Worried about rash and finger problem

[wunderlust]

I’d prefer to address this post to Dr. Handsfield if I may. I’ve been reading your posts for years now. I am worried about a rash that I had recently and would like to give you some info regarding it. The rash looked like acne and was worse under the armpits. There were also bumps on the arms and on the thighs. Nothing on or near the genitals. These acne-like areas and bumps weren’t liquid filled and they were absorbed by the skin without scaling or blistering.  I had six or so smaller bumps on the hands that seemed to be liquid filled but were very small and space out in different spots on the hands. The inside of one of my index fingers at the place where it bends was worse although it wasn’t as bad as the pictures I’ve seen of whitlow. It looked like some small squiggles, possibly liquid filled, without any red base. The finger was sensitive and a little stiff but wasn’t painful at all.  The skin peeled a little after it healed. I thought I got the problems with my finger from some yard work I did which involved weeding perhaps pulling some poisonous weeds. I really didn’t worry about it until I got the rash underneath the arm with a slightly enlarged lymph node in the armpit area. The rash probably occurred a few days after the problem with the finger. The rash probably was caused by scratching the skin in different areas (armpits, thighs).   Other things: I saw a woman who gave me a massage about a week to 10 days before the rash occurred. I did touch the woman’s genitals and other areas but didn’t put my finger inside. Everything else was covered.  I am also on the borderline of type 2 diabetes (I’m 50). Right now everything looks OK on the finger and the armpits but I am getting some red bumps that come up in various places that seem unusual to me. Some are quite itchy and some aren’t but I’m just am not used to getting these types of red bumps either. I don’t know if this is HSVI, II, HIV, bacterial or fungal infection, deodorant issue or something else.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  FYI, it is only by chance that I am replying.  Dr. Hook and I take questions randomly, ignoring request for either of us.  Our opinions and advice are always more or less identical, despite differences in style.

The good news is that no STD is a possible explanation for this sort of skin problem.  The bad news is that, beyond that, I can't really judge the possible causes.

The only STD that could possibly cause a fairly widespread rash like this is syphilis, but the features you describe are atypical for that STD.  And the rash of secondary syphilis can't start sooner than ~3 months after catching the infection.  The rash of acute HIV infection also isn't anything like you describe, and would almost always be accompanied by fever, sore throat, and other typical symptoms.  Further, syphilis and HIV also are very rare in settings like yours -- and you didn't have intercourse, so you couldn't have caught an STD.  Hand-genital contact and fingering are entirely risk-free.

Finally, herpes whitlow doesn't behave this way.  Whitlow usually accompanies other obvious initial herpes symptoms; and you already seem to understand the symptoms aren't typical for that problem.

The obvious solution is for you to see your primary care provider (presumably that's the doc or clinic where your boderline diabetes is managed); or contact that office and see if they recommend you go directly to a dermatologist.  Most likely it's nothing serious, but direct clinical evaluation is the only way to go.  (That is, don't try to continue any efforts to figure it out on line.)  In the meantime, you can dismiss herpes, HIV, syphilis, and all other STDs.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

Your private physician won't "call the house", especially if you discuss your desire for confidentiality with him.  There are federal laws that prevent this and the penalties are large ($5,000 fine).  In any case, since your symptoms have absolutely nothing to do with your sexual exposures, it shouldn't be an issue anyway.

There is nothing in your symptoms that suggests you have anything you can transmit to your kids or anyone else.

[wunderlust]

Dr. Handfield thanks so much for the reply.  I think you may have been the only one replying to posts when I first started reading them about 6 years or so ago.  I do like the realistic approach of your answers. I actually did have covered intercourse with the massage lady and have had done similar in the past.  I just didn’t insert my finger although definitely touched the genitals.  I don’t have a cut on my fingers where this happened. I’m not sure why the inside of the index finger although I did pick weeds between those two fingers. Although I have a significant other we don’t sleep together and I see a massage lady every couple of months.  It’s the only thing I do every so often. These Asian women do everything covered including oral and intercourse.  It’s only recently I started noticing anything.  I will definitely cut back on this type of thing because this has sent a chill through me.  I started thinking about medicine side effects also.  I have been taking Lovaza since the second week of August and I didn’t notice anything at first although I checked the side effects last night and then include: Dermatologic side effects including rashes (1.8%), alopecia, eczema, pruritus, and sweating have been reported.  Other side effects including taste perversion (2.7%) and lymphadenopathy have been reported.  I will need to check with the primary physician but I worry about confidentiality (they could call the house).  I could tell them to look at the problem and not say anything about the extracurricular activities and let them figure it out.  I called many dermatologists in order to get an appointment but their first appointments are about month and a week away.  I do have a couple of children. Thanks again Dr HHH.