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Question: I'm from Hawaii and I developed a rash on my shins after going hiking 3 weeks ago. The rash was initially little raised bumps that were the color of my skin; however, it formed into tiny raised itchy red bumps. I applied Cortisone cream which helped the rash and it disappeared after a week and a half. Then starting last week Monday the rash came back but this time more red and itchy. It is even starting to hurt somewhat and I am very concerned that I may have something more serious than a rash. I went to a MD and was given Triamcinolone Acetonide Cream USP and I have been using this from Saturday. However, I have not noticed any improvement in the intensity of the rash. FYI I also have Asthma and Allergies
Brief Answer:
Seems like Pityrosporum folliculitis
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have also seen the photograph.
Is this rash on both shins?
It looks like a case of Pityrosporum folliculitis to me judging from the fact that it is itchy. Sweating and heat does seem to predispose. Were your shins covered with socks or something, while you went hiking?
The cause of P. folliculitis is fungal/yeast (Malassezia furfur) which is a commensal, however, it can cause itchy bumps in conditions favorable for its proliferation (heat and humidity).
You have been using topical steroids. Corticosteroids being antiinflammatory, may help a bit with itching and inflammation but would actually make it worse as soon as you stop topical steroids because of a rebound. Moreover steroids would help the fungus to proliferate further. I think that is what has happened in your case too. So, you should stop using steroids.
If I was the treating doctor I would have treated it with a topical antifungal cream e.g Ketoconazole cream, twice daily. I am not sure if it is OTC in your country. You may inquire from a drug store Or else you may require a prescription
If you were my patient I would have also started you on Oral antifungal e.g either fluconazole or itraconazole. Oral antifungals would act faster. However, oral antifungals are a prescription drug and you can't get these OTC. Therefore, you must visit a dermatologist in your region for a prescription.
An OTC oral antihistamine e.g cetrizine 10 mg once daily would provide you symptomatic relief from itching.
Regards
Seems like Pityrosporum folliculitis
Detailed Answer:
Hello and welcome to healthcaremagic
I am Dr. Kakkar. I have gone through your query and I have also seen the photograph.
Is this rash on both shins?
It looks like a case of Pityrosporum folliculitis to me judging from the fact that it is itchy. Sweating and heat does seem to predispose. Were your shins covered with socks or something, while you went hiking?
The cause of P. folliculitis is fungal/yeast (Malassezia furfur) which is a commensal, however, it can cause itchy bumps in conditions favorable for its proliferation (heat and humidity).
You have been using topical steroids. Corticosteroids being antiinflammatory, may help a bit with itching and inflammation but would actually make it worse as soon as you stop topical steroids because of a rebound. Moreover steroids would help the fungus to proliferate further. I think that is what has happened in your case too. So, you should stop using steroids.
If I was the treating doctor I would have treated it with a topical antifungal cream e.g Ketoconazole cream, twice daily. I am not sure if it is OTC in your country. You may inquire from a drug store Or else you may require a prescription
If you were my patient I would have also started you on Oral antifungal e.g either fluconazole or itraconazole. Oral antifungals would act faster. However, oral antifungals are a prescription drug and you can't get these OTC. Therefore, you must visit a dermatologist in your region for a prescription.
An OTC oral antihistamine e.g cetrizine 10 mg once daily would provide you symptomatic relief from itching.
Regards
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you Dr. Kakkar I think I will schedule an appointment with a dermatologist. To answer your questions, the rash is on both of my shins and while I was hiking I was wearing shorts.
Brief Answer:
Welcome
Detailed Answer:
Hi.
Sure, do visit a dermatologist. Keep me updated.
Second possibility is acneform eruption due to topical steroids, your dermatologist might also choose to prescribe topical benzoyl peroxide gel, if he considers this possibility. However, itching is what makes goes more in favor of P folliculitis.
Let me know if you require any further assistance from my side.
Regard
Welcome
Detailed Answer:
Hi.
Sure, do visit a dermatologist. Keep me updated.
Second possibility is acneform eruption due to topical steroids, your dermatologist might also choose to prescribe topical benzoyl peroxide gel, if he considers this possibility. However, itching is what makes goes more in favor of P folliculitis.
Let me know if you require any further assistance from my side.
Regard
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. Bhagyalaxmi Nalaparaju
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