[26F] With widespread itchy, thick patches for 2 months

Patient Description

A 26-year-old female has been experiencing itchy, thick patches on various parts of her body, including both arms and legs, lower and upper back, upper chest, neck, ears, back of both knees, buttocks, calves, inner thighs, face, and breasts for the past two months. The patches are red, brown, raised, dry, and flaky. The itching worsens at night and is triggered by heat, sweating, and fragrances. Rubbing helps temporarily but irritates the patches soon after. Prednisone helped but did not make the patches disappear. The patient has a history of eczema, but this current condition is worse. She has not been around anyone else with similar symptoms and hasn't used any new skincare products, soaps, or detergents recently. The itching episodes usually occur in the fall and winter. There is no oozing, crusting, swelling, or pain in the affected areas, and no changes in her nails. She has a family history of eczema and has not traveled recently. Additionally, she has been diagnosed with anxiety, depression, and PTSD earlier this year and is currently taking several medications, including Doxepin 25mg (nightly), Gabapentin 300mg (three times daily), Hydroxyzine Pamoate 25mg (nightly), Prazosin 1mg, Fluoxetine 10mg, and a women's probiotic.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Eczema (Atopic Dermatitis): Given your history and family history of eczema, this is a likely cause. Eczema can cause red, brown, raised, dry, and flaky patches that are intensely itchy. It often worsens in the fall and winter due to dry air and can be triggered by heat, sweating, and fragrances.

    • Treatment: Eczema is typically managed with moisturizers, topical corticosteroids, and avoiding known triggers. In severe cases, systemic treatments like oral corticosteroids or immunosuppressants may be used.
  • Psoriasis: This is another chronic skin condition that can cause red, raised, and flaky patches. Psoriasis can be triggered by stress, which might be relevant given your anxiety, depression, and PTSD.

    • Treatment: Psoriasis is usually treated with topical treatments, phototherapy, and systemic medications.
  • Contact Dermatitis: This condition occurs when the skin reacts to an irritant or allergen. Although you haven't used new products recently, it's possible that prolonged exposure to certain substances could be causing your symptoms.

    • Treatment: Identifying and avoiding the irritant or allergen is key. Topical corticosteroids can help manage symptoms.

What you can do

While it's important to consult a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to manage your symptoms:

  1. Moisturize Regularly: Use a thick, fragrance-free moisturizer multiple times a day to keep your skin hydrated.
  2. Avoid Triggers: Try to avoid heat, sweating, and fragranced products as much as possible.
  3. Use Gentle Skincare Products: Opt for mild, fragrance-free soaps and detergents.
  4. Cool Compresses: Applying cool, damp cloths to the affected areas can help relieve itching.
  5. Over-the-Counter Treatments: You can try over-the-counter hydrocortisone cream to reduce inflammation and itching.
  6. Keep a Symptom Journal: Use MDandMe to journal your symptoms, track progress, and share longitudinal medical notes with your provider. This can help identify patterns and triggers.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe Itching or Pain: If the itching or pain becomes unbearable, it's important to see a healthcare provider.
  • Signs of Infection: If you notice any oozing, crusting, or increased redness and warmth around the patches, this could indicate an infection.
  • Worsening Symptoms: If your symptoms continue to worsen despite self-care measures, consult a healthcare provider.
  • New Symptoms: If you develop new symptoms such as fever, chills, or swelling, seek medical attention promptly.

Remember, while these tips can help manage your symptoms, it's crucial to consult a healthcare provider for a formal diagnosis and appropriate treatment.

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5 mo ago

People Also Ask


What are the common triggers for eczema flare-ups?

Common triggers for eczema flare-ups include dry air, heat, sweating, fragrances, certain fabrics, and stress. It's important to identify and avoid personal triggers to manage symptoms effectively.


How can I differentiate between eczema and psoriasis?

Eczema and psoriasis can both cause red, flaky patches on the skin, but they have some differences. Eczema patches are often intensely itchy and can appear anywhere on the body, while psoriasis patches are typically thicker, may have a silvery scale, and are often found on the elbows, knees, and scalp. A healthcare provider can help differentiate between the two conditions.


What are some effective treatments for managing eczema symptoms?

Effective treatments for managing eczema symptoms include regular use of moisturizers, topical corticosteroids, avoiding known triggers, and using gentle skincare products. In severe cases, systemic treatments like oral corticosteroids or immunosuppressants may be necessary.


Can stress and mental health conditions like anxiety and depression affect skin conditions like eczema?

Yes, stress and mental health conditions like anxiety and depression can exacerbate skin conditions like eczema. Stress can trigger or worsen flare-ups, so managing stress through relaxation techniques, therapy, or medication can be beneficial for skin health.


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