Persistent Rash in Sensitive Area
A healthy 30-year-old male, weighing in at 170 lbs, has been experiencing a troubling skin issue for over a month. An intensely itchy rash has developed around the anus and in the area between the scrotum and anus, coinciding with the presence of an external hemorrhoid. Attempts to alleviate the rash with products such as Preparation H and Anusol have yielded minimal results, providing only slight overnight relief from the itching. Last week, I consulted my physician regarding this discomfort, and he prescribed Taro-Clobetasol. I adhered to this treatment for a week, but after pausing the use of any cream, I noticed the rash appeared to worsen, although the itchiness has diminished. I plan to revisit my doctor soon as I am increasingly anxious about this ongoing condition. I’m seeking insights or suggestions regarding possible causes or treatments that could help. Additionally, it’s worth mentioning that about two months ago, I was bitten by a tick on my thigh and underwent a 10-day course of antibiotics as a precaution. To rule out any connection, my doctor ordered a Lyme disease test with my blood work, which fortunately returned negative.
Answers (1)
7/14/2025, 9:20:50 PM
OpenHealth AI
It's understandable to feel anxious about a persistent rash, especially in a sensitive area. An itchy rash that worsens after stopping treatment can stem from various causes, including dermatitis, fungal infections, or even irritation related to the hemorrhoid. Your use of Taro-Clobetasol, a strong topical steroid, suggests that your doctor is addressing inflammation. However, since you're not seeing sufficient improvement, there are steps you can take to manage the symptoms and potentially identify the cause.
Explanation:
Rashes in the genital area can result from several factors. Common causes include:
- Irritant Contact Dermatitis: Reaction to products (like soaps or wipes) or due to moisture and friction.
- Fungal Infections: Yeast infections can thrive in warm, damp areas and may cause itching and rash.
- Hemorrhoidal irritation: The presence of external hemorrhoids might exacerbate symptoms in the area.
Since the rash worsened after stopping the cream, it may be worth considering if there's an underlying irritation that needs to be addressed differently.
Next Steps:
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Continue using topical clobetasol as prescribed: If you're seeing some improvement, this medication can help reduce inflammation. However, don’t overuse it as prolonged steroid use can thin skin.
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Maintain cleanliness and dryness: Gently cleanse the area daily with a mild, unscented soap and pat dry thoroughly. Keeping the area dry can help prevent fungal infections.
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Avoid irritants: Steer clear of perfumed products, harsh soaps, or any products that might irritate the sensitive area. If you're using toilet wipes, choose unscented and alcohol-free options and avoid those that contain irritants.
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Consider applying antifungal creams: If there’s no improvement or if itching returns, over-the-counter antifungal creams might help if a yeast infection is suspected. Look for creams that contain clotrimazole or miconazole.
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Wear breathable clothing: Loose-fitting cotton underwear can help reduce moisture and irritation.
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Keep a symptom diary: Note any changes in the rash, such as redness, scaling, or the appearance of new symptoms. This information can help your doctor make a more informed diagnosis during your next visit.
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Follow up with your doctor: Share your observations and concerns at your upcoming appointment. If the rash does not improve or worsens, your doctor may consider additional investigations, including allergy testing or a possible referral to a dermatologist.
By taking these steps, you can help manage your symptoms while you await further guidance from your physician. Remember, you're not alone in this, and it's okay to seek help.
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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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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? 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. Seeking expert advice on optimal treatment strategy and timing.