Uncertain Diagnosis: Is It Eczema or Something Else?

Suspected eczema was shown to the doctor, but they were not very certain?

Hello Dr.
Wu: (I have atopic dermatitis) I live in Germany, and after moving recently, I kept my windows and doors closed for a few days to avoid mosquito bites since I haven't installed screens yet.
Around that time, I started experiencing intense itching on my knees, which later spread to both knees with dense clusters of small red spots.
After I installed the screens, I thought the ventilation would help, but I then noticed similar spots appearing behind my ears and on my neck.
A few days later, I also developed small spots on the inner thighs, elbows, and around my philtrum.
The spots on my thighs and elbows are slightly red, while those around my philtrum are not very red.
It feels like it's spreading! Additionally, I consulted a local family doctor, but he said he didn't know what it was, so I would like to ask if this condition could be eczema? But can eczema appear in the philtrum area and behind the ears? Furthermore, I've started experiencing mouth sores and discomfort in my throat these past few days, as if my immune system is declining...
Thank you, doctor.

Miss Chen, 20~29 year old female. Ask Date: 2020/07/06

Dr. Wu Yuxin reply Dermatology

No lesions were observed, and it is not possible to determine the issue.
If you are very concerned, please seek medical attention promptly.

Reply Date: 2020/07/06

More Info

Hello! Thank you for reaching out with your concerns regarding your skin condition. Based on your description, it sounds like you are experiencing a significant skin reaction that has spread to multiple areas of your body, including your knees, neck, inner thighs, and around your mouth. Given your history of atopic dermatitis (eczema), it is possible that you are experiencing an exacerbation of this condition, but there are several factors to consider.

Eczema is characterized by dry, itchy, and inflamed skin. It can indeed appear in various locations on the body, including the areas you mentioned. However, the presence of small, red, raised bumps that are spreading could also indicate other conditions, such as contact dermatitis, which occurs when the skin reacts to an irritant or allergen. This could be particularly relevant if you have recently moved and been exposed to new environmental factors, such as different soaps, detergents, or even plants.

The fact that you have developed sores in your mouth and are experiencing throat discomfort raises additional concerns. These symptoms could suggest a viral infection or another systemic issue, particularly if you feel that your immune system is compromised. Stress, environmental changes, and even dietary factors can influence your immune response, potentially leading to outbreaks of skin conditions or infections.

It is also important to consider the possibility of other dermatological conditions, such as hives (urticaria), which can present as itchy welts and can be triggered by allergens, stress, or other factors. Additionally, conditions like folliculitis (inflammation of hair follicles) or even a fungal infection could present similarly.

Given that your local physician was unable to provide a definitive diagnosis, it may be beneficial to seek a second opinion from a dermatologist. A dermatologist can perform a thorough examination and may recommend patch testing to identify any allergens or irritants that could be contributing to your symptoms. They may also consider a biopsy if the lesions do not respond to standard treatments, to rule out other skin conditions.

In the meantime, here are some general recommendations that may help alleviate your symptoms:
1. Moisturize Regularly: Use a fragrance-free moisturizer to keep your skin hydrated, especially after bathing.

2. Avoid Irritants: Identify and avoid any potential irritants or allergens, including new soaps, detergents, or fabrics.

3. Cool Compresses: Applying cool, damp cloths to the affected areas can help reduce itching and inflammation.

4. Over-the-Counter Treatments: Consider using over-the-counter hydrocortisone cream to reduce inflammation and itching. Antihistamines may also help with itching.

5. Maintain Good Hygiene: Keep the affected areas clean and dry, and avoid scratching to prevent secondary infections.

6. Monitor Symptoms: Keep track of any new symptoms, such as fever or increased redness, which could indicate an infection that requires medical attention.

If your symptoms worsen or do not improve with these measures, please seek medical attention promptly. It is crucial to address both the skin condition and any systemic symptoms you are experiencing. Your health and well-being are important, and a healthcare professional can provide the best guidance tailored to your specific situation.
Wishing you a speedy recovery and relief from your symptoms!

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