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I Have Had What I Thought Was Scabies On My

Posted on Wed, 7 Aug 2019

Question: I have had what I thought was scabies on my arms and hands. The problem started about a month ago. I have used Premethrin 5% cream several times. The rash appears to be a little better but lately I have been breaking out all over my body. The spots are red and raised. The itching during the night is almost unbearable. My legs have numerous spots that resemble bug bites. I also have mottled skin around my knees and thigh at times. What do I need to do because I am getting worried that it's not a simple skin disorder?

Follow up: Dr. Ilyas Patel (0 minute later)

I have had what I thought was scabies on my arms and hands. The problem started about a month ago. I have used Premethrin 5% cream several times. The rash appears to be a little better but lately I have been breaking out all over my body. The spots are red and raised. The itching during the night is almost unbearable. My legs have numerous spots that resemble bug bites. I also have mottled skin around my knees and thigh at times. What do I need to do because I am getting worried that it's not a simple skin disorder?

Answered by Dr. Ilyas Patel (2 hours later)

Brief Answer:
Please answer a few questions and post the photos of the lesions

Detailed Answer:
Hi,

Welcome to 'Ask A Doctor' service...

I can understand your concern about unbearable itching at night and poor response to permethrin cream. I am in doubt about the diagnosis of scabies. If it is scabies, it would be improved by permethrin cream. To reach a specific conclusion, I would like to ask you a few questions...

- please tell about your age and gender.
- describe the lesions... appearance, numbers, solid, filled with serous fluid or pus, crusted...etc
- tell about the sites affected... whether genital and groin area involved or not?

- on legs you have lesions... is that spreading to feet, soles?
- hands, forearms, arms, and axillae involved or not?
- what about scalp and face?

- you told that severe itching is there more at night.. is there burning also?
- do you have worries or tension?
- any other disease like diabetes or else you suffer?
- any drug history?
- family history of similar skin disease or any systematic disease?

Kindly answer the above questions and also post the photos of the affected areas. So, I can study your case properly and give you proper advice.

Awaiting your reply.

Thanks.

Dr.Ilyas Patel,
Dermatologist

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Answered by Dr. Ilyas Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ilyas Patel (1 hour later)

I am a 56 year old male. I have a history of hypertension and I am diabetic. My diabetes is diet controlled. I do not take any prescribed meds presently. I work as a medical assistant in a opiate addiction clinic. I have been under some stress but overall I am not under undue stress. Not sexually active. The lesions on my hands and arms are small round and redeemed areas. There are a few clusters of them that ooze clear liquid. No crusted areas are pus filled areas. The hands and arms do not itch. There is no lesions in the webbing of my fingers or on my palms. The lesions on my legs are single lesions with dark red centers that do not ooze. They itch terribly at night. The are not on the soles of my feet. They look like typical insect bites but I do not spend a lot of time outdoors. During the night my body is generally covered with large red raised blotches. I have considered an allergic reaction and even bed bugs but it even happens when I don't sleep in my bed. I don't use any illicit drugs.

Follow up: Dr. Ilyas Patel (0 minute later)

Follow up: Dr. Ilyas Patel (5 minutes later)

There are no lesions in my groin area or underarms. The itching at night is also paired with intense burning.

Follow up: Dr. Ilyas Patel (0 minute later)

There are no lesions in my groin area or underarms. The itching at night is also paired with intense burning.

Answered by Dr. Ilyas Patel (19 hours later)

Brief Answer:
Prurigo nodularis most probably

Detailed Answer:
Hi,

Welcome again...

Thanks for the history you gave. After going through the history, I can conclude that most probably you may be having a skin condition called prurigo nodularis.

Prurigo nodularis is a skin disease that causes hard, itchy lumps to form on the skin. The itching can be intense and severe. Patient can not control to scratch which may lead to bleeding or pain. Scratching can cause more skin lesions to appear.

Exact cause of prurigo nodularis is not known. But stress might trigger the condition. Once it starts at one place,, it spreads to other sites on the body.

It is difficult to cure, but it can usually be controlled and should therefore gradually improve over time. You should avoid to scratch the nodules consciously, so that it may slowly resolve and disappear. However, it may remain very itchy for several weeks.

Antihistamines, anxiolytics, opiate receptor antagonists, steroids and thalidomide are oral medications used by dermatologist. So, consult the dermatologist for the perfect and proper treatment.

He may also give intralesional triamcinolone injection in the prurigo nodularis lesions. That may be very effective to relive the itching and the lesions may be improved.

You may apply steroid cream like clobetasol propionate or tacrolimus oint after consulting the dermatologist.

I hope.. I have answered you up to your satisfaction. Still, if you have any query,you may ask... I would like to answer.

Thanks.

Dr.Ilyas Patel,Dermatologist

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Ilyas Patel (0 minute later)

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ilyas Patel (1 hour later)

The one thing I did not mention to you was that just below the skin I could feel hard lumps and knots. These were associated with the red spots. The lumps were very prevalent on my buttocks and thighs. I appreciate your information. I have been taking antihistamines and using hydrocortisone creams also. The stressors in my life are situational and I will work on trying to be less stressed. I will do more research on the above mentioned disorder. I also have made an appointment to visit a local dermatolgist. Much thanks!

Follow up: Dr. Ilyas Patel (0 minute later)

Answered by Dr. Ilyas Patel (14 hours later)

Brief Answer:
Prurigo nodularis most probably

Detailed Answer:
Hi,

Welcome again,

Thanks for appreciating my answer. I recommend you to consult the dermatologist as early as possible. And discuss with him about your disease and information which I gave you. He might advise you to take intralesional steroid injection to improve the condition and to relieve the unbearable itching.

I would like to get information about your treatment strategy and the status of the disease while getting treatment from the local dermatologist.

Thanks again... and wishing you healthy life.

Dr.Ilyas Patel,Dermatologist

Above answer was peer-reviewed by : Dr. Nagamani Ng

Answered by Dr. Ilyas Patel (0 minute later)

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. Nagamani Ng