What can cause itchy rashes on the arms, feet, penis, and waist?

Hi,

Welcome to icliniq.com.

I saw your clinical picture (attachment removed to protect the patient's identity). For me, the features are more consistent with lichen planus than scabies. Lichen planus presents with itchy violaceous fault-topped papules (bumps), mainly involving wrists and legs. It also involves mucosa of the mouth and nails. However, if you can fill in some additional information, I can make a precise diagnosis and suggest treatment options.

1. When did this start?

2. Do you have more itching during night hours?

3. Do you have similar itchy bumps around your belly button or armpits?

4. Anyone else in the family has similar lesions?

5. Do you have pets at home?

6. Did you have any illness before these bumps popped up?

7. Are you on any oral medication for other systemic diseases?

8. Do you have any white lesions inside your mouth? When eating spicy food, do you have a burning sensation in the mouth?

9. Do you see any changes in the nails?

10. Did you have hepatitis in the past?

11. Any stressful episodes in the recent past?

If possible, please send pictures of the bumps on your legs.

Hi doctor,

Thank you for the reply,

Considering the duration of onset of skin lesions, involvement of the tongue, the appearance of lesions on wrist, legs, which are itchy violet color, shiny bumps,

This is not scabies, for sure. Scabies is highly contagious, and it does not last for six months when treated.

This is lichen planus, is an inflammatory papulosquamous disorder of skin and mucosa, and can also involve nails and hairs.

Causes include,

1. Viral infections like hepatitis.

2. Certain medications like chloroquine antihypertensive medicine like beta blockers.

3. Dental amalgam-mercury.

4. Genetical factors.

5. Autoimmunity.

But most of the time, it is idiopathic, meaning the cause is unknown. Usually gets aggravated by stress.

Avoid scratching. Any trauma to the skin will lead to similar lesions along the line of trauma. This is called Koebnerization. I can see a few lesions on the wrist forming a line. This is koebnerization. So please avoid scratching/rubbing. Use moisturizer whenever you feel itchy.

Use mild soap like Cerave or Dove.

Avoid hot showers. Warm water is preferable.

Treatment options are,

1. Topical potent Corticosteroid creams for body lesion-clobetasol propionate 0.05 % should be used only on the affected area at night for two weeks on and two weeks off. Because corticosteroids, when used for a longer duration at a stretch, can cause skin atrophy (thinning).

2. Topical Tacrolimus 0.1% ointment to be used on affected areas in the morning.

3. Topical moisturizer with ceramide, like Cerave moisturizer lotion or Eucerine (Petrolatum and Lanolin). Both have ceramide, which helps to decrease itching and promote skin barrier repair.

4. For oral lesions, topical Triamcinolone Acetonide oral paste apply to the affected area at night for two weeks.

5. For genital skin, use Tacrolimus 0.1% ointment and apply it to the affected area at night.

Please feel free to ask if you have more questions about this skin condition.

Hi,

Welcome back to icliniq.com.

This is not contagious and does not spread from person to person. You can have sexual contact with your wife. Treatment response varies. There is no permanent cure for this lichen planus, but it can be controlled with above mentioned medications.

I suggest you use these creams for two months to see the improvement with 15 days on and 15 days off. You can use Tacrolimus twice a day when you are off steroids for 15 days.

I am sorry, but I cannot send a prescription since I hold an MD Dermatology degree from another country.

Hi,

Welcome back to icliniq.com.

You are welcome.

Take care.