Eczema?

Dear Doc,

21 yo college student here, had eczema when i was a baby, always dry skin in winter, some hay fever allergies but seemed to outgrow those in highschool. In January I started working out heavily,taking two showers a day on the days I worked out. I would usually wear two shirts and nylon windpants. I also switched detergants and fabric sheets.  I remember one load of wash where it seemed like the detergant didn't dissolve and was on some of the clothes.  Anyways, in the time i was working out, both of my nipples started to itch, a little bit more each day and skin was getting very dry.  I must confess I did itch them quite a bit but not to the point where they bled. They were crusty at one point and sometime oozed just a little bit.  I tried hydrocortisone OTC and aquaphor and that helped them a little. Then a rash, red, sort of bumpy appeared on my shoulders and upper part of one thigh.  Finally went to the campus clinic and the MD there said the rash looked like contact dermatitis or eczema (at that time the nipples were pretty much back to normal, just sort of scaly).  He prescribed some  Rx hydrocortisone, which cleared up the stuff on my shoulders and thighs after a few days, although it would seem to flare up after a shower.  I did become worried about this thinking the doc could have missed something and sort of had some anxiety.  Anways, then ~2 weeks later I had some spots show up on my arms (some on the middle and upper arm, right on top, not on the sides) that were small rosey colored, scaly patches and also a few on my legs. Had some small spots on my back as well. Also had a flare up on my face which was under control in about a day after a dosing of the hydrocortisone.  A family medicine doctor i know took a look and said it was either pityriasis rosea or eczema.  Went back to the clinic and the doctor (same one i saw who said contact derm/eczema) said pityriasis rosea/eczema/allergic reaction. He prescribed a stronger corticosteroid which calmed the bumps on my arms and legs.  There was one spot on the lateral right side of my trunk that seemed like a month to go away.  Anways, I went to Las Vegas for spring break (very dry climate) 1.5 week later and on the second day there my nipples flared up again and also a small patch on the right side of my face did too.  Have to mention that before i went a wore shirt that wasn't totally dry from the washing machine.  When i got back i put the meds on my body and that made them go down.  Skin is almost back to normal now, but i did make an appt to see a derm, but it is in may. I also noticed that it seems I have more of those small pinpoint red dots than i have had in past (some on arms, some on legs, some on trunk).  I guess I would like to know do you think this was all eczema?  Sorry so long but I felt like i have been in a state of hypersensitivity for like 2 months.  Hope you can help.

[Alan Rockoff, MD]

It sounds as though you do indeed have eczema.  The nipples are a common site, but eczema can produce dry, red itchy patches all over the place.

Eczema is a senssitivity people are born with, but the condition may come and go at wide intervals (such as infancy, followed by many years of clear skin, followed by patches like the ones you have.)  There's no rhyme or reason to their appearance.  Most of the time soaps and detergents have nothing to do with the outbreaks, even though it's tempting to try to find a correlation.

If you get better with hydrocortisone, that strongly supports the diagnosis of eczema.  So it sounds as though you are being properly taken care of, and don't need to worry until you see the dermatologist for confimration and, perhaps, a stronger prescription to help keep things in control.

Best.

Dr. Rockoff

[DermKid]

The small red points i was referring to look like small angiomas