Eczema or ?

[xerosis]

I am 63 years old,no hx of eczema,asthma,or allergies.Hx of mon(age 50) followed by CFIDS. About 1 year ago,developed intermittent intracrural pruritis.This spread to scrotum and pubis(pruritis),perineal(pruritis), perianal(pruritis),and sacrolumbar(papules,pruritis)areas followed by left and right chest (papules,pruritis, lichenification: now largely gone).

About 3 months ago,awakened with pruritis of lower legs and ankles(now gone). About same time,hands itched for 2-3 days, then returned to normal.More recently, volar hands became itchy,dry,scaly with some weeping vesicles at webbing.

Bounced from internist,to dermatologist,to allergist(extensive patch testing negative).

First tried powders(e.g.,Zeasorb),then ketoconazole cream.No help.Oral hydrocort helped.Lidomantle helps and I supplement prn with Atarax.No one has been definite about eczema.The only thing seen by Drs.have been excoriations,lichenifications,and papules.Vesicles are recent.Will return to dermatologist to show these.

At presently, groin(as above;especially pubis)and hands are focal areas.Waken in early AM with intracrural and/or pubic pruritis.

1. At my age, does this sound like an eczema development?
2. Could it be systemic(allergic)considering its development?
3. You recommended 1% hydrocort to others, but extended use thins skin and is immunosuppressant.What are other options?

[Alan Rockoff, MD]

Eczema isn't limited to warm, moist areas.  Scabies tends to be generalized.  I very much doubt you have it.

Dr. Rockoff

[xerosis]

Your response was understandably vague. Dermatologist and allergists only saw excoriations and lichenifications. Vesicles in hand webbing and on dorsal and lateral thumb are new and not yet seen. Scabies was never mentioned, but I will bring it up tomorrow.

1. As a male, what of the areas on left and right chest not under breast. They don't seem to fit pattern of warm, moist area unless secondary areas of infection.
2. Can scabies also present on palm or dorsal hand?

[Alan Rockoff, MD]

I guess it sounds eczematous, although your symptoms are hardly typical.  They don't suggest any other diagnosis either, with the possible exception fo scabies, which I assume has long since been ruled out.

This does not in any way sound systemic or allergic.

Hydrocortisone 1% does not thin the skin, even after extended use.  However, there are now two nonsteroid alternitaves, tacrolimus and pimecrolimus.  Your dermatologist may want to try either or both.

Best.

Dr. Rockoff