Red blotches and spots

[Susan1022]

Six days ago I developed an irritation in the crease under the buttocks and then it quickly spread to the upper inner thighs.  The next morning I noticed red spots/blotches on my palms. At the same time I noticed them in my armpits, but they did not itch at all. I also have them on my ankles but only on the inner side of the ankles. They are not bumps and are not raised, so they are more like red spots and blotches. Most don't itch except the ones in the crease under the buttocks and sometimes on palms of hands. There is one open raw crack in the skin in one location between two specific toes.  I don't know if this is related but I have never had athlete's foot in my life. One derm says syphilis or erythema multiforme, one derm says herpes, Lupus, leukemia are possibilities. CBC Diff and BMP normal, herpes antibodies high, ANA normal, syphilis test negative.  One other significant note:  this is the second time this has happened. Had it first time 6 weeks ago coinciding with a very bad upper respiratory cold, but the rash symptoms were more mild than they are now, but in the exact same places, including the toe.  This time I have mild respiratory like a stuffy nose and a little hoarseness, but the rash is much more severe.  Have we overlooked anything here?  What is your feeling?  I am so confused because one derm wants me to take prednisone, and the other warns against that kind of treatment.  No biopsy was done. I believe I do have genital herpes, however whenever I have had an outbreak over the years it does not look like classic herpes blisters.  About a week before this most recent splotchy outbreak I did have a genital outbreak of something, and it cleared up completely.  Then the splotches came on a day or two later and have lasted now almost a week.  They are fading now.  They did NOT have a target-like appearance to them as is described in erythema multiforme.  What do you suggest I do next?

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A related discussion, red bloches on hands was started.

[Susan1022]

And the moral to this story is the internet is a wonderful thing, and MedHelp.org is one of the finest health sites I have been on.  And the doctors' advice is wonderful to point you in the right direction. But nothing takes the place of a real life, real time, face to face doctor visit.  If you don't feel satisfied with one, see another!

[Susan1022]

Well, I finally got an appt. with a renowned dermatologist here in NJ.  He knew in three minutes what I had.  The raw crack in the skin between the 3rd and 4th toe on both feet clinched it.  Candidiasis - Erosio Interdigitalis Blastomycetica
Seems that before the first outbreak in January, I had had a pedicure in a small salon inside Newark Airport before a flight to Florida.  The place seemed clean enough, but perhaps not.  I also wore sandals not remembering that I needed to remove my shoes to walk through the security area. My feet, unfortunately, were bare.  I must have picked up a fungal infection and it has circulated through my body breaking out in red spots and blotches on palms, wrists, underarms, inner thighs, under buttocks, inside ankles and most importantly, between the same two toes on each foot.  The spots on my palms, inner thighs, and in the fold under the buttocks morphed into big crusty spots that eventually peeled.  Because I can't take oral Diflucan, I am using Oxistat cream topically between the toes and the rest should clear up by itself since everything is being generated from the infection in between the toes.  Hope this helps somebody out there, and would like to hear what Dr. Rockoff also thinks about this diagnosis.  Thank you!

[Alan Rockoff, MD]

Rashes that appear symmetrically and all over the place like yours are usually systemic--such as from a virus.  Erythema multiforme is a possibility, and some cases of that condition are triggered by herpes.  But you don't describe anything that sounds like an acute attack of herpes, and I don't know what "herpes antibody high" means.  Even is you have herpes antibodies, it doesn't mean that you have had an acute attack that would trigger erythema multiforme.  As for syphilis and leukemia, normal syphilis tests and blood counts would seem to rule those out with confidence, as would the fact that this eems to be a recurrent problem.  Some doctors prescribe prednisone for erythema multiforme, but there's little evidence that it does much, and if the case is not too severe it probably isn't necessary.  What I think you should do is pick one dermatologist and put these questions to him or her.  There is no need, to say the least, for you to sit at home and worry about syphilis and leukemia when you don't have them.  If herpes is judged to be the trigger--and I'm not at all sure that's the case from what you've said--then suppressing outbreaks with an anti-herpes antibiotic like acyclovir may be worth talking about.  But you need to talk about it in person.

Best.

Dr. Rockoff