Upper Chest Rash - Should I Simply Monitor It?
Since March, I’ve been dealing with a pinkish-red rash shaped like a circle or an oval on my upper chest. When it initially surfaced, it was a bit itchy. At that time, a nurse practitioner at an urgent care facility suspected it was ringworm, so I followed her recommendation to use antifungal cream; however, the rash persisted unchanged. In my attempt to address it further, I applied hydrocortisone cream, yet the rash remained unresponsive. Consequently, I reached out to my primary care nurse practitioner via My Chart, and she prescribed Clobetasol Propionate 0.05%, a potent steroid cream, instructing me to apply it twice daily for a maximum of two weeks. Now, after three months, this rash has settled on my chest, featuring a slightly elevated and rough surface, but thankfully, it no longer itches. It measures approximately 5-6 cm across. The border on one side is well-defined, while the opposite side appears more faded and indistinct. Recently, I received notice that I am “no longer eligible” for my health insurance, which makes me hesitant to spend money on a condition that might not be serious. What course of action would you recommend? For your reference, I am a female, standing 5'5" and weighing 148 pounds. I reside in the northeastern United States and currently take Paxil 30 mg and Xyzal over the counter for allergies. My medical history includes anxiety, asthma, seasonal and indoor allergies, and a severe shellfish allergy.
Answers (1)
6/15/2025, 3:30:42 PM
OpenHealth AI
It sounds like you've been dealing with a stubborn rash for quite some time, and I understand your concern about whether it's serious or just something that needs monitoring. Given the details you've shared, here are some key points to consider and next steps you can take.
Summary of Main Points:
- Rash Overview: The rash has been persistent for months, hasn’t responded to antifungal treatment or hydrocortisone, and has remained stable without itching.
- Possible Causes: The characteristics of your rash (pinkish-red, circled shape, rough surface, well-defined border) suggest it may be a type of dermatitis, but a definitive diagnosis can't be made without a professional evaluation.
- Monitoring vs. Action: Given the lack of change despite treatment and its duration, further evaluation may be beneficial, especially if your insurance situation improves.
Explanation:
The rash you describe could potentially be something like eczema, psoriasis, or another type of dermatitis rather than a fungal issue, especially since it's been resistant to antifungal treatments. While the lack of itching is a good sign, the persistence and physical characteristics of the rash warrant closer evaluation to rule out any underlying conditions or to consider alternative treatments.
Next Steps:
- Monitor the Rash: Keep an eye on any changes in size, color, texture, or if it becomes itchy again. Note any triggers that may worsen it, such as stress, allergens, or products you use.
- Moisturize Regularly: Use a gentle, fragrance-free moisturizer daily to keep the skin hydrated. This can help in managing dermatitis.
- Avoid Irritants: Refrain from using harsh soaps and skincare products that could irritate the area further.
- Document Your Findings: Keep a journal of the rash’s appearance and any symptoms you notice—this will be helpful for future evaluations.
- Plan for Professional Evaluation: As soon as your insurance situation is resolved, consider visiting a dermatologist for a proper assessment. Conditions like psoriasis or other skin disorders may require different treatments and should be diagnosed accurately.
Conclusion:
While monitoring the rash can be an option for now, a professional evaluation would provide clarity and possibly more effective management. If any new symptoms arise, or if the rash worsens, seek medical advice sooner. Please take care, and keep me updated on your progress!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 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Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. 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