Skin Problem

[diffdiag]

I am a 36 year-old male.  Around the middle of November ’04, I developed a severe, itchy, red rash on my lower left side, just above my hip.  It starts like a cluster of pimples that eventually become flat and blotchy creating a larger palm-sized red patch.  I went to the dermatologist and he told me it looked like a fixed drug eruption.  I told him I wasn’t taking any drugs but I was taking two supplements: coral calcium and a grass-based whole food vitamin.  He told me to stop taking both supplements and gave me a three-day regimen of prednisone and a topical anti-inflammatory.

It seemed to work and the rash stopped itching and started to heal.  Then, a similar smaller rash appeared on the right side of my abdomen.  I went back to the dermatologist and he told me that he need to take a punch biopsy of the newly affected area because he believed it might be CTCL and he wanted to test for everything.

After a weekend of believing I had cancer, my test results came back negative for CTCL but positive for many allergens.  My dermatologist then sent the sample out for a second opinion.  The consultation report reads as follows:


GROSS DESCRIPTION:
5mm Punch Biopsy Specimen / bisected

MICROSCOPIC DESCRIPTION:
There is an inflammatory cell infiltrate present around the vessels of the superficial and deep papillary plexuses.  The infiltrate consists of lymphocytes, histiocytes, eosinophils and neutrophils.  Scattered eosinophils and neutrophils are present between the collagen bundles.

DIAGNOSIS:
Superficial and Deep Perivascular Mixed-cell Dermatitis

NOTE:
The differential diagnosis includes urticaria like allergic reactions of the superficial and deep type (chronic urticaria), arthropod bites, urticarial pemphigoid and a drug eruption.


In the meantime, I had new similar skin eruptions on the top of both thighs, the sight of the biopsy, my crotch (not on genitals) and near my armpits.  All went away in a few days with another 3-day round of prednisone and topical steroidal cream.

Now, I have a similar small eruption on the lower left side of my neck and a very faint eruption on my lower left abdomen.  The rash on my neck is small and itches only slightly, but it looks the same (a small cluster of pimples).  In addition, I tend to be itchy in the areas that were affected but have now healed

I have not been to my dermatologist since before the latest eruption on my neck.  He insists that this is a fixed drug eruption even though I had been taking those supplements for about 18 months before I had any problems and I stopped taking them 6 weeks ago.

Do you have any thoughts on what this might be?

Thanks.

[Alan Rockoff, MD]

I'm afraid not, though the biopsy report is reassuring in a way.  The report is nonspecific, meaning that it doesn't point to a specific diagnosis.  There's no indication of CTCL (a serious form of skin cancer), but fixed drug eruption doesn't seem to fit the picture either, since the rash didn't stop even though you stopped the supplements.

Don't be confused by the references to allergic reactions and arthropod bites--all the nonspecific biopsy reports include those as a matter of course, just for completeness.

You may have some form of eczema, which will need to be suppressed by the use of topical creams and oral antihistamines (better to stay away from too much prednisone.)  

I think you should consider getting another opinion--not necessarily a criticism of your current dermatologist, just that another pair of eyes may look at the problem from a fresh perspective.

Take care.

Dr. Rockoff

[diffdiag]

I read that urticaria can be caused by vibration.  Can the condition I described be caused by the vibration of a sonic toothbrush?  I started to use one around the time the first rash developed and still do.  Thanks.

[BOUG55]

A related discussion, Rash was started.