Long Term Rash

My wife is suffering from a rash that started about a year ago.  It first started when we were on vacation in St. Thomas last January.  We spent the day at the beach sunbathing and snorkeling and that evening she felt as if her backside was on fire.  Red and itchy.  We went to a local clinic and the Doctor there gave her a topical spray to help the itching and an antibacterial cream (He thought maybe sand fleas or some plant).  The problem lessened a little and we thought she may have sat or brushed against something.  After we returned home the problem continued with the itching and welps.  She noted the welp looking areas mainly on her backside but also down the top part of the backs of her legs.  Extremely itchy to the point that she can't sleep at night.  We visited a dermatologist that our G.P. recommended.  He took a biopsy and precribed a steroid cream.  No relief.  The biopsy showed no particular fungus or gave any indication of what was causing the rash.  As time went on we also noticed that the rash also has appeared around her ankles.  We then saw a dermatologist at the Duke Medical Center, she took an additional biopsy on a fresh area, again the results were inconclusive.  She prescribed several antibiotics and steroids, all with little results.  My wife was then referred to another Dermatologist at Duke.  Basically the same routine, same results.  She recently had an allergy test that didn't indicate any particular areas she was overly sensitive to.  A lot of history with this case and no one seems to have a suggestion of what to do next.  Help, any suggestion to try next?

[Alan Rockoff, MD]

Brad:

I don't know of any rashes cintracted in the tropics which don't go away for a year.  The original rash sounds like what the locals call "sea lice."  (Actually, they're small hives from the sting of jellyfish larvae which gatger under bathing suits.)

I have never seen these persist, however.  Obviously, the dermatologists you saw did not recognize the rash, nor did their biopsies shed meaningful light.

Is your wife possibly perpetuating the rash by scratching all the time.  Are there still hives and welts, or just areas which have been rubbed or scratched?

If she is not doing so, I would recommend at least these symptomatic treatments:  One Aveeno oatmeal bath for 10 minutes at bedtime; Benadryl 25-50 mgs at bedtime, application of Sarna lotion (OTC) liberally and often to suppress itch.

Good luck.

Dr. R

[Brad]

Yes, the dermatologists feel that the problem continues to persist somewhat due to the scratching.  The ones around her ankles come and go though even without scratching.  These are welts on her backside and ankles which come and go with the itchiness.  We'll try the treatments you recommended and go from there.  She is most interested in resolution of the itching at this point so she can get some consistent rest.  Obviously her patience is wearing thin.  Thanks,

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