Identifying this rash/skin disease (I have seen multiple doctors)

I started getting little dots all over my chest legs and arms in March. They were so small that one could barely see them from 1-2 feet away. I still wanted it checked out and went to my dermatologist. She told me she didn't know what it was, took a biopsy (2 actually), and gave me some Cortisone. A week later I got the results, i was told it was a "medical eruption", which seemed odd to me because the only medication I ever take is an Advil or Sudafed when i'm "really sick". The rash went away a little and then came back again near my ams and on my chest. I went to get a second opinion from my other dermatologist, he looked at me, said he was 100% sure that what I had were warts, and gave me Condylox Gel 0.5% (originally used for genital warts) but he said it would help. I started putting cream on all the lesions which took me about 45 every time. I went back a week later, with no improvements. Now he wasn't so sure anymore, so he took a biopsy from 4 lesions and sent them in. He gave me Clobetasol Propionate 0.05%. I started using this cream and saw results in most places. The biopsy this time came back as "linchen planus". he told me to keep taking the cream. All seemed well, but after a trip to Holland it felt like i was "breaking out" again. This time it was mostly on my neck and shoulders and chest. I should add that my chest never really cleared up. I went to the dermatologist again and received Metro Gel 1% and Promiseb. Ultimately what I ended up doing was going to florida to be in the salt water with the sun (I am a firm believer in the "power" of salt water and sun to heal skin lesions")  I started taking antihistamines about a month ago. Pictures can be found under my profile
Extra Strength cotisone (the over the counter kind)
Condylox Gel 0.5%
Clobetasol Propionate 0.05%
Promiseb
A yeast cream (I forget which one)
Metrogel 1%
and lately antihistamines

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum, Nick!

I admire and support your eagerness to find answers. I would like to have more information and then give you even more informative answer:

1. Were you sick (infection of any sort, chronic immunologic disorder, etc.) before skin lesions appeared first time?

2. Did you experience any other symptoms – systemic and/or skin related? How about skin itching or pain? Any other health issues?  

3. Please describe one or few typical lesions (color, size, any scaling, blistering, crusting, itching, pain, irritation, etc.).

Thank you.


Wishing You Optimal Health,
Dr. Jasmina Jankicevic

[Nick98]

Thank you for your reply.

1. I was a little sick before I started getting the lesions. For me "sick" is a throat ache, stuffy nose, and maybe a little bit of an elevated temperature, so it wasn't that big of a deal.

2. The lesions did not itch or hurt in any way, if I didn't see them, I wouldn't know that I have any, so from a comfort stand point, they really do not bother me, obviously from a visual stand point it's a whole different story.

3. As you can see on my pictures, they are little dots that are located fairly close to one another mostly on my chest, neck, and shoulders. Again, they don't itch in any way. They used to be somewhat irritating on my neck, but I feel like the antibiotics in the Metro Gel 1% soothed that. They generally don't crust over, if they get irritated from my shirt, sometimes i will see a little puss.

I hope this helps, I can take more detailed pictures if needed.

thanks,
Nick

[Jasmina Jankicevic, MD, MSc, CCRP]

Nick,

Based on several information you shared including that you had an upper respiratory infection (probably viral) prior to first skin lesions, type and distribution of lesions, their chronic character and lack of subjective symptoms, it is quite probable that you have been experiencing Pityriasis lichenoides chronica (PLC). However, differential diagnosis includes Psoriasis guttata, Pyriasis rosea, Lichen planus, etc.

Once your physician confirms the diagnosis, optimal treatment strategy can be implemented. PLC does not necessarily require therapy, but remission can be reached in less time if proper therapy is applied. Your dermatologist will decide.


Wishing You Optimal Health,
Dr. Jasmina Jankicevic

[Nick98]

Thanks again for your answer.

I have seen 3 dermatologists already, and no one seems to know what it is. I am currently traveling a lot and don't really have time to see my dermatologist (not to mention that my trust in them is absolutely gone). Like I mentioned above, one of the biopsys came back as lichen planus, but according to my symptoms, they don't really match up.
Should I stop taking antihistamines? Also, if it is PLC, should I re-start my topical steroids?

thanks,
Nick