Dr. Muhammad Zubayer Alam
Pulmonology (Asthma Doctors)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
Six months ago, I had small scab-like things that were painful, but I realized that most of them look like they had an orange excretion around them. And it did not look like a regular scab. When I went to go and see if the scab would pull off suddenly, the brown circle pulled back into my skin, and you could see red squiggles under my skin like it was some type of worm. I have them all over my body. They literally have eaten holes all through my skin, and I have been put on the strongest antibiotics for long periods of time. No doctor has actually tested them the closest I got was an ultrasound, and the doctor said they could see something moving under my skin and asked me if I had broken something off under my skin. I ended up leaving AMA. I can feel something moving under my skin. They are leaving huge holes and scars and scab-looking things. It seems like they are entering through my toenails. I had perfect feet, and now my toenails are basically torn apart, and it hurts. I can literally see them entering through my toenails at times and my fingernails. I can feel one on my spine. You can see the scab marks, but if you touch them or pull on them, they will move under my skin and top out at a different place in my skin. When I tried pinworm treatment, it seemed like it almost worked. It irritated them a very lot and made them burn very badly and get very itchy. But then it seems like they almost came back worse. From the research I have done, it sounded to me like hookworm, so I took around and hookworm treatment chocolate bar that I ordered online, which seems to work, but then it came back even worse. Because I believe they were still in my clothes or linen, etc. I was on Risperdal wish creates milk in my breast, so my breasts were being attacked horribly, and I did read that parasites like milk, so I stopped taking that medication. But now, my breasts are all scarred up. My entire body is scarred up. I really cannot take much more of this. It is like my worst nightmare. I am attaching the images. Kindly help me.
Hi,
Welcome to icliniq.com.
According to your statement, you have been suffering from red itchy swellings or Calabar swellings associated with surrounding urticaria and pruritus, feeling of something moving under the skin, holes in the skin, chronic abscesses, etc.
According to the pictures provided here (attachments removed to protect the patient's identity), you may suffer from cutaneous filariasis. Cutaneous filariasis is a parasitic disease caused by a thread like filarial nematodes or roundworms in the family Filariae. Cutaneous filariasis may be caused by Loa-Loa, Onchocerca volvulus, Mansonella streptocerca, etc. These worms may occupy the subcutaneous layer of the skin.
Typical clinical presentations of cutaneous filariasis are red itchy swellings or Calabar swellings, usually on forearms or wrists. They can also appear on the face, back, breasts or legs. The swellings may be associated with surrounding urticaria and pruritus. The migrating worms can be noticed under the skin. Dead worms may cause chronic abscesses that may lead to the formation of granulomatous reactions and fibrosis. Again, subcutaneous nodules may be found over bony prominences of the thorax, pelvic girdle, or knees, and adults worms can live within these subcutaneous nodules.
Some investigations like detection of eosinophilia by CBC (complete blood count) with circulating eosinophil count and serum IgE (immunoglobin) level, identification of microfilariae by microscopic examination or antigen detection using immunoassay, PCR (polymerase chain reaction), and ELISA (enzyme-linked immunoassay) methods are more sensitive tests, identification of adult worms by subcutaneous biopsy, etc., can be done to find out the underlying etiology like Loa Loa, Onchocerca volvulus or Mansonella streptocerca that is responsible for your cutaneous filariasis and treat them accordingly.
Loa Loa is treated with Diethylcarbamazine (DEC), Onchocerca volvulus is treated with Ivermectin and Doxycycline, and Mansonella streptocerca is treated with Ivermectin.
So, it would help if you visited a doctor physically for undergoing some investigations that are mentioned above for confirming the underlying causative agents for your cutaneous filariasis and then treat them with DEC or Ivermectin. Filariasis is spread by mosquitoes, so avoid mosquitoes.
Take care. Let me know if I can assist you further.
Patient's Query
Hi doctor,
Thank you.
Is there any over-the-counter medicine that I can buy that would help? Can you suggest me some medication? Kindly give your opinion.
Hi,
Welcome back to icliniq.com.
It will be better for you to undergo the investigations first to detect the underlying causative agent for your skin problems and then treat them. Diethylcarbamazine and Ivermectin are not over-the-counter medications. It is a prescription medication. This medication needs a doctor's prescription. So, it would help if you went to a doctor physically to undergo some investigations and further treatment purposes as the drug are needed. To go straight and try to figure out the exact etiology for the skin lesions and then treat them accordingly with medications. Otherwise, these drugs may fail to cure.
I hope this was helpful.
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Pulmonology (Asthma Doctors)
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