Brief Answer:
Itchy rash

Detailed Answer:
Hello,
Welcome to healthcare magic.
I have gone through your history and clinical photograph.

The possibilities I would consider in your case include eczema, Pityriasis lichenoides chronica and small plaque parapsoriasis.

Eczema could be intrinsic or extrinsic.
A common type of intrinsic eczema in your age is adult type atopic dermatitis.
Did you have any eczema as a child?
Do you have any other forms of allergy wither in yourself or your family ( including wheezing /asthma, hay fever/ nasal allergies, etc)

Extrinsic eczema occurs due to exposure to various environmental allergens.
Have you been exposed to anything out of the routine lately?
Have you been doing any outdoor activities like gardening/ hiking/etc?

Pityriasis lichenoides chronica and parapsoriasis are typed of skin rashes which have no identifiable cause. These run a chronic course with relapses and remissions.

The best way to confirm the diagnosis in your case is by doing a skin biopsy. We will then be able to proceed with the right management instead of trying various temporary measures.

Could you clarify the questions I have asked so we could get more clarity?

Regards,
Dr. Johny Chacko

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Brief Answer:
Eczema management

Detailed Answer:
Hello,
Thank you for your clarifications.

With your past history of eczema and asthma, I would consider the diagnosis of Atopic dermatitis.

Atopic dermatitis is an intrinsic eczema, as I mentioned earlier. It has remissions and relapses. The common triggers for relapses include changes in weather, air conditioning, exposure to external triggers like diet, wool, contact allergens,etc.

Could you think of any factor which could have triggered a relapse?

Have you changed anything recently in your diet, e.g- have you added any new type of fruit/ vegetable/ nuts/ health supplements like green tea, etc to your diet?
Have you used any new soap/ cosmetics especially with added fragrance? Fragrances, harsh soaps and colorants could worsen your eczema.
Hypothyroidism could lead to dryness of skin which in turn could worsen your pre- existing eczema.

If you could identify/ suspect any particular allergen, please avoid it and see if it helps to control the eczema.

I would suggest the following measures for you -
1. Do continue topical steroid twice a day. 1% hydrocortisone is available over the counter. You may need a more potent steroid, but since this is the strongest one available over the counter, you may have to use this till your next appointment.
Use it on top of the moisturizer (see below) on the rashes for 15 days.

2. Use a soap free cleanser like Cetaphil cleanse for bathing. Use very little cleanser and do not rub/ scrub/ lather too much.

3. Bathe only using lukewarm water. Avoid hot water as it strips the skin of its natural oils.

4. Moisturize frequently. This is the most important step to treat the current rash as well as to prevent relapses. Moisturize using a colloidal oatmeal based moisturizer ( like Aveeno). Moisturize within 3 minutes after a shower and repeat as frequently as you wish. Use it all over the hands and legs and not on the rashes alone.

5. Use a humidifier if you are in an air conditioned atmosphere. Lack of humidity can worsen the rash.

6. You could take an antihistamine like Benadryl at bedtime for 10-15 days. This will give you symptomatic relief as well as prevent you from scratching. Scratching the rash will worsen the eczema and set in what is called as an " Itch-scratch cycle". Avoid rubbing/ scratching.

You could discuss the option of a topical immunomodulator called Tacrolimus with your dermatologist. This does not have the side effects of a steroid and can be used for longer duration to prevent relapses.

Hope this helps you.

Wishing you good health,
Dr. Johny Chacko

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Brief Answer:
Eczema management

Detailed Answer:
Hello,
I hope this helps you.
Regards,
Dr. Johny Chacko

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