Rashes

[masspanic]

My question has a few parts to it. I had a tonsillectomy in March of 2006. Before surgery I was smoking more than a pack a day. Also, I've been taking Celexa 10mg/day for a few years now for anxiety/panic. Due to surgery I quit smoking, and because of quitting smoking, I experienced heavy depression despite the Celexa. During recovery from the tonsillectomy and after due to depression, I spent most of my time in bed.  I had synthetic pillowcases on my pillows that supposedly stopped allergens, mites, etc. Over those, I had regular cotton pillowcases. Over time, I gained 40 lbs. on top of being overweight already.  I'm close to 300 lbs. now at 6'2". At this time, I developed a rash on my head and underarms. My underarms were very irritated by deodorants and stung in the shower. They often got extremely itchy. My head was red, irritated, raised in areas, scaly, itchy and flaky. If I itched, my fingernails would catch on the raised areas.  I went to my primary and a dermatologist, and tried a few different meds. I am now using Luxiq on my scalp every other day or as needed, and hydrocortisone/iodoquinol on my underarms every other day or as needed. These meds work well, but the rash will come back if I don't use them. I work in a pharmacy, and wear an undershirt from my doctor's advice. Also, I wear a shirt and tie, and a lab coat. I often wear rubber gloves up to my biceps to mix IVs. I shower before work and sweat profusely afterward. It takes me a couple of hours to cool down. This occurs on days off also, even wearing just a t-shirt. I can't go to work without the undershirt because I often will sweat through my shirt. There's no underarm odor surprisingly, but if I detect a slight odor from my underarms, it smells musty, like a basement.  After all this rash occurred, I took off the synthetic pillowcases figuring they might be trapping heat and making me sweat. I now use an anti dandruff shampoo daily to fight flaking. I do use a pomade on my hair that's an oily gel. It could be a problem, but using anything else makes my scalp dry and even more itchy. Now that it's getting into winter, I often drive to work with the windows down to cool off after my shower and avoid sweating at work. I often find myself very hot and sweaty when nobody else is, and can't cool down. I stand under air-conditioning vents and use fans at work to cool down. I could understand in the summer, but now in the winter it's getting weird to people. I sometimes wake up sweating also. I'm wondering if the swelling from the rash on my scalp is keeping me hotter, longer? Why is my doctor telling me to use the meds so infrequently? Looking at my skin meds online, I see that the directions say to use multiple times a day. My doctor said I'd be using the meds indefinitely as long as the rash occurs... "like a heart condition." So, forever? Also, does smoking mask eczema symptoms? I thought I heard that somewhere. So does quitting allow it to come through? Thanks for your time.

[Alan Rockoff, MD]

Most of what you're describing sounds like eczema.  The key thing about eczema is something you point out yourself: "These meds work well, but the rash will come back if I don't use them."  That's about the size of it.  Stick with what works; it's the best you can do, and it isn't bad.

As for the sweating and feeling heat, I'm afraid I don;t know what that's all about.  All I can recommend is to keep as cool and dry as possible.  There are oral anti-sweat drugs you can discuss with your doctor (such as Robinul), but they can cause dry mouth and other side-effects.

I don;t know why your doctor is telling you to use medications infrequently.  You should ask him or her.

Take care.

Dr. Rockoff