Why does a persistent itchy rash occur in a 12-year-old?

Question

Hello doctor,

My 12-year-old daughter has had a skin problem on and off since she was a toddler. We guess it to be eczema. It started in her inner crease of the right elbow as a pink, itchy spot, and it spread to her left hand in between her middle fingers and palm. The skin is pink, peels off, and is itchy. I have tried many creams, lotions, soaps, and medicines that are available over the counter. But nothing helped. She has not had any known allergies before. I have attached the pictures. Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have seen the pictures you sent (attachments removed to protect the patient’s identity). It is hand eczema (dermatitis). Dermatitis is confined mainly to the hands, with or without minor involvement of other areas. The disease can be acute, lasting less than three months, or chronic.

Sometimes, there may be recurrent flares in between periods with normal skin. The causes can be endogenous, like (atopic), repeated pricking or rubbing, dyshidrosis (increased sweating), and idiopathic, like hyperkeratotic hand eczema. The exogenous causes are chemical contact with detergents, soaps, allergens, contact with irritants, food or drug allergies, and infection (bacterial, fungal, or viral). The differential diagnosis is tinea manuum and keratolysis exfoliativa. The risk factors are wetness, stress, high temperature, cold, dry air, low humidity, occlusion, atopy, and dry skin. Kindly avoid the known allergens and irritants. And I suggest you apply Emollient Barrier creams (Hemp oil, Canola oil, Soybean oil, Omega acids) and Motium cream (Mometasone) at night for four weeks. And apply Mupirocin ointment in the daytime for 15 days. Wet dressing with Povidone-iodine is needed. Avoid excessive sweating, stress, and dry conditions, and minimize frequent hand washing, as it triggers eczema. Does he have a fever or any fluid oozing from the site?

Kindly revert. Thanks.