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Are itchy swollen bumps on chest caused by TINEA?

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I have had a skin problem since about mid-March. It started with a rash on my hands that looked like little, red bumps and itched horribly. My hands were also a bit swollen, then became very dry and flaky like chapped skin exposed in winter.
This has come and gone a few times. I first thought it was an allergy to something, but have used no new products. Also, it seems to flare up even after I've stuck to only the things that seemed 'safe'. I kept a spreadsheet of products and ingredients for a while until it seemed that there were ingredients in common on both sides of the list, so I gave up.
The rash would go away and when it came back, it would come back on more areas than before. First, just my hands, then my lower legs, then patches on my arms.
The worst started happening a little over 2 weeks ago. I had red, dry, mostly peeling and very itchy patches on all of those areas, so I broke down and went in to my clinic. My doctor is on indefinite leave, the other doctor in the clinic moved away and so only the physicians assistant was available. She suspected tinea and prescribed 2% ketoconazole cream, a steroid pack, 4mg carbinoxamine 2x/day, and Nizoral shampoo as a cleanser.
Now, 8 days later, I am worse than ever. It has actually spread some and my skin is so dry that it is cracking and bleeding. I'm still itching like crazy.
I've read a bit about tinea, but I'm confused. Most people say it occurs in areas that have been moist and hot. I do not have itchy rash on my feet or my body at all. It on my chest high around my neck and along my shoulders only. These are areas typically dry and open to air.


Category: Dermatologist

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Category: Cosmetic and Plastic Surgeon
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Expert:  Dr. Kruti Jobanputra Banodkar replied 4 Days ago

Updated Reply, Post Review -
Hello,
The rash that you have doesn't seem to be tinea in the photos that you have sent. As to why the assistant might have thought it to be tinea should be difficult to say.
The history that you provided points to two things - the recurrent nature and the on n off rash points to urticaria or hives. And the itchy dry scaly skin points to an allergic contact dermatitis. Both hives and allergic contact dermatitis have a common component of allergy. This allergen could be even environmental and not only some thing that you may have come in contact with.
At times, it might be difficult to pinpoint a single cause, the cause at times may even be seasonal eg. Pollen etc.
It would be wise to start treating it in order to relieve discomfort and prevent recurrences.
As I mentioned you could take tab. Allegra and apply a moisturizing lotion.
But it is vital that you visit a dermatologist because it's not possible to review a case completely by just seeing pictures and regular follow ups where a doctor can examine you physically will go a long way in altering the treatment as per the clinical improvement.
Hope this helps you. Would be glad to answer any follow-ups.
============================
Hello

Thanks for posting your query at DoctorSpring.com

I can understand your concern.

You seem to be having an allergic contact dermatitis with auto eczematization. That means many areas of the body have been affected due to hypersensitivity.

I would recommend that you need to go back to a dermatologist who can thoroughly evaluate you physically, look for the focus of allergy and treat that. Till you get an appointment, you can take an antihistamine like tab. Allegra 180'mg once a day. You need to apply a thick emollient or moisturizing cream on the affected areas. It's important to visit your doctor so any small focus of a fungal infection if present can also be detected and treated.

You can apply cortisone cream to the affected areas , only once a day to you meet your dermatologist.

Please let me know if you have any queries.

Take care,
Regards.


Patient replied :

Well, this feedback is not really helpful, but I suppose I can understand the difficulty. I called 11 dermatologists' offices this week in 4 different towns/cities within a 3 hour radius of me. The next available appointment I was able to get is on September 17th. That is why I tried this service. I plan to keep the appointment, but this leaves me with weeks to suffer through 100+ degree temperatures in long sleeves to avoid making colleaugues uncomfortable.Not to mention, limited sleep due to constant itching.
The thought of this being an allergy seems bizarre since I have never reacted to anything before and I'm 34 years old patientold. Even irritation from an insect bite only lasts a couple of hours at best with me.
I have tried just about everything over the past few months with almost no relief. It will just magically get better and then reappear.
I do have some questions, however. I was told that if it is a fungus, cortisone should NOT be used and that it would aggravate the problem. I was also told that if it were a bacterial infection, I should not use benadryl ointments. In this situation, I have NO IDEA what it is. What is safe? What moisturizers are safe? There are many cautions about using those.


Expert:  Dr. Kruti Jobanputra Banodkar replied 3 Days ago

Hello.
Thanks for your reply.
I understand your concern about the itching. Hence, I have recommended an anti histamine called allegra which will relieve the itching. You should go ahead and take it. If that is unavailable, tablet Claritin 10 mg, once in the night should do. In case of severe itching, you can can take one in the day too but it has a potential for sedation. So if you have taken it during the day, activities that require high alertness like driving etc. are better avoided.
What you have does not seem to be a fungal or a bacterial infection, hence the recommendation to use cortisone cream. It is a very mild cream and can be used safely to relieve the inflammation and dryness that you have.
I have not recommended any benadryl ointments for you. You can use vaseline body lotion which is a safe and effective moisturizing lotion.
With the anti-histamine tablet and the cortisone cream, you should have good symptomatic relief. So please go ahead and start the recommended treatment.
Thanks.


Patient replied :

So, you think that I've been itching for over six months and I haven't tried over the counter allergy medication? I've taken Allegra, Zyrtec, and Claritin. In desperate moments, I've taken Benadryl, but that leaves me unconscious for the next 6 hours. However, all of these still leave me itching.
I'm really wishing you had just said, "Hey, we can't help." and given my money back. Now I've heard the same useless advice from at least 2 'medical professionals' (the same advice I got off of WebMD) and I've paid out over $100 for it. Meanwhile, I'm still just sitting her suffering and waiting for my dermatologist appointment in 3 weeks.


Expert:  Dr. Kruti Jobanputra Banodkar replied 2 Days ago

Hello

Thanks for your reply.

I understand your concern.

Since you have tried the anti allergy medications , the other option to control your condition would be taking oral corticosteroids under the supervision of your dermatologist.

Also hopefully you have tried updosing of anti histamines or a combination of anti histamines.

I recommend that you understand that a doctor who is reviewing your condition online has limited resources to advise you regarding your medical concern, the lack of facility of examining the patient as a whole, and lack of opportunity to review the results of treatment with regular follow ups, leaves a doctor in a position to give you general guidelines about your condition and its treatment.

Until you tell me that you have taken anti allergic medication to relieve itching, it would not be right on my part to presume that you may have tried and hence not recommend you any more.

The idea is to continue with anti histamines. Allegra in the morning and claritin at night, one tablet each would go a long way in helping with the itching. However, it's important to rule out and the cause for the itching and eliminate it.

Hope this was helpful to you.
Regards.


Dr. Kruti Jobanputra Banodkar
Category: Cosmetic and Plastic Surgeon
Experience: 
Diploma in Dermatology - Royal College Of Physicians & Surgeons Of Glasgow, UK , 2010
Residency - DNB, Dermatology -  K.J Somaiya Hospital, Mumbai, 2009
Medical School & Internship - MBBS - Dr. D . Y . Patil Medical College, Mumbai, 2004
Dr. Kruti Jobanputra Banodkar and 4 other Medical Specialists are ready to help you

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