Friday, October 21, 2011

Calling All Dermatologists/ Dr. House Where Are You When I Need You?


What is this stuff? I used to see rashes all day in ER and urgent care, but this is a new one. I first thought it was a ringworm, fungal type of thing, but I'm not sure that the mild antifungal cream did a whole lot. It has been on the legs, top of feet and now very prominently on the back. I finally took the little guy to the Nurse Practitioner, who was not sure what it was and prescribed a combination antifungal/steroid cream. The Medical Assistant who triaged us  in the office was positive she knew what it was and it looked like she had been around a looong time and had seen a lot of kids, but the Nurse Practitioner would not commit to a Dx. The cream seemed to do the trick. He has has not had the cream applied for several days now, and the rash is still gone. Opinions?

3 comments:

  1. I have had patients with the same thing, difficult to get rid of...requiring the stronger ointment - the milder didn't do anything. I would still say ringworm.

    One patient was really having trouble getting rid of the infection, the whole family had these spots. Once it gets out of control, it's very difficult to treat.

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  2. I've seen really stubborn, patchy fungal areas that looked a bit like this and were correlated with candida overgrowth in the gut.

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  3. It looks like pityriasis rosea. It is the result of a virus that he might have had previous a few months ago. Usually an asymptomatic virus. The rash is harmless....its a trunk rash that begins with a herald patch then spreads on the trunk (front and back) and a few spots on the arms and rarely the face. An IM injection of steroids in the back side and steroid creams should do the trick. Seek treatment fast because these scars can take up to 2 years to fade.

    -Survivor of pityriasis rosea and RN Student

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