Confused About Diagnosis

I went in to see my doctor last week for what I thought was a spider bite on my leg. (I had broken out in hives.) He gave me some antibiotics and had the spot cultured for MRSA. Over the weekend I was itching all over my legs and noticed that I had some inflammation on the other leg--itchy red rash with yellow/clear fluid inside bubbles. I went in again and he told me it was herpes, put me on 3gm. of Valtrex a day, and said to see if they come back.

This made me uncomfortable. I went to the dermatologist the next day. He said I was bit by an insect; the bite was infected; I was allergic to the ointment prescribed; I spread the rash through scratching.

My only concern is that I did have unprotected sex in June. Very brief encounter; I stopped it half way through. I went to PP in July for STD testing. When I asked for a herpes test, the doc said she didn't see any signs whatsoever of herpes and didn't recommend testing at that point. Everything else was negative.

From the research I've done, I haven't seen a case of herpes appearing on the lower legs. My legs itch (although the itching has decreased since I started using a cortisone cream), but the lesions aren't painful at all. Some of the blisters are in clusters; some are spread over the leg (maybe 14-15 spots). They drain, and the skin then scabs. I've not been sick otherwise. From what I understand, my exposure was limited. Am I right to question my doctor's diagnosis? Does further testing in this situation sound reasonable?

[H. Hunter Handsfield, M.D.]

Herpes absolutely is not the cause of this problem, regardless of blister-like lesions.  Lots of dermatologic conditions, especially allergic ones and chemical irritations, are associated with vesicles or other blister-like lesions.  And certainly genital herpes never occurred on the lower legs.

Good luck--  HHH, MD

[MLWTR]

Any chance you ran into some poison ivy? It is a very itchy but not painful blistery rash that shows up about 48 hours after exposure to the plant. (In skin areas where you didn't contact as much of the oil from the plant, the rash can take a day or two more to show up, so you can see additional blisters and itchy areas popping up for a few days). Poison ivy is what is called a weeping rash, because the blisters to tend to ooze a bit.

Anyway, this is just a thought. Sometimes dermatologists in urban areas aren't so quick to recognize poison ivy because they don't see it much.

[MeredithB]

My doctor considered poison ivy at first, but ruled it out because my possible exposure to it had been longer than the traditional time frame. I had been in the woods 1 1/2 week earlier. Someone else who was also there had been diagnosed with a herpes virus (he started showing symptoms at the same time I did), but it turns out that it was probably exposure to oleander.

The blisters that are clustered look similar to some pictures of herpes that I've seen. I just haven't found anything to suggest that herpes appears on the lower legs like this. A few clusters in a semi-straight line and several indivually scattered around my calf. His diagnosis seems a bit premature and not well-documented...and the Valtrex made me sick.

[monkeyflower]

Yeah. Well, I'm no doctor, but I definitely don't think you have herpes. That seems like an awfully weird diagnosis and treatment. I think I'd definitely go with the dermatologist's assessment of the situation. After all, they're the skin experts :-) You can get tested for herpes if you want, but not because of this.

[who_dis]

If you had been in the woods a week or so earlier, you can still break out with poison ivy if your skin came in contact with anything that had the oil on it, even after some time has passed.  Did you by any chance put on the same pair of pants, or boots or something that might still have had the oils on it?

[gracefromHHP]

Did he take a pcr swab of the blisters when he suspected it was herpes?  That's far more accurate than a visual diagnosis.

The higher doses of valtrex can make you feel pretty miserable :(

Are you going to follow up with another dermatologist?

grace

[MeredithB]

Thank you to everyone. This has been the most reasonable place I've found so far to get some solid advice. I didn't think a herpes diagnosis was accurate and have already stopped taking the Valtrex.

I definitely have a spider bite, and I think the other lesions are from poison oak or oleander.