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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have Agoraphobia. Red Dots On Toe, Taken Antibiotics. Serious?

my 37 year old son has been diagnosed with severe agoraphobia, is house bound for 2 years. every time it has been urgent for him to go out of his home, it results in such severe symptoms that he is hospitalized for it. A little over a week ago after showering he was trimming an ingrown toenail and peeled off a small callous on the inside edge of his big toe. It started stinging at that point and he thought maybe he had introduced some bacteria into that spot because of the stinging. He started doing foot soaks for a few days. The area was pink on that side of the toe, but not red. No fever, no pus. Since he is housebound and terrified of the thought of having to go out to a doctor, he decided to start taking an oral antibiotic just in case the toe might be infected. The toe thing did not get any worse, but after 2 days on the penicillin he developed a couple of pin-point sized red dots on the top of his big toe, which the next day turned into about 6 red dots with nothing else happening. He was also using a triple antibiotic cream and an antifungal cream (desonide) on his toe after each foot soak. He emailed me photos of his toe over a few days, and the toe looked ok to me. Then he said his roof of his mouth was white & he was sure it was thrush, when I said it didn't look like thrush, he said then it must be leukoplakia which he said must mean he has HIV, but he had been smoking cigarettes because of his extreme anxiety, and I said it was most likely the smoking causing it. So all of this stuff I think is because he is so terrified that one of these maladies, the toe, the red spots on the toe or the white color on the roof of his mouth is going to become urgent and he will be forced to leave his house and go to a doctor. The toe doesn't look bad, it is not red or painful, just puffy where he peeled the callous off, no fever. The red dots on top of big toe has gotten a few more but are just dots, they are not doing anything else, not progressing except a few more in number, the white color roof of his mouth is the same. Since his mother-in-law, who hadd lived with them had died a couple of years ago when a dialysis shunt was being installed and she had also had M.R.S.A., he is sure the red dots on the top of his toe is M.R.S.A. and he will die a horrible death. He is panic stricken about the possibility of having to leave his house and go have a doctor take a look at those 3 things which don't look bad to me from the photos he has been sending. I can't find a doc to do a house call to take a look. What are the chances that those 3 things he has is serious or may lead to one of the things he is afraid that it is. Now his focus is that the red dots on his toe is M.R.S.A.
Wed, 17 Jul 2013
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Psychiatrist 's  Response
Hi,
Thanks for using healthcare magic.

It seems that your son is anxious to hypochondriac level.
Red spots on toe has variety of reason . in your case it might be just due to ingrown nail which may get infected. You should consult surgeon for the same for treatment.

For treatment of agoraphobia, You should consult psychiatrist for detailed evaluation and management. After ruling out physical causes and confirmation of diagnosis, doctor may prescribe Anti depressant agents like paroxetine or anti anxiety agents like clonazepam or alprazolam to control anxiety.

He may get benefit by counselling and exposure and response prevention therapy . For that, you may consult psychotherapist.

I hope It may help you.

Thanks.
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Have Agoraphobia. Red Dots On Toe, Taken Antibiotics. Serious?

Hi, Thanks for using healthcare magic. It seems that your son is anxious to hypochondriac level. Red spots on toe has variety of reason . in your case it might be just due to ingrown nail which may get infected. You should consult surgeon for the same for treatment. For treatment of agoraphobia, You should consult psychiatrist for detailed evaluation and management. After ruling out physical causes and confirmation of diagnosis, doctor may prescribe Anti depressant agents like paroxetine or anti anxiety agents like clonazepam or alprazolam to control anxiety. He may get benefit by counselling and exposure and response prevention therapy . For that, you may consult psychotherapist. I hope It may help you. Thanks.