I have an odd skin condition. Three general practioners have looked at it and said they have no idea what it is (all three confidently asserted that it was NOT eczema). My own web research suggests that it is not eczema. However, when I went to a dermatologist, she took a one-second look at it and said it was probably eczema. However, she was in and out of the room in less than a minute, so I didn’t get the impression she was paying that much attention. The corticosteroid cream she has prescribed has had no effect after a week of religious application.
I going to go back for another appointment, obviously, but I would like to have some ideas about what to ask about and/or what this could be so that I am better prepared to ask questions. In the meantime, I am continuing the corticosteroid treatment.
The condition started as some patches of dry-looking skin on the top surface of one breast, approximately 2 cm by 7 cm. The skin was not flaky or itchy, it just looked a bit hardened (like healthy snake skin), and maybe just barely reddish. A similar spot developed on the back of my hand shortly afterward, approximately 3 cm diameter. Mosturizer didn’t help. At this point the patches were pretty much invisible, but could be felt as patches of stiff, dry-feeling skin.
After about two months, the skin under these stiffened patches has slowly started to pigment. They are still flat, stiff skin, and not flaky or itchy. They started to darken at around the same time that I tryed using over the counter cortisone cream on them, but I don’t know if this was causal.
This doesn’t sound at all like eczema to me, since eczema is normally raised, flaky, very itchy, and non-pigmented.
Of all things to diagnose over the internet, dermatological conditions are probably the least likely to be done so accurately (they’re almost entirely dependent on the appearance unlike most other medical conditions where the story or history is as important as the examination). So, if you’re not satisfied get another REAL opinion.
ALERT
** Way TMI below **
I mean just look at this. Many, many types of eczema.
Mis,
Derm is hard enough with the patient in front of you. I won’t even hazard a guess.
I’ll share these dermatology secrets, though (and for this, you must mail me a single eyelash from your first born):
Eczema is incredibly common as rashes go.
Uncommon presentations of common diseases are more frequently encountered than common presentations of rare diseases.
Most rashes probably resolve on their own.
Based on the above, assuming the rash is not suggestive of something altogether different from eczema, dermatologists make the diagnosis of eczema often. Steroids are prescribed and rashes resolve. We make lots of happy patients.
If no improvement is noted with 2-4 weeks of treatment, alternate diagnoses are entertained (especially in someone that doesn’t exactly fit into the eczema wastebasket).
BTW, Eczema is usually scaly, red, and itchy. Pigmentation is not inconsistent with eczema of a few months duration. In fact, I associate the transition of redness to browness with resolution of rashes.
Did the Derm give you triamcinolone or fluocinonide?
PS email a picture of the affected breast and I promise a diagnosis
PPS listen to anything the Derm you go to says ten million times more intently than anything the well-meaning knucleheads here say (except for Karl Gauss, listen to him:))
Gah, the blacked out eyes on the eczema pix are pretty scary.
I have eczema. Sometimes it itches, sometimes it doesn’t. Cortisone appears to have little effect; keeping the area well moisturized but not letting it stay damp helps but nothing really seems to “cure” it and it generally clears up in time only to reappear someplace else. It is pigmented and slightly scaly during the almost-healed period; the pigmentation has always faded with me but may not always according to my doc. As always, see a doctor, etc, etc.
Don’t worry, I not going to take internet responses as gospel. I’m going back to the dermatologist. I just felt that the dermatologist’s first take on my rash was dismissive, so I was looking for other opinions/suggestions/possible diagnoses to discuss with her when I see her.
This is a good point.
In answer to various questions and suggestions:
Satyricon, it doesn’t look anything like ichthyosis. Thank God.
KarlGauss, as much as all of those pictures of eczema cover a wide range of what skin can possibly look like, my spots don’t look much like any of them. However, I am listening attentively to all of you who are saying that the condition presents in a variety of forms.
The Altas of Dermatology is not terribly useful to me, since I don’t know the name of what I’m looking for. Which, of course, you knew. Nitwit.
And yes, I acknowledge that a dermatologist knows about a far greater number of diseases than I do.
choosybeggar, the dermatologist gave me triamcinolone (0.1% ointment). Does it matter? And if I’m sending out pics of my breasts, I’d really rather send the healthy one, if you know what I mean.
If you really want to throw her for a loop, say you fear you’ve contracted pityriasis lichenoides et varioliformis acuta (AKA PLEVA or Mucha-Habermann disease) or better yet, the much feared, malignant atrophic papulosis (AKA Degos’ disease). Neither of these resemble eczema, but I bet her expression will be priceless.
Triamcinolone is a mid-potency steroid. It means that if the rash didn’t resolve on it, your Derm will probably jack you up to either fluocinonide (AKA lidex-high potency) or clobetasol (AKA temovate/ultravate-ultra high potency) before considering steroids a failure.
And you can send pictures of whatever breasts you got.
Psoriasis itches like a sonuvabitch, and topical corticosteroids usually do help quite noticeably. The OP says “not itchy or flakey and corticosteroids have no effect”, so that’s not actually all that likely.
My mom has a similar patch on her hand as described by the OP. No real idea what it is. Doctors and dermitologists all say “some form of eczema” but they don’t really know.
As KarlGauss said there are many, many types eczema and related skin conditions. Sometimes they present a little strangely or your particular skin can have attributes that make it confusing (my mom’s dark latin skin behaves in a way that adds a bit more confusion as far as diagnosis because “discoloration” is kind of subjective, for example).
Karl Gauss’s second link is a good one if you have the time to sit and sift through all that.
Hope your dermatologist can sort it out. It’s annoying not to know.
mischievous, what were you prescribed as medication? You mentioned a topical steroid, is it DESOWEN?
I have a rash that is mainly on my forhead and goes down onto my nose. I’ve had a couple of dermatologists tell me that it is really just dandruff. The desowen cream will get rid of the rash, but not the underlineing problem. The rash really bothers me, but nobody else seems to notice it.
I went through a course of triamcinolone and a course of fluocinonide (just as choosybeggar suggested), which had no effect. The dermatologist decided that it wasn’t eczema, after all, so she did a biopsy.
Just got the results today. The official diagnosis is now morphea, a localized form of scleroderma. The dermatologist openly admits that she is not 100% certain about this diagnosis, but she “can’t think of anything else that it could be”. Unfourtunately, there doesn’t seem to be any good way to treat morphea, although she’s trying me on Dovonex.
So, on the plus side, my disease has a cool name and is not life-threatening. On the minus side, it’s not terribly treatable and a little web research indicates that it normally lasts several years. Additionally, it’s still spreading actively.
I’m going to see if the Dovonex has any result over the next month or so. If not, I think I’m going to seek out a second opinion - not because I don’t trust this woman, but because it seems that dermatology problems are genuinely difficult to diagnose.
Anyway, that’s my news, for anyone who’s interested.
Well your symptoms sound delicious, <I must place my first ‘thread’ about dry, flaky scalp or something…> is the condition not a fungal infection? Sounds familiar and leaves…
