Possible fugus, dyshidrosis, dermatophytid reaction?
22 y/o male caucasian with no history of chronic illness, no drug or environmental allergies, no history of eczema or other skin conditions, and in good health otherwise.
1 week history of small vesicles on hands and feet that look like they are filled with a clear fluid, those on feet now red. The vesicles first appeared (one week ago) around the wrists of both hands and progressively spread along the palms and also appear in between my fingers and on top of thumb and fourth and fifth digits on both hands. The following day, I noticed the same appearance on the tops of my feet (but not the soles). No itching or pain, but occasional stiffness as if there was inflammation.
On the third day, my palms and wrists turned red with the vesicles still present. Also, I noticed my lower back/top of my buttocks had started to itch (but my hands and feet did not) and was red. This itchiness and redness spread down my buttocks to my inner thighs but the itching was minimal. There are no vesicles or bumps associated with this area. I went to a Nurse Practitioner who said she thought I had a contact dermatitis and presribed and anti-histamine (Zyrtec) for the itching/redness on my thighs; and a topical corticosteroid (Triamcinolone) for my hands and feet.
The next day I went to a dermatologist who said that I did not have a contact dermatitis, but a viral xanthoma. She told me to continue using the cream but there was nothing else to do but wait 7-14 days for it to clear.
Now, the rash on my buttocks/thigh has become white and the skin is flaking off. It feels continuously warm. The skin on my penis has also shown scaling.
The vesicles on my feet have become more numerous and are red. My hands have started to feel "leathery" and dry and the vesicles feel very deep-seated and hard. The ones on my fingers are still clear-looking; some of the vesicles on my palms have become a red/purple hue and other are still clear. My tonsillar lymph nodes are now fairly enlarged and painful at my jaw line. I do not have fever or feel fatigue or malaise and have no other signs of infection other than my swollen lymph nodes and the rash on my buttocks.
I am thinking that I may have a dyshidrosis on my hands and feet, but don't know what about the rash in my pelvic area. I read about how some dermatophyte infections can produce circulating fungal antigens that give rise to immunologically mediated hypersensitity reactions in the skin (resulting in erythema or vesicles), a dermatophytid reaction. Don't know if this is a possibility? I just don't feel that this is a viral xanthoma and can not find any explanation for the physical manifestations on my hands, feet, and pelvic region with such different characteristics. Thanks.
The term the dermatologist used was probably, "viral exanthem." This just means a viral rash, and it sounds indeed as though that's what you have. A virus produces rashes that are widespread and more or less symmetrical, unlike dyshidrosis which only affects the hands and feet. The acute nature of your rash suggests something that will happen once and go away. As it does, the skin often peels, just as you say. My advice is to keep the skin moist and wait another week. If you still have concerns at that time, you ought to call the dermatologist who saw you the first time.
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