Eczema gone bad? or infection?

[Chrisjoel]

My fiance' (22yr male) had his first bout of itching in Kuwait while he was in the military.  After much trial and error the doctors diagnosed him with eczema and prescribed a long term course of topical steroids.  The eczema has always been localized to scars and a few other places and seasonal (with winter).  Two weeks ago he broke out in an incredible rash covering his torso, thighs and now nearly everywhere.  He discontinued the steroids after reading that long-term use might make things worse and took a few days worth of Benedryl.  75mg did nothing to stop the itching, so we figured it was not an allergy and discontinued the Benedryl.  The spots vary from large (1/2") scaly spots with surrounding redness to tiny pimple-sized red bumps with no surrounding redness.  He is afraid to put anything topical on for fear of making it worse.  Consequently, he is constantly itchy and miserable.  He has very dry skin and uses an Aveeno bath soap that has previously proven effective at relieving dryness.  It makes his skin less dry, but does nothing for the itchy spots.  If this is eczema, what can he do to relieve the symptoms and will there be any benefit from seeing a doctor?  If this is a virus, can the doctor do anything to cure it or will he/she be able to relieve any symptoms while it cures itself?  I basically need to know what benefit there will be from professional help and what we can do to relieve the itch in the meantime while we get an appointment.  He is currently uninsured so I don't want to waste a lot of money on unnecessary tests, but by the same token, he needs relief ASAP.  Thank you.

[Chrisjoel]

Thank you so much for your input.  We have an appointment on Monday.  He will be glad to hear that he can continue the steroid cream over the weekend.  It provides at least SOME relief.  You provide a great service with this forum.  Especially for those of us with a couple of days before our appointment...to help relieve the suffering in the meantime.  Thanks again.

[Alan Rockoff, MD]

Although I obviously can't be sure without seeing the rash, what you describe is consistent with eczema.  This inborn skin sensitivity comes and goes, and varies from a few spots to occcasional widespread outbursts.

Regular use of steroid creams does not "make matters worse."  On the other hand, they often don't help when the condition is extensive.  Neither does Benadryl.

Your fiance needs proper diagnosis and effective treatment so he won't be miserable.

One of the useful things about us dermatologists is that we don't do many tests, because we don't have very many to do, and besides, we can often tell what we need to just by looking.

I therefore suggest that he consult a dermatologist who can:
1. examine him
2. perform a skin biopsy if that's needed, which it may not be
3. recommend therapy, whether topical or a short course of oral cortisone if that's approproate
4.  there are now non-steroid creams effectiove fro this condition, and they may also be worth considering

Of course, this may be something other than eczema, but he'll need a visit to find out.  From what you say is his degree of discomfort, it sounds like a worthwhile investment to find out.

Best.

Dr. Rockoff