Itch that started between legs.

[AtlantaGa]

25 year old male. (Part 1 of 2. In the unfortunate event that you do not read Part 2, I should note I have applied Fluocinonide .05%, Permethrin 5% cream, and Clindamycin Phosphate 1% lotion with no success.)

Two months ago an itch began on the interior of my left thigh while wearing compression shorts at the gym. (I understand sometimes information may lead a doctor in the wrong direction, but it's worth noting I workout 4 times a week, and sometimes I wear my gym clothes on back-to-back days.) Thinking the itch would go away, I did not see a doctor. After a month, the itch spread to both thighs, between the buttocks, and waist, and began interfering with my every day life: severe itching in addition to it waking me up at night. At this time, I saw a dermatologist who appeared to not pay much attention and stated the cause was exposure to nickel from my keys, and prescribed me to Fluocinonide .05%. After applying half the tube with the condition continuing to worsen (spreading to my penile shaft, forearms, wrist, hand, and palm), I returned to the dermatologist 3 weeks later.

As it stood at the time of that visit and as it stands today, the rash between my legs consists of redness around the hair follicles where the itching is. On my penile shaft, there was a bump that the dermatologist stated looked like what could be scabies (there are now two bumps). On the inside of my wrist, where there is no hair, the irritation is red and raised. My forearms occasionally get red itchy bumps, then go away. My waist has red itchy bumps (but they do not go away). The back of my hand gets the same red itchy bumps, but these goes away (probably because they are not continually irritated like clothes will do to a waist). And my palm gets itchy bumps that are not red, but I am able to extract clear puss by applying pressure. On this visit to the dermatologist, I was prescribed Permethrin 5% cream, head to toe, for scabies.

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum. Thank you for both of your posts. We shall try to help as much as possible by providing information about appropriate diagnostic and therapeutic strategies in a case such as yours.

First of all, it is necessary to establish diagnosis. With multiple topical therapies introduced, clinical manifestations are changed and can be a challenge to recognize the underlying disorder. Therefore, in such a case, it is advised to discontinue topical therapy (under doctor’s close supervision) for at least seven days (corticosteroids for two weeks even) before skin and overall health is evaluated again. Very detailed medical history is a paramount! Basic diagnostic tools that could be utilized are skin biopsy and skin cultures. First differential diagnoses to look at are: scabies, disseminated eczema, skin infections (bacterial, fungal…). The list of differential diagnoses is not short.

In the meantime, try to exclude any lifestyle habits that could contribute to further aggravation (exposure to different topical irritants and underwear/wardrobe made of synthetic materials).

Once the exact diagnosis is known, optimal therapeutic strategy can be established easily.

We may be able to provide additional comments if we could see the skin lesions you mentioned and tried to describe. If you decide to post photographs, feel free to let us know.

Wishing You Optimal Health,
Dr. Jasmina Jankicevic

[AtlantaGa]

Second photo update, one week after original photo. Just a reminder, this started between my legs.

The two itchy, tough skinned bumps on my penis have not gone away. My grundle has the same itchy, raised skin feel as my elbows. I do sit in a chair with my elbows on arm rests for a lot of the day (Chronic Pressure Urticaria? It's been over two months living with the itch).

Thank you, as always, for your time and help.

http://www.medhelp.org/user_photos/show/203630?personal_page_id=2123152

[AtlantaGa]

Thank you very much for your help and time. I have discontinued use of topical therapies, and discontinued working out in case it was aggravating the problem. On April 8, a dermatologist give me a steroid shot to treat the itch, stating it would take a few days to a week to set in and will last about two months. Unfortunately, the itch hasn't subsided.

The silver lining is I was able to take a picture today of a new rash on my elbow. Although this looks worse than anything else I've had, it might be a good indicator of my condition. It is on both elbows, and I first noticed it while wearing a long sleeve shirt (contact dermatitis from laundry detergent?). The picture is on my profile and attached below.

Again, I'm extremely grateful for everything you've done.

http://www.medhelp.org/user_photos/show/202431?personal_page_id=2123152

[AtlantaGa]

Part 2:

Not convinced of the diagnosis, I visited a different dermatologist. Same symptoms, and before applying the Permethrin 5%. She scraped two bumps and found no scabies (though she did state it's possible to still be scabies). This dermatologist stated it could be folliculitis, although she wasn't sure what it was, and prescribed me Clindamycin Phosphate 1% lotion to be applied twice daily.

Not believing it was scabies (I had scabies 5 years ago, and the symptoms did not appear to be the same), I applied the Clindamycin Phosphate 1% lotion first, which caused extreme irritation to the bump on my penile shaft causing extreme inflammation. Although I understand the irritation may not immediately go away, after having applied this lotion twice, not only has the irritations not been reduced, but more red itchy bumps have surfaced. Because of this, and because of the now large inflamed bump on my penis and the itching never subsiding, I have a difficult time believing I have folliculitis. Whatever I have, it appears to be having a reaction to Clindamycin Phosphate 1% because it appears to cause more itching and the bump on my penis inflamed quite a bit.

I then applied the Permethrin 5% cream at night after a shower and before bed, head to toe. Because I have had no decrease in symptoms and generally one application is curative, I do not believe my irritations are due to scabies.

In sum, I have applied Fluocinonide .05%, Permethrin 5% cream, and Clindamycin Phosphate 1% lotion with no success. I also scrub my body in the shower with antibacterial soap (Dial). I have also used Gold Bold between my legs and between my buttocks in hopes that if this was fungal, the lack of moisture may cause it to dissipate.

I really want to get back to my life, and desperately seek genuine help. I am interested in learning whether my symptoms display any type of specific cause, or if the earlier diagnosis' are a common misdiagnosis for some other bacteria, viral, fungal, or any other type of infection/irritation.