Persistent Rash Issues
A 28-year-old woman with an average level of health is experiencing ongoing skin issues. Chronology of Events: Friday - Returned home after a four-day trip to Kentucky. Saturday - Noticed what appeared to be a spider bite on her face. Sunday - The irritation began to spread upwards along her chin, stretching towards her ear and eye, with additional spots appearing on her torso. Monday - The rash intensified, developing small blisters and becoming highly itchy. She visited an urgent care facility where she was prescribed an antibiotic and prednisone. While doctors suspected disseminated shingles, she personally doubts this diagnosis. Other possibilities included contact with poison ivy, oak, or sumac; however, the rash on her torso continues to spread more than a week after possible exposure. She ruled out bedbugs or any other insect bites. Fast forward to Saturday - Her facial rash has dramatically improved, healing about 90%. Unfortunately, the rash on her torso persists, worsening despite treatment. She has two remaining, reduced doses of prednisone and is applying hydrocortisone cream to the affected areas, using ice packs for relief, but none of these measures have been effective. The initial spots are now bruised with yellow discoloration, while new patches appear bright red and swollen. She has changed her bed linens and reviewed other potential irritants, yet there is still no sign of improvement.
Answers (1)
7/19/2025, 9:01:32 PM
OpenHealth AI
It's understandable to be concerned about a persistent rash, especially when it's spreading and accompanying skin changes occur. This situation may indicate an ongoing inflammatory response and could potentially signal an allergic reaction or another skin condition. Addressing your needs prioritizes finding relief and understanding the current state of your rash.
Explanation:
The timeline you've shared indicates a significant skin irritant was encountered, possibly during your trip. While the facial rash has improved, the torso rash worsening despite treatment can be frustrating. The yellow discoloration and bruising suggest possible secondary changes like infection or a reaction. It's important to consider that conditions like eczema, allergic reactions, or a more atypical dermatological condition could evolve after initial irritation, especially given the timeline.
Next Steps:
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Reassess the Rash: Take note of new developments—size, color, and any additional symptoms. This documentation can help track changes and identify potential triggers.
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Continue Care with Hydration and Moisturizer: Keep the affected areas moisturized to support healing. Use a fragrance-free moisturizer to help soothe irritation.
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Monitor Itching and Blisters: If you notice any signs of infection, such as increased warmth, swelling, pus, or spreading redness, this could indicate that the rash is worsening and requires more intensive treatment.
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Consider Elimination and Low-Allergen Environment: Since the rash has detracted from your usual comfort, review any new products or detergents used, and try switching back to hypoallergenic options if possible.
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Optimize Prednisone Usage: If advised by a healthcare provider, discuss your next plan for prednisone intake, whether to continue the remaining doses or if a different corticosteroid regimen might be beneficial.
Make sure to keep monitoring the area closely. If your torso rash continues to worsen, or you notice systemic symptoms (like fever or widespread rash), it may indicate a need for further medical evaluation, possibly with a dermatologist who specializes in skin conditions. I hope this helps you feel more informed and empowered regarding your situation.
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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.