Medication Consultation for Persistent Skin Allergies and Joint Concerns - Internal Medicine

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It sounds like you are experiencing a challenging situation with persistent skin allergies and joint concerns. Based on your description, it appears that you may be dealing with a condition known as dyshidrotic eczema or pompholyx, which is characterized by itchy, fluid-filled blisters on the palms of the hands and soles of the feet. This condition can be exacerbated by stress, humidity, and allergens, which may explain the worsening of your symptoms during stressful times.

The fact that you have been experiencing these symptoms for over six months and that they are recurring suggests that there may be an underlying issue that needs to be addressed. The presence of crusting and thickened skin indicates that your skin barrier may be compromised, leading to increased susceptibility to irritants and allergens. Additionally, the moist and sticky feeling between your fingers could be a sign of secondary infection or a fungal component, which is not uncommon in cases of eczema.

Regarding your allergy testing, it is interesting that you are only allergic to dust mites, as this is a common allergen that can contribute to various allergic reactions, including eczema. The ANA (antinuclear antibody) test result of 1:640 is noteworthy, as elevated levels can indicate an autoimmune process. However, it is important to note that a positive ANA test alone does not confirm a diagnosis of conditions like rheumatoid arthritis or lupus; further testing and clinical correlation are necessary.

As for the medications you have been prescribed, including hydroxychloroquine (希骨樂) and mefloquine (殲瘧), these are typically used for autoimmune conditions and malaria, respectively. While hydroxychloroquine is often used in the management of lupus and rheumatoid arthritis, it is generally considered safe for use in patients without these conditions, but it is essential to monitor for potential side effects, such as retinal toxicity and gastrointestinal disturbances. It is crucial to have an open dialogue with your healthcare provider about the rationale for prescribing these medications, especially in the absence of a confirmed diagnosis of autoimmune disease.

In terms of managing your skin condition, here are some recommendations:
1. Moisturization: Regularly apply a thick, fragrance-free moisturizer to your hands and affected areas, especially after washing. This helps restore the skin barrier and reduce dryness.

2. Avoid Irritants: Identify and avoid any known irritants or allergens that may be triggering your symptoms. This includes harsh soaps, detergents, and certain fabrics.

3. Stress Management: Since you mentioned that your symptoms worsen during stressful times, consider incorporating stress-reducing techniques such as mindfulness, yoga, or deep breathing exercises into your routine.

4. Topical Treatments: If your symptoms persist, a dermatologist may recommend topical corticosteroids or calcineurin inhibitors to reduce inflammation and itching.

5. Follow-Up Testing: Given the elevated ANA levels, it may be prudent to follow up with your healthcare provider for further evaluation, including additional blood tests or referrals to specialists if necessary.

6. Avoid Scratching: Try to avoid scratching the affected areas, as this can lead to further irritation and potential infection.

In conclusion, while the medications you are taking may not pose significant risks in the absence of a confirmed autoimmune condition, it is essential to have ongoing communication with your healthcare provider regarding your symptoms and treatment plan. Additionally, focusing on skin care and identifying potential triggers will be key in managing your persistent skin allergies. If your symptoms do not improve or worsen, seeking a second opinion from a dermatologist or an allergist may be beneficial.