Rash

[debbiedc]

I woke up from a nap about 2 weeks ago with an odd rash on my toes. I thought at first I had poison ivy or some such thing. Since I stil have the rash I don't think it is poison ivy. The rash is only on the first 3-4 toes, itches like crazy and I do mean crazy. I have some fungal cream that seemed to help but isnt anymore. The rash is comprised of small blisters with a dark dot in the middle, it is not scabies cause it is not in a line, but in a group. Any ideas? any one.....

[Kimberly Kaye]

My son's rash sounds like what yours looks like. The doctor said it was a Staph infection and put him on antibiotics. It went away almost immediately. Get a culture or blood test and see.
Good Luck
Kim

[debbiedc]

I went to the doctor and saw the PA she said I have no idea what that is and gave me steroids and a fungal creme so far so good seems to be helping

[Boardcertifiedderm]

I hope you rash has resolved by now. If not, I suggest you obtain a referral to a dermatologist. There are a number of possibilities of course. Already mentioned is some type of infectious disease. Bacterial infection can itch, although typically it might not be as intense as yours sounds. Blisters can be cultured for bacteria, usually staph or strep. Fungal infections typically itch much more and can devleop blisters as you describe. Typically fungus or "athlete's foot" begins between the toe webs and spreads. *Usually between the 4th-5th toes. Occasionally it can also be secondarily infected with bacteria.

Another possibility in the "differential diagnosis" is an allergic contact dermatitis. Although this is typically on the weight bearing surface of the soles, it can be to glues and rubberized chemicals in the toe piece of various shoes. Don't throw out your shoes just yet, but if the rash coincided with a new pair, set them aside. To make it more complicated, you can be exposed to a chemical without allergic reaction and at some later point, suddently become allergic.

Although most rashes such as yours are self limited or the patient "discovers" the cause by trial and error, there is simply no substitute for being examined by a residency trained dermatologist. Hence my direct suggestion to request a referral to a dermatologist.

Good luck!

Board certified dermatologist

[debbiedc]

the rash is better worse better worse. I have done 2 backs of steriods and the .25%cortisone creme. Right now it is at a worse stage and I have an appt tomorrow with the pa of our dermatologist will let you know what he says, if I still have a toe tomorrow right now I could itch it off

[Boardcertifiedderm]

Very good job! Perhaps show the PA my note and lobby for a referral to the derm. The intensity of itching is aligned with fungal infection vs allergic contact dermatitis. If there is toe web wetness, then it's more likely fungal. Fungal infections respond slowly to creams alone when they are flaring and sometimes oral antifungals are necessary (or steroids as you did). Given though that you have had two rounds or oral steroids and it is recurring strongly, I would, especially if the toe webs are spared, consider allergic contact dermatitis. This is often sharply demarcated (easily seen where it starts and stops on the skin) but when flared can spread more diffusely.

Sometimes unfortunately, more has to be done to evaluate it. Sometimes a small biopsy is necessary, but this is the exception. Usually if there is a high index of suspicion for allergy, screening patch testing can be done. (patches on the back) This discovers a likely allergen about 25-30% of the time. If it is negative and the dermatologist does not do more extensive testing (many do not) then a referral to a colleague or regional patch test center at a local university can be considered. Fortunately, again , the problem can often be solved without the aforementioned.


Good luck. The dermatologist should be able to help you quickly.

board certified derm

[debbiedc]

I am pretty allegic to latex, my derm. did patch testing last year, but this is weird and you would think that if it were allergic more of my foot would be affected. it it only certain patches on certain toes, not all the toes or the actual foot top or bottom and not at all in the webbing of the toes. I have alredy been to the foot doc and he ruled out a fungal infection, such as athletes foot, but did wonder why the othe stuff isn't helping. If my shoes have latex in them where do I find shoes that don't, it seems that ALL shoes say 'man made material', which poses the risk that there is some form of latex. I already have to watch what type of panty, and bra I wear, I hate to have to give up on shoes cause of latex too.
thanks for all your help will let you know what the pa and or doc says tomorrow, I think I might insist on a scraping or biopsy.
will update tomorrow

[Boardcertifiedderm]

If you have no toe web inflammation, this is probably a contact dermatitis. Have your derm review the prior patch tests (these are not always perfectly accurate). The most common causes of allergic reactions to shoes include rubber compounds as found on the patch test series including MBT and Thiuram, both of which are often used in latex products as vulcanizers. (in shoes they are used in the glues). There is likely a correlation between the prior "latex" reaction on the patch test series and your toe reaction. Often only some toes will react as there may be more glue under some areas of the toe piece in the shoe. See if you are wearing any shoes with worn bits of lining inside.

If your derm thinks the rash fits the pattern of allergic rxn and especially if your patch testing showed an allergy to MBT, Thiuram or chromate (tanning agent in leather) then he can refer you to various vendors of shoes without rubberized glues.

If he is a member of the american contact dermatitis society, he has access to a substitution database too.

Let him evaluate you. It sounds like a biospy may not be indicated and in the case of allergic reactions will not be definitive. Let him evaluate your situation.

board certified derm.

[debbiedc]

Sorry it took me so long to get back to you but I have had troubles, first the PA says it is some kind of eczama(sic) caused by stress, he perscribed clobex spray which help slightly. till I went away to the woods wore shoes and socks for about 6 hours I woke up the next morning with my toes covered in blisters, painful blisters I could hardly walk. The pa without rechecking this new development gave me Protopic ointment, that seems to be helping. However, I am concerned that there are brown spots wherever the itching was. If this is truely something caused by stress I m seriously considering quitting my job since there is so much drama there.

[Boardcertifiedderm]

Please rereview my last post, you should take a copy to have the attending dermatologist review you case. At this juncture it is beyond his scope of practice. I'm confident the dermatologist will see you.