Mysterious Skin Rashes Leave Doctors Puzzled
Age 32, female, residing in the UK, weighing 145 kg, I face challenges with obesity and a complicated medical history. This includes atrial fibrillation managed with bisoprolol at 7.5 mg and edoxaban at 60 mg daily, as well as experiences with Prinzmetal angina, sleep apnea, bipolar disorder type 2, borderline personality disorder, anxiety, depression, and stage 2 chronic kidney disease. Furthermore, I suffer from hidradenitis suppurativa, currently classified as stage 2-3. For roughly a month, I’ve been dealing with a persistent rash that stretches from my left foot to my knee. This rash has been excruciatingly painful, characterized by a burning and throbbing sensation, though it does not itch and is not elevated. When I consulted with an Advanced Nurse Practitioner (ANP), she was at a loss regarding the cause. Her treatment plan included prescribing co-codamol (30/500 mg) along with a recommendation to apply dermol cream. Following that weekend, I developed a remarkably tender area on the back of my thigh and beneath my buttock on the same leg. It had a bruised feeling despite no visible marks at that time. The next day, multiple clusters resembling blisters emerged and the pain intensified. Consequently, I scheduled a follow-up appointment for the following Monday with a doctor. Unfortunately, he too was unable to determine the nature of the rashes. In an examination, he gently prodded the recent blister outbreak with a pen's flat end, prompting a reaction from me, to which he noted, "That must have hurt." He prescribed a combined steroid, antibiotic, and antifungal cream for treatment. Since then, my initial localized rash shows no signs of improvement, while the blisters have begun forming scabs. Adding to my anxiety, I previously experienced necrotizing fasciitis in that same leg two years ago, nearly leading to the amputation of the limb due to a central line infection. This history amplifies my concern about the current skin issues I am facing.
Answers (1)
9/14/2025, 6:50:40 PM
OpenHealth AI
I understand that you are experiencing a persistent and painful rash that has recently developed blisters, and your medical history adds layers to your concern. It’s important to continue addressing this issue with care and attention due to your past health challenges.
Key Points:
- Persistent and Painful Rash: Given the duration and intensity of the pain, along with your complex medical background, careful monitoring is crucial.
- Past Medical History: Your history of necrotizing fasciitis raises a valid concern regarding any sudden changes in skin conditions.
- Current Treatments: You've received steroids, antibiotics, and antifungals which indicate an active response to potential underlying issues.
Explanation:
Skin rashes can be caused by various conditions, including infections (both bacterial and fungal), inflammatory conditions, or even reactions to medications. It's particularly concerning when new symptoms arise like blister formation, suggesting a possible worsening of the condition.
The residual rash that is painful but without itching could suggest different dermatological conditions such as dermatitis, or it could even be linked to hidradenitis suppurativa, which can sometimes flare up in response to stress or other health issues.
Next Steps:
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Continue Current Treatment: Use the topical steroid, antibiotic, and antifungal cream as prescribed, ensuring to apply it evenly and as directed to avoid additional irritation.
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Monitor Symptoms Closely: Keep a detailed diary of your symptoms including:
- Changes in rash appearance (size, color, presence of blisters).
- Pain levels and what relief methods help.
- Any new symptoms such as fevers, chills, or worsening pain.
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Identify Triggers: Note if any activities, foods, medications, or even emotional stressors coincide with flare-ups. This could help pinpoint exacerbating factors.
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Follow Up: Contact your healthcare provider as planned, but consider asking for a referral to a dermatologist if the rash does not improve within a week after starting the crème. A dermatologist can provide a more specialized assessment and treatment.
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Self-Care Tips:
- Keep Areas Dry: Gentle, non-irritating cleansing with lukewarm water and mild soap, followed by careful drying can help.
- Avoid Tight Clothing: Loose clothing can reduce friction and irritation.
- Manage Stress: Since you have a history of anxiety and depression, using stress management techniques like mindfulness or breathing exercises could help mitigate your symptoms.
Remember, you deserve to have clarity about your health. If you notice any new severe symptoms or rapid deterioration of your condition, please seek immediate medical attention.
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