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1290681 tn?1272076630

Unknow rashes (even after 4 biopsy)


I have been suffering from an unknown skin rash condition.  The rash started appearing on my right breast/lower arm pit (when I was 30) and it spread to my lower abdominal, then behind my thighs, knees...neck, upper arm, lower arm, collar bone over the last 3-year time.  I never had these rashes on my face, but they started appearing over the past 2 months above the neck.

I have seek various doctors' opinions, but this rash remains a mystery and no doctor can provide a firm diagnostic.  My rash doesn't itch and they come and go.  These rashes appear in "bumps" under the skin and when these bumps erupt, that's when I realize I have a new rash.  There is no way of predicting when these rashes will appear.  These rashes sometimes leave pigmentation and these pigmentation are now everywhere on my body (together with my new appeared rashes, these are creating an embarrassment when I expose my skin wearing short sleeves or shorts).  Still....they come and go.

I'd like to seek your professional opinion here... I'm generally a very healthy person.  I don't consume alcoholic drinks or take drugs/vitamins.  I sleep normally and exercise once in a while and my period comes timely/normally on monthly basis.  The first big outbreak occurred in 4/07, but thought you may want to know the following....

- Had probably only a few pimples from childhood to now (generally have a very clean facial complexion).
- Don't have much facial or body hair...hence no need to shave regularly
- 2001:  Raised a stray kitten for 8 months before it mysteriously passed away over night.  Sometimes notice rashes on my legs...it erupts, but was easy to peel off and leaving no marks.
- 2003:  Noticed a strip of very red protruded rash around the right groin/upper thigh area area.  Non-itchy and didn't seek any doctor's consultantion.
- 2/07:  Had oysters and fish in Singapore which resulted in severe food poisoning.  My stomach was so upset that I was vomiting everything that I consumed (i.e. water, light rice soup/congee) within 20mins of consumption.  Rested in bed for 2 days...then left Singapore.  Didn't get a chance to follow up with any doctors after this incident.
- mid 3/07:  Visited Vietnam and stayed for 1-week.
- 3/31/07:  first sight of rashes appeared around my collar bone.  Non-itchy or painful, so didn't look into it.
- mid 4/07:  first outbreak on my right breast/lower arm pit area.... completed a biopsy, but everything turns out ok.  Dermatologists only gave ointments as treatment and advised that this rash may be caused by an internal, not skin, issue.
- 1/09:  had 2nd biopsy performed.  Report says:  in the upper half of the dermis, there is perivascular and interstitial infiltration by lymphocytes and eosinophils.  A few polymorphs and dermal oedema are also seen.  The overlying epidermis exhibits slight hyperkeratosis, acanthosis, minimal spongiosis and lymphocytic exocytosis.  no apoptosis, fibrnoid necrosis or nuclear dust can be found.  the toluidine blue stain is negative for mast cells.  Diagnostic:  may be an underlying allergic condition.

- 3/09:  Saw a specialist in Immunology and Allergy.  He advised that I probably suffer from hypersensitivity vasculitis and the cause of it is no longer possible to ascertain.  Given the lymphocytic nature of the lesions, there is a good chance of responding to hydroxychloroquine.  He started me on Plaquenil 400mg qd and 2 weeks later I returned for a blood test....  still no improvements for my rash.  In fact, the non-itchy rash continued to spread....

- 9/09:  Tested for South China 3g Allergy Profile, IgE.  The exam only shown that I am allergic to Cat Dander-Epithelium (0.17)
- 1/10:  After various visits to my GP, I finally advised that I had been constipated and it has been like this for about 2 years.
- 2/10:  an ultrasund scan is performed on the whole abdomen.  Impressions:  minimal fatty infiltration of the liver; no gallbladder disease; no abdominal masses or nodes.
- 4/10:  3rd biopsy performed (2 samples).  Diagnosis:  chronic dermatitis with eosinophils suggestive of hypersensitivity causes....

Well...can anyone help here?
1 Responses
563773 tn?1374250139
The tests that you have undergone suggest an allergic or hypersensitivity basis to the disease. It can be due to chronic hives/dermatitis which comes and goes. It is essential to rule out the presence of serious illnesses of which recurring hives can be a symptom. Examples are hepatitis, hyperthyroidism, lymphomas, collagen vascular diseases, and cancers of the rectum, kidneys and gastrointestinal tract.

Please discuss these treatment options with your dermatologist.

I hope it helps . Take care and regards.

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