Red skin blotches and Herpes?

[Susan1022]

Female, 50, and think I have had herpes about 10years, however the outbreaks do not look like classic herpes blisters, but rather like a pimple/bump under labial skin that erupts and becomes raw. I had an outbreak two weeks ago that took five days to go away. This outbreak, for the first time, looked more like classic herpes with small blisters. Two days after that disappeared, I developed an irritation with red spots and blotches in the crease under the buttocks and then it quickly spread to the upper inner thighs. The blotches are so many that they overlap each other, and not target-like at all as described in erythema multiforme. The next morning I noticed red spots/blotches on my palms that became more pronounced and itchy in the few days that followed. The palms had a "pins and needles" feeling for a few days. At the same time I noticed lots of small red spots in my armpits that did not itch at all. I also have the spots on the inner sides of the ankles. They are not bumps and are not raised so they are more like red spots and blotches occuring under top layer of skin. Most don't itch except the ones in the crease under the buttocks and sometimes on palms. There is one open raw crack in the skin in one location between two specific toes. Don't know if this is related but 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.  Note: this is the second time this "rash" has happened. I had it first time 6 weeks ago coinciding with a bad upper resp cold/flu, but the rash symptoms were more mild than now, but in the exact same places, including the toe. This time I have stuffy nose and a little hoarseness but the rash is much more severe. No biopsy was done. What do you suggest? Also, if this is herpes related, why has it not done this before after an outbreak of vaginal sores?  

[H. Hunter Handsfield, M.D.]

You don't describe anything that sounds like herpes.  However, if a dermatologist thinkgs herpes is a possibility, you have to take that seriously.  The erythema multiforme business is interesting, because herpes is a common trigger (maybe the most common one) of EM outbreaks.  In any case, no distant expert can provide any clear answers when two or more docs have already tried based on direct examination, especially for a skin condition that has been evaluated by two dermatologists!

All genital herpes recurrences happen only on one side of the body, not both (e.g., if on the right labia one time, with rare exception, that's where every outbreak will be). And each outbreak typically covers a patch no bigger than a quarter, often dime-sized or smaller; and each outbreak occurs within 1-2 inches of all the other episodes.  So to the extent you have such symptoms, herpes is a good bet.  Nothing else you describe is herpes.  It certainly never causes a blotchy rash of the sort you describe.  You're going to have to sort it out with your dermatologist or other providers.

Finaly, I'm amazed you say nothing about an HSV blood test.  If positive for either HSV-1 or HSV-2, it won't necessarily explain your non-herpes-type symptoms.  But if negative it will prove you aren't infected.  If not yet done, discuss it with your doctor(s).

Bottom line:  My best guess is that you don't have herpes at all.  But if you do, for sure it doesn't explain most of the problems you describe.

I hope this helps. Best wishes--  HHH, MD

[urmother]

does chlamydia show on a urine test that isnt testing for stds, justbacteria because of burning during urination?

[H. Hunter Handsfield, M.D.]

A test for chlamydia can be done on urine.

Thread jump.  No follow-up questions.

[urmother]

Yeah but what if the test was just for any bacteria or microorganism ? Would chlamidya show up since its a bacteria?

[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. Handsfield also thinks about this diagnosis.  Thank you!

[H. Hunter Handsfield, M.D.]

I really can't say anything about it, except to repeat that herpes was never a serious consideration.  Dermatologists have pretty fancy names for some things, and I never heard that one before.  However, you can be sure that candida has not "circulated through" your body.  It spreads on the skin, not internally.

[Susan1022]

Thank you, yes that is what he said... it spread all over my skin. I chose the wrong word.  Thank you for all your info!
Susan