Persistent Skin Rashes: Allergies or Immune System Issues?

Q: Persistent Skin Rashes: Allergies or Immune System Issues?

Hello, thank you for your question. <br>My answer is as follows： <br>Q： I would like to ask if this is considered an immune system issue? Because he only develops new red rashes on his right arm where he was bitten by mosquitoes initially, and it's not without reason that the ras

Environmental stimuli and mosquito bites causing a rash that has not improved over time?

Hello, I would like to ask about my friend who is 27 years old.
In July, he worked in a central kitchen, which is a humid and hot environment, handling food while wearing gloves.
After just seven days, he developed red rashes on the backs of his hands that were itchy, leading him to resign and seek medical attention.
The doctor suggested he might be allergic to the gloves.
He has been taking medication and applying topical treatments, but there has been no improvement.
During the treatment period, he was also bitten by regular mosquitoes on his right arm, which caused a significant number of itchy red rashes to appear there as well.

He has had a history of being allergic to mosquito bites since high school, where the bitten areas would become red, swollen, and develop blisters.
Typically, after seeing a dermatologist and using medication, he would recover within a week.
However, he is unsure if the ongoing allergy on the back of his hands, which has not yet healed, is contributing to the new rashes from the mosquito bites.
It has now been two months, and he continues to apply medication and take oral treatments daily.
The allergic reaction on the back of his hands has left only rough skin scars that are no longer itchy, but the rashes on his right arm have not improved and continue to produce new ones, while the old ones heal.
The dermatologist mentioned that he is allergic to himself, indicating that his immune system cannot differentiate between harmful and harmless agents, leading to the continuous emergence of new rashes (during this time, he has had minimal exposure to irritants, no sun exposure, and has been careful with his diet, following the doctor's advice and consistently taking medication).

I would like to ask if this is considered an immune system issue? The new rashes only appear on his right arm where he was bitten by mosquitoes, and they do not seem to arise without reason.
Despite visiting several dermatologists, there has been no improvement.
Should I take him to see an allergist or immunologist, or should he continue seeing dermatologists and maintain his current treatment regimen? Is it normal for skin conditions like this to be so persistent and take several months to heal? Thank you.

Bai Ya, 20~29 year old female. Ask Date: 2022/09/18

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
My answer is as follows:
Q: I would like to ask if this is considered an immune system issue? Because he only develops new red rashes on his right arm where he was bitten by mosquitoes initially, and it's not without reason that the rashes keep appearing...
However, after visiting several dermatologists, there has been no improvement.
Should I take him to see an allergist or immunologist, or continue seeing a dermatologist and keep taking medications and applying ointments? Is it normal for skin diseases to be so stubborn and take several months to heal?
A: Yes, there is an abnormality in the local skin immune function.
It would be advisable to consult an allergist or immunologist.
Some localized allergic issues, such as contact dermatitis from wearing rubber gloves, can indeed take a longer time to treat.
It is recommended that if there is a chance of wearing gloves again, you should first wear thin cloth gloves before putting on rubber gloves.
Additionally, topical medications should be applied until the skin is completely normal before stopping; do not apply intermittently, as this can prolong the treatment duration.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/09/18

More Info

Your friend's situation appears to be quite complex, involving both allergic reactions and potential immune system issues. Based on the information provided, it seems that your friend is experiencing persistent skin rashes that have not improved despite treatment. This raises several important considerations regarding the underlying causes and the appropriate course of action.

Firstly, the initial rash on your friend's hands, which developed after working in a humid environment while wearing gloves, suggests a possible allergic contact dermatitis. This condition occurs when the skin reacts to allergens or irritants, in this case, potentially the material of the gloves. The fact that the rash has persisted for two months, despite treatment, indicates that there may be ongoing exposure to the allergen or that the skin barrier has been compromised, making it more susceptible to further irritation.

The subsequent reaction to mosquito bites on the right arm, which has resulted in new rashes, could be indicative of a heightened sensitivity to insect bites, known as papular urticaria. This condition is common in individuals with a history of allergic reactions and can lead to significant discomfort and persistent lesions. The immune system's response to these bites may be exaggerated, leading to the formation of new rashes as the body continues to react to the allergens.

Your friend's experience of having rough skin scars on the back of the hands, while the arm continues to develop new rashes, suggests that there may be an underlying issue with the immune system. The statement from the dermatologist about your friend being "allergic to himself" could imply an autoimmune component, where the immune system mistakenly targets the body's own tissues. This is not uncommon in conditions such as eczema or atopic dermatitis, where the immune response is dysregulated.

Given the complexity of your friend's symptoms and the lack of improvement with standard treatments, it would be advisable to consult with an allergist or an immunologist. These specialists can perform more comprehensive testing to determine if there are specific allergens involved or if there is an autoimmune process at play. They may also recommend different treatment strategies, including potential immunotherapy or more targeted medications that could help manage the immune response more effectively.

In terms of managing the current situation, it is essential for your friend to avoid known triggers, such as the gloves that caused the initial reaction and any other allergens that may exacerbate the condition. Maintaining a proper skincare routine, including the use of emollients to restore the skin barrier, can also be beneficial. Additionally, keeping a diary of symptoms and potential triggers may help identify patterns that could inform treatment decisions.

It is not uncommon for skin conditions, especially those involving the immune system, to take time to resolve. However, if your friend continues to experience persistent symptoms despite following medical advice, seeking a second opinion or a referral to a specialist would be a prudent step. The journey to finding the right diagnosis and treatment can be lengthy, but with the right support and medical guidance, improvement is certainly possible.

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