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Suggest Treatment For Allergic Contact Dermatitis

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Posted on Tue, 28 Jul 2015
Question: Hello. My name is XXXXXXX XXXX. Thank you for taking the time to read about my issue.
About two years ago I began to have issues with athletes foot fungus on the minor two toes of both feet. This would come and go. Then sometime last year in the summer I was bitten by an infected mosquito. The bite caused my feet to swell especially my right foot and leg up through underneath the knee. It was hot to the touch of red and painful. I was given two courses of antibiotics combined with a topical steroid for the duration of a month total and the issues subsided. Soon afterwards though, what look like ringworm was now on top of my toes and heading towards mid feet. The inching was intense and if I scratch too hard, if it would swell and liquid would come out. Pretty soon my left foot was covered midway on my right foot was covered up until the ankle. I was pretty sure I had ringworm because of the appearance, itching, swelling, weeping, crusting etc... and so I purchased antifungal creams. Nothing worked except Terbinafine and a selenium sulfate prescribed soap/lotion. I began to see and feel relief. Desiring to speed up the pace, I visited a health clinic physician (I had to go through the sliding scale fee as I am currently not working and therefore do not have insurance.)

I explained to him that after many months of antifungal pills and topical creams, the only thing that seemed to work was this combination of terbinafine (over the counter) topical cream and the selenium sulfate soapy lotion. Honestly, I was hoping that he would prescribe me Terbinafine in pill format and a stronger selenium sulfate so that I would finally get rid of this once and for all. All in all I had about a 60% improvement at that time. But instead, he felt that I had contact dermatitis. I explained to him that I had received treatment I'm going to diagnosis before and it didn't work. He then proceeded to prescribe a strong liquid steroid- Clobetasol Propionate, to be poured into CeraVe lotion mixed together and applied twice a day.

Within a few days I saw a marked improvement of about 50%. The skin was returning to its normal tone, cracking and peeling had subsided, and the itching was minimal. However about a week and a half later, I began to develop bumps on both feet resembling mosquito bites. In other words what I had before was not replaced by all of these different sized bumps, most of them small, they were itchy and will turn white one scratched. However, the feet no longer swell. I would like to submit a photo if possible.

I'm still using the lotion but I don't know what to do anymore other than return to the same physician. I have read that if I had a fungus, steroids was the worst thing possible to prescribe as the fungus feeds on this. I read that initially the condition improved but then it worsens. Please help me; I am desperate to get my feet back to their normal condition. Of note is that I have type 2 diabetes and Crohn's disease.
doctor
Answered by Dr. Ilyas Patel (7 hours later)
Brief Answer:
Allergic contact dermatitis most probably...

Detailed Answer:
Hi,

Welcome to MCH...

I read detailed history you provided and saw the photos you uploaded. After that I could come to conclusion that most probably you might be having allergic contact dermatitis. It dose not look fungal infection at present.Due to continuous scratching,your skin of lower legs and feet became tough,thick,dry and discolored...leading to lichen simlex chronicus. Now your hand is also affected. There may be some agents causing such disease, which can be called allergens. Try to find out such triggers...like soap,detergents,housedust, housedust mites,pollens,wool....etc.You have diabetes, so please keep it controlled. You consult dermatologist for firm diagnosis and perfect treatment. However, I would suggest as follow...

- antihistaminics
- steroids in tappering dose..keep the diabetes controlled
- applications of tacrolimus oint
- application of potent steroid cream like mometasone
- keep the area cleansed by antiseptic like diluted dettol
- try to avoid contact with suspected allergens

I hope this would help you in managing your skin problem..but,keep patience to have good result, as the disease runs long course and might relapse.

Thanks.

Dr. Ilyas Patel MD

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Ilyas Patel

Dermatologist

Practicing since :1982

Answered : 4527 Questions

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Suggest Treatment For Allergic Contact Dermatitis

Brief Answer: Allergic contact dermatitis most probably... Detailed Answer: Hi, Welcome to MCH... I read detailed history you provided and saw the photos you uploaded. After that I could come to conclusion that most probably you might be having allergic contact dermatitis. It dose not look fungal infection at present.Due to continuous scratching,your skin of lower legs and feet became tough,thick,dry and discolored...leading to lichen simlex chronicus. Now your hand is also affected. There may be some agents causing such disease, which can be called allergens. Try to find out such triggers...like soap,detergents,housedust, housedust mites,pollens,wool....etc.You have diabetes, so please keep it controlled. You consult dermatologist for firm diagnosis and perfect treatment. However, I would suggest as follow... - antihistaminics - steroids in tappering dose..keep the diabetes controlled - applications of tacrolimus oint - application of potent steroid cream like mometasone - keep the area cleansed by antiseptic like diluted dettol - try to avoid contact with suspected allergens I hope this would help you in managing your skin problem..but,keep patience to have good result, as the disease runs long course and might relapse. Thanks. Dr. Ilyas Patel MD