Itching myself mad!!

[errnnj]

I'm driving myself crazy...I have a rash all over my body.  Not covering my whole body, but rather scattered tiny red bumps in no particular pattern. I first noticed it about a 5-6 weeks ago, as a few tiny itchy bumps on my right arm.  Didn't think much of it at first, just thought it maybe was a viral thing, since I had a 2 day bout with  sore throat and swollen glands just prior to noticing it. About 2 weeks ago, I noticed the original spots went away, but I got a really itchy patch on my right wrist, along the medial side of my wrist.  I scratched so much I scabbed.  When the itching got worse I stared taking Allegra and Pepcid, and hydrocortisone cream since it started showing up other places too, which only provided minor relief.  Then I wondered if I had bed bugs or scabies (I'm a nurse in a busy ER), or an allergy to my detergent, so I changed to All Free and Clear Detergent/Fabric Softener and washed all my bedding and clothes in hot water and dried them in the dryer on high.  Also got a mattress cover, and pillows and pillow covers. But the rash is getting worse.  Saw my PMD yesterday morning, he diagnosed it as folliculitis and is concerned about CA-MRSA b/c one of the tiny bumps got red and swollen, so he took a swab.  So I've been taking for the past 36 hours: Augentin BID (allergic to Bactrim), Pepcid BID, Atarax TID, Bactroban ointment to the spots I scratched open BID as well as my daily meds (Synthroid 50mcg ad omeprazole 20mg).  New spots are popping up everywhere--forearms, underarms, back, stomach, buttocks..and the itching is worse!  No fever, no pus drainage anywhere....I even got the doc to give me permethrin cream just in case) and used that yesterday...aaarrrggghhhhh...what else can I do besides cool showers....can I be missing something here???

[Bhupinder Kaur, MD]

Hello,
The usual treatment of scabies is topical permethrin. It is the most effective scabicidal medication. Usually applied overnight and repeated weekly once for 2-3 weeks. The skin should be cool and dry before applying the anti-scabies medications. Avoid taking hot water baths before as this will cause the medication to be absorbed deeper. To be effective, the medication has to act on the superficial layers where the mite and its larvae reside. Since it has been only one week when you started the treatment, so it has to be continued for 2-3 weeks. Permethrin and oral ivermectin are the best treatment options of scabies.

There is a rule that all family members of the patient of scabies also need to be treated even if they do not have any itching or rashes. Hence please ensure that all your family members also get the topical treatment. You can wash your clothes in hot water.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[errnnj]

I forgot to add that I am using the Permethrin 5% cream.  Although my doctor didn't think it was scabies, I told him I was concerned about it (even though I am a clean person, considering some of the patients I work with).  So I used that Friday.  Today things seem to  be way better..still have marks all over, but they aren't nearly as itchy, and not getting worse...Also using a sulfur based soap just in case...

If I used the cream, how long do I have to be doing my laundry in hot water/hot dryer, and can I return to work tomorrow?

[Bhupinder Kaur, MD]

Hello,
Going by your symptoms,the possibility of scabies is high.It is an infestation of the skin with the Sarcoptes scabiei mite. It is characterized by intense itching, usually at night and by small insect-type bites lesions on the skin. Diagnosis of scabies is made by scraping the skin and viewing the material under a microscope to see the characteristic mite or eggs.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.