Hive mystery

[AlynBc]

I recently was visiting my fiancé when I began itching terribly in my genitals. I had a bikini wax so I figured I was having a reaction to that. I used aloe, butt paste (for the zinc oxide), witch hazel, cortisone cream, Benedryl, you name it, without much if any relief. The itching got so bad after a week that we went to see a doctor. The doctor said it looked like folliculitis but may be infected. He originally was going to give me cipro (antibiotic) and prednisone, but said after consulting his literature was just going to do the prednisone and hydroxy something. He then gave me a shot of solumedrol. Well within one hour my entire body, every part head to toe was bright red and covered in severely itchy hives. Since returning home I have seen 3 doctors who all say that the solumedrol would not have caused the hives, but there's not one other thing I can think of that could have done this. I'm still using creams and Benedryl but without relief. I haven't slept more than 2 hours in over a week. I have no idea what to do but I cannot stand this constant itching, it's ruining my life because I cannot function at work or school. I am praying for answers or relief and maybe someone has had a similar experience and can offer me some advice. This is getting really scary!

[AlynBc]

A million thanks for that response! I've now been to a dermatologist twice and my gynecologist. My gynecologist said there was no infection, and prescribed me a corticosteroid cream. The cream has not helped and I am weary of continuing its use because he did not examine the area that is bothering me the most. The worst itching is in the anal region and it feels as it is literally 'in' the canal. Since he did not look or feel in there, I am left feeling scared and miserable, as it is not going away. The dermatologist who I also explained the location of the itching has not examined that area. I realize it may be a not-so-pleasant area to be in, but this constant itching is not so pleasant either. I had pinworms when I was little and the symptoms do not match up, but I over-the-counter treated just because I am at a loss. The dermatologist at the second appt. gave me another steroid shot for the body hives, which helped for a few hours. He also prescribed me azithromycin and diflucan. I have taken both and a day later, I see or feel no changes, which may be because it has not had enough time to do anything, or that it is not treating whatever this is. I looked up everything that you had posted, I had researched most of the things prior. I have had this issue before, which my gyno knows but hasn't inspected that region since. He at one point thought he saw flat warts and used an acid in the region. I myself do not see any bumps but I also feel the worst internally and have no idea what I am feeling for. This is getting beyond ridiculous because the itching never stops! I am thinking my only other option is to see another board certified derm who will actually examine the areas. This is embarrassing enough as it is and the fact that a medical professional won't even examine me in the affected areas makes it that much worse. Again, I really appreciate the response, it feels great for a professional to take the time to explain some things to me!

[David Tinkelman, M.D.]

If the severe itching began shortly after the bikini wax, that would strongly suggest that the bikini had something to do with the itch, most likely infectious, allergic or irritant and that, instead of providing relief, one or more of the substances you applied may have actually aggravated the skin reaction.

Assuming from your comments, that the itching was limited to your genitals he most likely of these would be allergic contact dermatitis.  However there are a number of other causes for such an acute reaction.  Please see the following that also includes infectious causes (“folliculitis”) to include viruses, bacteria, parasites (e.g. scabies and lice) and fungi.

Acute Pruritus (itching)
Infections
   •     Candida (Monilia) dermatophytosis
   •     Herpes simplex virus, human papillomavirus, molluscum contagiosum
   •     Staphylococcus aureus, Streptococcus
   •     Pinworms, scabies, pediculosis
Dermatoses
   •     Contact dermatitis (irritant, allergic)
   •     Atopic dermatitis/eczema
   •     Psoriasis

Contrary to what your doctors stated, it is possible to have an allergic rash in response to the administration of injected corticosteroids such as solumedrol.  The following is from Lexicomp (Drugs) online

“Dermatologic reactions: Urticaria, pruritus, sneezing, facial swelling, contact dermatitis, and macular rash may occur with corticosteroid allergy. Dermatologic reactions may occur following exposure by any route, including systemic (Chew, 2000; Nucera, 2002) and inhaled corticosteroids (Kilpiö, 2003).”

It has been suggested (see following abstract) that the allergic reaction occurs in reaction, not to the steroid, but to a compound called sodium succinate attached to it.

Authors Full NameWalker, Annett Isabel. Rawer, Helen-Caroline. Sieber, Wolfgang. Przybilla, Bernhard.
Institution Klinik und Poliklinik fur Dermatologie und Allergologie, AllergieZENTRUM, Ludwig-Maximilians-Universitat, Munchen, Deutschland. annett.***@****-muenchen.de
Title Immediate-type hypersensitivity to succinylated corticosteroids.
Source International Archives of Allergy & Immunology. 155(1):86-92, 2011.

The best advice I can give you is for you to seek help from a Board Certified Dermatologist immediately.  Such a specialist should be able to diagnose the cause and provide specific treatment.

Good luck

[AllergyPA]

Your urticaria may respond to a combination of Zyrtec and Singulair.  Ask your doctor for a prescription for the Singulair.   Zrytec is available as an over the counter medication.