Is It Scabies or Dyshidrotic Eczema? Your Skin Condition

Uncertain whether it is scabies or dyshidrotic eczema?

Last October and this May, I experienced eczema, and the doctor prescribed me BCC and BCG ointments to apply.
At that time, I was being treated at a clinic near my school in Taipei.
After moving to Taipei for my studies, I occasionally experienced itchy skin.
At the end of June this year, I developed some rashes on the back of my legs, which I assumed were just regular eczema, so I continued to use the leftover BCC ointment from May (the eczema in May was located on the inner thighs, groin area, and the back of my neck).
From late June to early July, I went on a graduation trip to Thailand, where I engaged in water activities, walked barefoot, and had massages in saunas and nude settings.
After applying the ointment for two days, I ran out of it and stopped using it.
At that time, I had small blisters on the inner and outer parts of my left hand's webbing, and small blisters also appeared between the toes of my right foot near the dorsum.
I thought it was dyshidrotic eczema.
After returning to Taiwan, I went back home to Taoyuan and did not seek further medical attention.
Gradually, I developed rashes on the front of my legs, arms, and the back of my hands.
The original small blisters disappeared and turned into rashes.
Due to persistent itching, three areas on my forearms and the back of my neck became red and swollen like pimples.
Eventually, I couldn't tolerate the itching anymore, so I sought treatment at a clinic in Taoyuan.
On July 18th, during my initial consultation, the doctor asked if I usually used sunscreen.
I replied no, and she mentioned that it's easy to develop such rashes from sun exposure in the summer.
However, when I told her about my recent trip to Thailand, she examined me closely and suggested it looked somewhat like scabies, possibly due to unclean hotel conditions and potential insect infestation.
She prescribed me Ulesfia to apply at night and Calamine lotion to use morning and night, instructing me to wash my clothes in hot water for seven consecutive days.

On July 20th, during my follow-up appointment to pick up medication, the doctor asked if I felt any better.
I thought the itching had indeed decreased, but a few rashes had appeared and were still itchy.
I asked the doctor if it was indeed scabies, and she said to treat it as if it were.
However, during both consultations, no detailed examinations were conducted to confirm the diagnosis, and the doctor did not advise me to isolate myself.
My family and boyfriend do not have similar symptoms.
Upon closely observing the skin rashes, I could not find any burrows.
Is it really possible that this is scabies? If it is indeed scabies, is this treatment too simplistic? Should I seek consultation at another clinic or hospital? Thank you for your response, doctor.

Xingxing, 20~29 year old female. Ask Date: 2017/07/21

Dr. Wu Yuxin reply Dermatology

Without actually seeing the lesion, it is difficult to determine the issue.
If it is causing you significant distress, please seek medical attention as only a professional can assess the problem and provide appropriate treatment.
It sounds like you are a cautious person, so if you have indeed applied the ointment and have been washing your clothes continuously for seven days, there is no need to worry.

Reply Date: 2017/07/21

More Info

Based on your description, it seems you are experiencing a complex skin condition that could potentially be dyshidrotic eczema or scabies. Both conditions can present with itchy rashes and blisters, but they have different underlying causes and treatment approaches.

Dyshidrotic Eczema is a type of eczema characterized by small, itchy blisters on the hands and feet. It often occurs in response to stress, heat, humidity, or exposure to certain allergens. The blisters can be very itchy and may eventually dry out and peel. This condition is not contagious and is typically managed with topical corticosteroids, moisturizers, and avoiding known triggers.

Scabies, on the other hand, is a contagious skin infestation caused by the Sarcoptes scabiei mite. It is characterized by intense itching, especially at night, and the presence of a rash that can include small blisters and burrows (tiny tunnels in the skin where the mites live). Scabies is usually spread through close physical contact, and it can also be contracted from infested bedding or clothing. Treatment typically involves prescription topical medications like permethrin cream or oral medications like ivermectin.

From your account, it seems that your doctor suspected scabies based on your symptoms and recent travel history, which could have exposed you to the mites. However, the absence of burrows and the fact that your family and boyfriend do not have similar symptoms raises some questions about the diagnosis. Scabies usually requires thorough treatment and often necessitates that close contacts also be treated to prevent reinfestation.

Regarding the medications prescribed, it is essential to follow your doctor's instructions closely. If you are not seeing significant improvement or if new symptoms arise, it may be wise to seek a second opinion or consult a dermatologist for a more comprehensive evaluation. A dermatologist can perform a skin scraping or other diagnostic tests to confirm whether scabies or another condition is present.

In the meantime, here are some general recommendations:
1. Avoid Scratching: Scratching can worsen the rash and lead to secondary infections. Try to keep your nails short and consider wearing gloves at night if itching is severe.

2. Moisturize: Use fragrance-free moisturizers to help soothe the skin and prevent dryness, which can exacerbate eczema.

3. Avoid Triggers: If you suspect certain soaps, detergents, or environmental factors are triggering your symptoms, try to avoid them.

4. Follow Treatment Protocols: If your doctor has prescribed medications, ensure you apply them as directed. For scabies, it is crucial to treat all affected areas and follow up with your doctor if symptoms persist.

5. Monitor Symptoms: Keep track of any changes in your skin condition, including new rashes, changes in itching, or the appearance of blisters. This information can be helpful for your healthcare provider.

In conclusion, while it is possible that you may have dyshidrotic eczema or scabies, a definitive diagnosis requires a thorough examination and possibly additional testing. If your symptoms do not improve with the current treatment or if you have concerns about the diagnosis, seeking a second opinion from a dermatologist would be a prudent step. Your skin health is important, and getting the right diagnosis and treatment is essential for effective management.

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