Persistent Rash on Hands: Causes and Concerns

Q: Persistent Rash on Hands: Causes and Concerns

Hello Albert： Regarding the sudden appearance of itchy white spots on the back of your hand, this medical history suggests acute papular eczema; however, it is unusual that it has not resolved after three weeks. <br>If you have been undergoing continuous treatment, it should impr

Rash on the hand?

Dear Doctor,
I apologize for interrupting you during your busy schedule.
My situation is as follows: at the beginning of this month, I suddenly developed some small white bumps on the back of my right hand, located around the joints of my index and middle fingers.
They are itchy but the itchiness subsides after about ten minutes.
A few days later, I noticed similar small bumps appearing on the back of my left arm, behind the wrist joint.
They resemble water droplets and are also itchy, but if I ignore them, the itchiness goes away after a while.
However, I often experience itchiness in the mornings and after dinner in the evenings, although it doesn't last long.
It has been over three weeks now, and the bumps have not disappeared; sometimes they still itch.
I have consulted a doctor, who advised me not to worry, but I find it strange that they have not resolved after such a long time.

About a week before the bumps appeared, I had consumed a large amount of shrimp.
Recently, I have also experienced itchiness all over my body, but no bumps have developed in other areas.
Could you please tell me what this might be? I asked a friend, and they suggested I get tested for HIV.
Do these symptoms resemble HIV-related rashes? My sexual activity is not particularly promiscuous.
Additionally, if I look closely at my arms in sunlight, I can see some small white spots concentrated on the upper part of my forearms, which are not itchy and seem to have pores in the middle.
Could this be a sebaceous issue? I tend to have oily skin, both on my face and scalp.
Could this be the main cause of my problems?
Thank you very much for taking the time to respond amidst your busy schedule.
I wish you all the best and good health.
Thank you!

Albert, 20~29 year old female. Ask Date: 2008/07/24

Dr. Zhang Zhibo reply Dermatology

Hello Albert: Regarding the sudden appearance of itchy white spots on the back of your hand, this medical history suggests acute papular eczema; however, it is unusual that it has not resolved after three weeks.
If you have been undergoing continuous treatment, it should improve, unless the treatment has been intermittent, which can prolong allergic reactions.
If it were caused by shrimp consumption, it would typically present as a generalized distribution, with symptoms fluctuating, rather than remaining in the same location.
This is not related to HIV infection, as viral rashes usually accompany systemic symptoms like fever and are generally not itchy.
As for the issue on your arm, the white spot centered around the hair follicles is likely "keratosis pilaris," which usually has no symptoms unless there has been prolonged scratching leading to inflammation.
Treatment can include exfoliating agents (such as retinoids, urea, salicylic acid, etc.).
For more information on "keratosis pilaris," please see http://dermnetnz.org/acne/keratosis-pilaris.html.

Reply Date: 2008/07/24

More Info

Dear Patient,
Thank you for reaching out and sharing your concerns regarding the persistent rash on your hands and arms. I understand that experiencing unexplained skin issues can be distressing, especially when accompanied by itching and discomfort. Let's break down your symptoms and explore potential causes and concerns.

From your description, it seems that you have developed small white bumps on the back of your right hand and the inner part of your left arm, which are itchy but tend to resolve quickly. The fact that these bumps have persisted for over three weeks raises some questions about their nature and underlying causes.

1. Possible Causes of the Rash:
- Allergic Reaction: Given that you mentioned consuming a large amount of shrimp shortly before the rash appeared, it is possible that you are experiencing an allergic reaction. Shellfish allergies can manifest as hives or rashes, often accompanied by itching. Even if you have consumed shrimp before without issues, allergies can develop over time.

- Contact Dermatitis: This condition occurs when the skin reacts to something it has come into contact with, such as soaps, lotions, or even certain fabrics. If you have changed any products recently, this could be a factor.

- Eczema or Psoriasis: These chronic skin conditions can cause itchy, inflamed patches on the skin. Eczema often appears in response to allergens or irritants, while psoriasis is an autoimmune condition that can lead to scaly patches.

- Folliculitis: The small white bumps you see could also be related to folliculitis, which is the inflammation of hair follicles, often caused by bacteria or irritation.

2. Concerns Regarding HIV:
- It is understandable to be concerned about the possibility of HIV, especially when discussing skin rashes. However, HIV-related rashes typically present differently and are often accompanied by other systemic symptoms such as fever, fatigue, or swollen lymph nodes. If you have had unprotected sexual encounters or are concerned about your risk, it would be prudent to get tested for HIV and other sexually transmitted infections (STIs) for peace of mind.

3. Skin Oiliness and Pores:
- You mentioned that you have oily skin and that you can see small white spots on your arms, which may be related to sebaceous glands. Oily skin can lead to clogged pores, which might result in conditions like acne or milia (small cysts). Maintaining a good skincare routine can help manage oiliness and prevent clogged pores.

4. Next Steps:
- Since the rash has persisted for over three weeks, it would be advisable to follow up with a dermatologist. They can provide a thorough examination and may perform tests to determine the exact cause of your rash. Treatments can vary widely depending on the diagnosis, ranging from topical steroids for inflammation to antihistamines for allergic reactions.

- In the meantime, try to avoid scratching the affected areas, as this can lead to further irritation or infection. Keeping the skin moisturized and avoiding known irritants can also be beneficial.

In conclusion, while there are several potential causes for your symptoms, a professional evaluation is essential for an accurate diagnosis and appropriate treatment. Please do not hesitate to seek medical advice, and remember that your health and well-being are of utmost importance.

Wishing you good health and a speedy resolution to your concerns.

Best regards.

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