OpenHealth Q&A

25-Year-Old Male with Rash Issues: Is Eczema the True Culprit?

**Height:** 5'6" **Weight:** 180 lbs **Ethnicity:** Chinese **Main Concern:** Experiencing rash outbreaks across various regions of my body, uncertain if the issue is scabies, dermatitis, or another condition altogether. **Past Medical Concerns:** Previously diagnosed with eczema on both calves **Current Treatments:** doxycycline 100 mg, mupirocin 2% ointment **Symptom Duration:** One month. **Lifestyle Choices:** No tobacco, alcohol, or drug usage. Initially, I had two significant areas of oozing eczema located on both calves, with the right being particularly severe. In July, I began to feel intense itching on my right wrist, which the following day branched out into rashes appearing across my body, including private areas. These rashes manifested as small, raised bumps, either clustered together, randomly scattered, or arranged in linear formations. When scratched, they would seep a clear liquid that dried to form yellowish crusts. Additionally, I experienced mild eczema flare-ups on my face and lips and noted yellow crust around my ears and scalp. Regrettably, I didn't capture images of the initial rash, mistakenly assuming it was merely eczema, which I can now see was a lost opportunity. The only remnant of the original inflammation are dark brown spots visible in some photos, which are scars from flattened and non-itchy rashes. Upon returning from a trip, I sought advice from a dermatologist who diagnosed me with scabies, leading me to treat with permethrin (three doses), ivermectin (one dose), triamcinolone acetonide twice daily, mupirocin on the oozing eczema for a week, hydrocortisone for my lips, roflumilast cream on my face, and doxycycline to combat any bacterial infections. During the initial week of treatment, I noted improvement; the rashes diminished, and the weeping eczema appeared to clear up. However, shortly after administering the second dose of permethrin, I observed new, itchy bumps forming on my limbs alongside flare-ups of previous rashes. I diligently changed bed linens daily and thoroughly washed my clothes, yet I realize I wasn't as meticulous as necessary in maintaining cleanliness, still using my phone without gloves and walking barefoot without vacuuming. The subsequent treatment session found me more cautious, using disinfectant on high-contact surfaces and donning gloves while managing my phone. After consulting another dermatologist, she administered additional permethrin doses for safety. The rashes shrank once again, only to flare up soon after. On my third visit to a dermatologist, she advised stopping the fourth dose of permethrin, citing potential skin damage, and shifted my treatment to ivermectin alone to eradicate any lingering mites. The resulting rashes presented a concerning, pus-like secretion culminating in yellow crusting, particularly on my hands, waistline, and the larger eczema patch on my right leg. Anxiety mounted as I feared a severe re-infection of scabies. However, my latest consultation with the second dermatologist revealed that the rashes resembled eczema with impetigo. As I examined my hands more closely, their appearance indeed aligned with eczema characteristics, triggering contemplation: could I have been misdiagnosed? Did I have untreated eczema that became infected? Several factors offer me a glimmer of hope that I might be dealing merely with dermatitis and not scabies: 1. My eczema history includes primarily localized flare-ups on my calves, and I remember a particularly terrible outbreak as a child, which affected my entire body, including my face. I thought this episode might be similar but milder, anticipating it would resolve naturally. Usually, I refrain from treating eczema and avoid scratching as it clears up. Potentially, this instance worsened due to excessive scratching. 2. The first dermatologist quickly diagnosed me with scabies, failing to conduct any thorough examination or tests. No skin scrapes or dermoscopy were performed; he simply argued that the rash patterns indicated scabies, citing personal experience. While my rash resembles scabies considerably, I still harbor doubts about his conclusion. He neglected to mention that my entire family would also require treatment upon my diagnosis. The second dermatologist's initial opinions seemed ambiguous, while the third appeared surer that it was indeed scabies, advising my family to undergo permethrin treatment, yet I still retained a strange sense of skepticism. 3. None of my family members have exhibited any symptoms. We share the same household, and I vacationed with my brother shortly before my diagnosis. Though relieved they remain symptom-free—which might suggest our collective caution—it's curious my brother has shown no symptoms despite our close proximity. 4. My experiences with permethrin left me questioning its efficacy, especially when I used it on my genitals and noticed worsening symptoms. Ultimately, it was only after integrating Triamcinolone acetonide and mupirocin that I began to feel relief, now managing just a hint of itching. I couldn't ascertain the effectiveness of ivermectin either. Interestingly, Triamcinolone acetonide is known for treating eczema, provoking speculation that perhaps permethrin was ineffective because I don't actually have scabies. The challenge lies in the fact that cross-referencing types of eczema reveals nothing closely resembling the initial rash I experienced. Furthermore, I couldn't confirm that eczema rashes develop in the same patterns I've displayed. The locations of my rashes notably align with common scabies areas. One hypothesis I conceived is that the weeping eczema might have been infected with a form of impetigo or bacteria, thus spreading the bacteria to my fingers and other regions, prompting new rashes. However, I'm uncertain. I have a follow-up with my third dermatologist next Friday, and I'm currently awaiting biopsy results from the second dermatologist taken from my right hand and stomach area. With all this in mind, do the rashes resembling eczema paired with impetigo seem plausible in my case? Do these rashes appear merely as standard eczema? The resources I've found online have yielded similar imagery, leaving me without clarity, so as I await my next dermatologist appointment and biopsy results, I'm hoping someone can provide insight into this situation.

Answers (1)

8/9/2025, 12:12:03 AM

OpenHealth AI

Based on your detailed description, it seems you may be experiencing a combination of issues potentially involving eczema, impetigo, and lingering effects from previous treatments for scabies. Let’s break down your situation and outline clear next steps.

Summary of Key Points:

1. Complex Symptoms: Your rashes could be due to eczema with secondary infections (like impetigo) or lingering symptoms from scabies.
2. Past Treatment Efficacy: Concerns about the effectiveness of permethrin and the role of your eczema history are valid, as treatments may interact or complicate conditions.
3. Next Steps: A thorough follow-up with your dermatologist, including reviewing biopsy results, will be essential for refining your diagnosis and treatment plan.

Explanation:

• Eczema vs. Scabies: Eczema is a chronic skin condition that can flare up due to various triggers, leading to itchy, inflamed skin. It can sometimes become infected, resulting in yellow crusting from a bacterial infection (impetigo). Scabies, caused by mites, leads to intense itching and a characteristic rash, typically found in specific areas of the body. Given your history of eczema, it’s plausible that an eczema flare could have been misdiagnosed as scabies, especially if proper diagnostic testing wasn’t performed initially.

• Implications of Treatment Success: Your report of relief upon using creams like triamcinolone and mupirocin suggests that the inflammation may have been due to eczema rather than scabies. The weeping skin and subsequent infections might also indicate that your skin barrier was compromised, making it susceptible to secondary infections.

Prioritized Next Steps:

1. Continue Monitoring Symptoms: Keep a detailed diary of your symptoms, noting any changes in appearance, itchiness, or response to treatments. Pay close attention to the lesions and any new ones that form after washing or using specific products.

2. Await and Review Biopsy Results: Make sure to follow up on your biopsy findings as they will provide crucial insights into whether you have eczema, an infection, or another skin condition.

3. Hygiene Measures: Maintain diligent hygiene to avoid further irritation or infections. This includes:

   • Frequent handwashing while avoiding harsh soaps.
   • Continuing to wash bed linens and clothing regularly.
   • Being cautious about scratching to prevent skin damage and secondary infections.

4. Skin Care Routine: Consider using fragrance-free moisturizers to help maintain skin hydration. Use your cortisone cream as instructed, especially during flare-ups, and continue mupirocin on any areas that appear infected. Discuss with your dermatologist a potential skin care regimen that can be soothing and supportive for eczema.

5. Consultation for Treatment Adjustment: Based on the upcoming appointment with your dermatologist, be prepared to discuss the possibility of adjusting your current management strategy depending on the biopsy results. If scabies is ruled out or if eczema is confirmed, treatment may need to focus more on managing eczema rather than using anti-scabies treatments.

6. Family Member Monitoring: Since no one else in your household has shown symptoms, continue reassuring them that they need not be overly concerned, but do monitor for any changes, suggesting they consult a doctor if needed.

Conclusion:

While you are rightly concerned about the ongoing issues with your skin, it sounds like you’re taking appropriate steps towards clarifying your diagnosis. Focus on symptom management, maintaining hygiene, and awaiting professional guidance based on your pathology results. If your rashes worsen or new symptoms arise, don't hesitate to contact your healthcare provider sooner. Remember, skin conditions can be complex, but with continued care, improvement is possible.