hard, pus-filled bumps on entire arms

[pattimac]

My 34-year-old daughter has suffered for about 10 years with hard, seemingly callused, red bumps, filled with pus, on both arms.  The skin on the rest of her body is beautiful.  She has seen many doctors, three of therm were dermatologists.   She has been "diagnosed" with prurigo nodularis, even though these bumps have never itched!  Her allergist treated her for an infection.  The antibiotic gave a little improvement but just for a short time.  The last dermatologist took a sample and treated her for pseudomonas folicultiis.  The antibiotic, which she took for seven days, gave just slight and short-lived relief.  She has also used clobetasol, which seems to help just a little also.

Maybe it's not a dermatologic problem.  Should she see some other kind of specialist?  Needless to say, she has tried to think of anything she uses or that her arms come in contact with that is different from the rest of her body.  She can't come up with anything.

Other than this problem, she is in excellent health.  She is 5'7", 155 lbs.   She eats healthful foods -- no crazy diets or no-calorie sweeteners.  She does have a rather stressful job in private industry -- not extreme stress, just the usual deadlines and such.  She is so conscientious that she probably worries more than she should.

Please help.  Thanks in advancd    

[pattimac]

I must apologize to you.  I did not tell you that my daughter doesn't pick at her lesions.  I guess we are a little sensitive about that subject after seeing so many doctors.  I only mentioned that it has never itched.

Just trying to get my $20 worth from you.  Thanks.

[pattimac]

As I said in my message to you, she doesn't pick at her bumps.  That's always the first thing the doctors seem to assume, even in person.  Today she reminded me that her Scottish terrier (recently deceased) had a staph infection.  He was always on medications for skin ailments and other problems.  We wonder if my daughter has contracted something from her dog.  The problems did begin soon after the dog's problems started.  The bumps are often red and hot to the touch.  What about bacterial folliculitis?  Can it be cured?  She has seen several dermatologists.  They put her on an antibiotic, but with little effect.

[Alan Rockoff, MD]

Prurigo nodularis refers to bumps and patches that come about from picking and rubbing.  Does your daughter pick and rib at these bumps?  if she does, no treatment will help her until and unless she finds a way to stop, permanently.  I can't square this possibility with a culture that grows Pseudomonas bacteria.  So basically, I can only suggest that your daughter leave the bumps alone (unless she already does) and work with a dermatologist in person, which is the only way she's going to know how to deal with this.

Best.

Dr. Rockoff