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Forum Name: Dermatology Topics
Question: Dyshidrosis? Or Something Else?
|channeal - Fri Apr 03, 2009 9:49 am||
I am a 57-year-old female and, when my first child was a baby, I got a rash on my wrist. It was a raised, red, intensely itchy area and if I looked closely, I could see that it was made up of many tiny blisters which eventually broke and secreted a liquid. My doctor at the time thought it was dermatitis, but did say that the round shape of the rash made her wonder if it could possibly be fungal. She gave me some anti-fungal ointment which seemed to clear it up immediately.
That was 31 years ago and the rash has recurred at varying intervals ever since! For years now though, it has only affected my hands and only happens when I accidentally cut myself. I always believed the rash to be fungal because of what the doctor said all those years ago - and because anti-fungal ointment seems to be the only thing that has any effect on it. The rash has increased in severity throughout the years and now can spread outwards very quickly. The blisters can be enormous now - and I mean enormous. Hugh, dome-shaped blisters. The whole area of the affected hand oozes a clear (or slightly yellow) liquid from the blisters. The itching is unbearable, but is eased instantly - and for several hours - by putting my hand in very hot water.
5 years ago I had a bad outbreak following a fairly deep cut on the back of my hand and was, for the first time, sent to see a dermatologist. He told me that he thought I had dyshidrosis and sent off some skin samples for testing. These came back negative for the various other diseases they tested for, but the skin scrapings did show some fungal elements and I was put on a 6-week course of oral anti-fungal tablets. However, the dermatologist was still of the opinion that the blisters are caused by dyshidsrosis, but that this is brought on by some sort of reaction to the fungus (I do not know what type of fungus was found).
The following year I fell and hurt my hand and - sure enough - the rash came back. Once it had gone though I decided to do an experiment and try putting anti-fungal cream on any new cuts/scratches immediately they occurred. This strategy was amazingly successful and I had no trace of the skin rash for 4 years, despite having the occasional cut/scratch - as is usual for any woman trying to run a home and open tins etc! That is, until now..........
I had a small cyst on my left buttock which burst on the Friday exactly 3 weeks ago. By the time I saw my doctor on the Monday, it was looking quite nasty and had a bit of a red rash around it. Quite rightly, my doctor put me on a course of antibiotics. Later that day though, I developed a really nasty rash covering a very large area around the cyst. The rash discharged a watery fluid for 3 days. At the same time, the old blister rash suddenly appeared on my hands. The itching on both my hands and around the cyst was truly unbearable - but, once again, running really hot water over both areas got rid of the itch for several hours. The rash eventually settled down a bit, but the cyst itself showed no sign of improvement and I was put on a second course of antibiotics. Just as I was coming to the end of this second course, I decided to try putting a hot poultice (made from chamomile flowers) onto it. It immediately burst and my doctor has remained happy at the way it has healed up since.
Unfortunately though, the opening up of the cyst again triggered off a repeat of the chain of events that followed the original incident - and on Tuesday the itchy, weeping rash around it flared up and I got a new set of blisters on my hand. I also noticed a few little blisters on my left foot. The really alarming thing though is the fact that my lips swelled up: I was worried for a time that I was having an allergic reaction to the antibiotics, but then I realised that the rash consisted of tiny blisters. I put some anti-fungal cream (which, of course, contains some hydrocortisone too) onto my lips and the swelling immediately went down. Evidence of the blisters is still there though.
My doctor agrees with me that I seem to have some weird reaction to trauma, but she has not shown any inclination to send me back to the dermatologist. I therefore decided to do a bit of research myself on the internet and came across epidermolysis bullosa and am concerned that I might have a form of this - either epidermolysis bullosa acquisita (which I understand is not hereditary and usually occurs in the third and fourth decade of life) or epidermolysis bullosa simplex (which I understand can, in its milder forms, sometimes remain undiagnosed until adulthood). I have absolutely no knowledge of any of my ancestors ever having had any kind of skin problems, although I am a little concerned because my daughter has in the past sometimes complained about having strange, unexplained blisters in her mouth.
I wrote a letter to my doctor setting out my concerns and handed it into the surgery yesterday, so am still waiting for a response - but I wondered if you had any thoughts on what I have told you? As far as you are aware, does dyshidrosis ever occur only following trauma? Can it ever affect the mouth/lips? Would the tests the dermatologist did 5 years ago (when I was told they were testing for possibilities other than dyshidrosis) have picked up something such as epidermolysis bullosa?
Any information you can give me will be much appreciated; I have really suffered so much discomfort during the past three weeks and just long to get it all sorted out!
|John Kenyon, CNA - Mon Apr 27, 2009 11:10 pm||
Based upon your very painstaking history and explanation I feel this doesn't sound like dyshidrosis. It may well be one of the more mild, late-onset forms of epidermolysis bullosa (and a new subset has been proposed by researchers of even the mild form), but the only thing that throws me off here is the fact that it seems to have responded so well to antifungal medication. This shouldn't make sense unless of course it was a coincidence that it went into remission right at that time. The only other thing I can think of is that you may have a long-lived, indwelling fungus that remains dormant unless the skin is somehow traumatized, allowing it to spring back to active status. This also seems fairly unlikely, but the fact that it was remiss for so long after the experiemnt with the antifungal treatment does suggest such a thing. Otherwise it may well be a not-very-dangerous late-onset, mild variant of EB, which could easily skip generations or pass without notice because of its extremely mild presentation (and believe me, what you've had would be considered mild compared with classic EB, which starts in childhood).
Further study by dermatology would be the best bet. even though they seem to have exhausted most of their ideas. In the meantime, if this does repsond to antifungal treatment then perhaps what works is the best approach, even if the real mechanism isn't understood. Again, if this is EB it is a very mild, non-threatening variant, just annoying.
I hope this is helpful. Good luck to you and please do feel free to follow up with us here as needed.
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