using all that he had reactions to.  He has a history of asthma and eczema.  The asthma has been serious at times.  He has a history of allergies, including allergies to peanuts & chocolate.  He is very careful of what he eats.  He has bought new bedding, including mattress & pillows with hypoallergenic materials.  He has been to see local doctors and doctors at Chapel Hill (dermatologists, GP's, immunologists & herbalists). He is currently on a medication for organ transplant patients (started 3 weeks ago), but the only result so far is severe leg swelling.  The rash is so intense & painful, that sleep is impossible even with hydroxyzine, doxepin & Ambien. The problem has recently become so painful, that it hurts to wear clothes.   He can't take much more of this. People stare at him as if he's a monster and have asked him if he was burned in a fire.

The doctors say it's not psoriasis.  They told him if he comes back again like he did yesterday, they'll admit him.  But he can't take it any more.

Please, is anyone familiar with a condition like this, or does someone know of a doctor who is willing to consider the improbable or unusual.   Thanks for reading this

[Alan Rockoff, MD]

I understand your concern and of course that of your suffering friend, but I'm afraid I have no specific suggestions to offer.  It sounds as though the doctors he's seen have indeed considered many diagnostic possibilities.  Although your friend may indeed not be able to take this anymore, but now would not be a good time to give up--medicines like the one started three weeks ago--presumably an immune suppressant--take several weeks to work.  I suggest that your friend ask his doctors straight out what their long-term plans are and whether they would consider soliciting help from specialists in other areas.  Maybe you should accompany him when he asks, since he may be in no mental state for listening.

Good luck.

Dr. Rockoff