Seeking Advice: My Mother Has Developed a Severe Rash
Hello everyone, I’m reaching out on behalf of my mother, who is 65 years old and of African-American descent. Approximately a week ago, she noticed a severe rash that is incredibly itchy. Initially, it appeared on her chest but soon spread to her back, shoulders, arms, and neck. Here’s a brief timeline of her situation so far: - After three days, she visited an urgent care center where she was prescribed prednisone, taking 40 mg daily for five days along with antihistamines. Unfortunately, the rash did not completely subside. - Following this, her primary care physician recommended triamcinolone cream at 0.1% concentration. - However, since starting the triamcinolone treatment (applied primarily to her trunk and back), her condition has worsened with increasing bumps and further spread of the rash. - Additionally, she’s been experiencing fatigue, tiredness, and chills. Detailed description of the rash: - It consists of numerous small, red, itchy bumps that cluster around the hair follicles on her chest, back, and shoulders. - There are no blisters or signs of pus, and the discomfort primarily revolves around itching rather than pain. - The rash appears to present symmetrically across her body. - It seems to deteriorate rather than improve with the use of the steroid cream. Medications she has tried include: - A five-day course of prednisone - Cetirizine, 10 mg daily - Famotidine, 20 mg - The recently started triamcinolone cream, which appears to exacerbate the issue - Benadryl has been used sporadically to help with sleep and itching Here are my concerns: - Is it possible that she has Malassezia folliculitis or could it be folliculitis induced by steroids? - Could scabies be a possibility that is being concealed by the steroids? - Why hasn’t there been any noticeable improvement with the combination of prednisone and triamcinolone? I have several questions for the community: - Does her rash seem more aligned with yeast folliculitis or allergic/contact dermatitis? - Should we eliminate the use of steroid cream entirely at this point? - Would utilizing an antifungal shampoo such as ketoconazole or a selenium sulfide wash, or even oral fluconazole, be advisable? - Should we consider treatment for scabies, like permethrin? - At what stage should we be concerned about potential infection, especially with the onset of chills? Any insights or similar experiences would be greatly appreciated. We intend to see her healthcare provider again soon, but I want to approach the appointment armed with the right knowledge to advocate for thorough evaluation and appropriate treatment. Thank you for your support!
Answers (1)
8/18/2025, 3:21:48 PM
OpenHealth AI
It sounds like your mother is experiencing a challenging and uncomfortable skin condition. Given the details you've provided about the rash's progression and her symptoms, it appears more complex than a simple allergic reaction. Let's break this down into manageable parts.
Key Points:
- Rash Characteristics: The small, itchy bumps spreading symmetrically suggest a potential folliculitis or other inflammatory skin condition.
- Treatment Concerns: The worsening condition with steroid cream indicates it may not be suitable for her current situation, particularly if there's a possibility of fungal involvement.
- Accompanying Symptoms: Fatigue and chills could signal a systemic issue or potential infection, warranting careful observation.
Explanation:
The rash could be related to several factors including, but not limited to:
- Malassezia Folliculitis: This is common in areas rich in sebaceous (oil) glands and often worsens with steroid use.
- Folliculitis or Steroid-Induced Folliculitis: Steroids can inhibit natural immune responses, allowing conditions like folliculitis to worsen.
- Scabies: While less likely in the absence of direct contact history, scabies can cause intense itching and can mimic other skin conditions.
The lack of improvement with prednisone and the steroid cream is concerning, suggesting the need for a different treatment approach.
Next Steps:
-
Discontinue the Steroid Cream: Given her worsening condition, stop using the triamcinolone cream. Switching to topical treatments that don’t contain steroids may prevent further irritation.
-
Consider Antifungal Treatments:
- Use a ketoconazole or selenium sulfide shampoo to wash affected areas. This can help if Malassezia is involved.
- Topical antifungal creams may also be beneficial, but consult your healthcare provider before starting these treatments.
-
Monitor Symptoms Closely:
- Keep an eye on any changes in her condition, especially the presence of pus, increased redness, or swelling, which may indicate infection.
- If chills persist or worsen, or if she develops a fever, this needs urgent medical evaluation.
-
Assessment for Scabies: If there are concerns about scabies, especially if she's itching intensely at night, discussing possible treatment like permethrin with her doctor might be warranted.
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Document Changes: Keep a record of her rash's development, including any new symptoms or changes in the appearance of the rash. This will be valuable information for her healthcare provider.
Follow-Up:
When you see her healthcare provider, express your concerns about the lack of improvement and discuss the possibility of a skin culture or further investigation into the origin of the rash. Advocating for a thorough evaluation can help pinpoint the correct diagnosis and treatment plan.
Remember, it's essential to approach this situation with care and not to rush into multiple treatments without professional guidance. Thank you for your dedication to your mother’s health; your involvement will help ensure she receives the best care possible.
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