mystery rash getting painful

[mpmom]

My 10 year old son developed some red bumps behind his left ear over a month ago.  They were not affected at all by a few days of Cortaid, so I took him to Dr. #1 who didn't recognize it and asked Dr. #2 for his opinion. He was diagnosed with numlar eczema and given Elocon.  For a while the bumps got slightly better, then after about 2 weeks flared very red and became one solid dime-sized raised red spot. Dr. #3 (all doctors same practice) said it is fungal and gave us Loprox.  Loprox made the spot itch and burn and turn bright red, so back to the office.  Physicians' Assistants #1 & #2 didn't know what it is, so asked Dr. #4.  He thought still fungal, took a culture and gave us Spectazole.  One week after Dr. #4, the spot is 4"X3" (MUCH larger), very red and covered with tiny blisters filled with yellow pus.  The sore area extends from behind his ear almost to his shoulder.  Latest phone call to Drs office said culture is negative so far (but they claim it could take up to two weeks to show anything).  They say the blisters are a secondary infection on top of the fungal, so keep using Spectazole and now add Bactiban to fight bacterial infection.  The spot gets larger every day, it is painful for my son and hideous.  Can't get into see a dermatologist for weeks, and am still waiting for referral letter from pediatrician's office.

Does anyone have any suggestions?  The original bumps showed up about 5 days after staying in a marginally clean motel for a soccer tournament.  Pool towels?  Tick bite?  (Colorado, not a hot-bed of Lyme Disease).  Pet Mice?  Pet lizard?  Dog?  I've checked, the dog seems free from any rash.

Should we ditch the fungal cream? It seems to be making it much worse, but if it IS fungal I don't want to delay treatment.  Could it be viral?

Thanks.

[Alan Rockoff, MD]

I am not sure, of course, but fungus does not seem like the diagnosis at this point.  I am also reasonably sure that the cleanliness at the motel is not relevant.

A bacterial or viral condition should be sought and treated.  I recommend a culture of the blisters and perhaps a skin biopsy.

I urge you to have your doctors lean on a dermatologist to see your son as soon as practical.  There is no need, I feel, to have him wait for weeks.  I am confident your pediatricians will agree, and that the dermatologist they consult will cooperate.

Best.

Dr. Rockoff