Dogs may be culprit in the case of owner’s rash

January 24th, 2010

DEAR DR. GOTT: I have developed an itchy rash for the third time in a year. At the end of March, my arms broke out with this terrible itch between the elbows and wrists. Within 24 hours, my arms swelled and developed blisters that oozed yellow pus that had an odor. Because the itching was terrible, I saw my doctor, who prescribed prednisone and cephalexin. My arms healed.
Then at the end of April, my legs developed the same rash, blisters and itch. Again, I was given the same prescriptions, and my legs healed somewhat. The itching, oozing and swelling disappeared but in several places, I was left with patches of what I call “alligator skin.” These patches are dry and bumpy but don’t itch or otherwise bother me. They are on the inner sides of my knees, ankles and thighs, and I have a small patch on the lower portion of my stomach.
A few years back, I remember having the same thing happen to my legs. At that time, my doctor sent me to a dermatologist who quickly told me it was a vascular condition and referred me to a vascular MD and a surgeon. Both told me that it was not vascular and to go back to the dermatologist. I lost faith in dermatologists then.
This rash reminds me of when I was a kid and used to pick berries and would get poison ivy on my hands. My fingers would swell, and it was painful. The rash I have now reminds me of the poison ivy. I told my doctor about this.
I have bad knees, am overweight, and can’t get around well so I don’t get out into my yard much unless I’m with my two dogs.
I now have the rash, etc., on my legs again. It started around my ankles this time and is driving me crazy. I am back on the same medicine as before, and now my doctor wants me to see a dermatologist. Given my past experience, I’m hesitant and feel I should be seeing some other kind of physician.
Do you have any recommendations or advice? By the way, I am a 69-year-old female, and the only other medications I take are Synthroid for a thyroid condition and occasionally Benadryl for the itch of the rash.
DEAR READER: Based on your description, I agree with your conclusion that it is likely poison ivy or other plant dermatitis. The fact that it primarily occurs on your legs and arms leads me to believe that you are likely coming in contact with the offending plants’ oils when the dogs rub against your legs or you are picking up or holding them.
I urge you to consult with a second dermatologist about the rash. Unless you have had several bad experiences, there should be no reason to lose faith in these specialists. Your past experience of misdiagnosis sounds to me as if the dermatologist was merely precautious and likely said it “might” have been vascular and referred you on to make certain that you received proper care. If it was determined not to be a vascular condition, you should have returned to the dermatologist for further examination.
Because you have developed this rash again, I urge you to request that the blisters (and any fluid that may be draining) be cultured to determine if a virus or bacteria is causing it. As to your so-called “alligator skin,” this may be simply thickened skin owing to the repeated rashes and blisters. It could also be caused by friction of clothing or skin on those areas.
If this rash is truly caused by a type of plant dermatitis, I believe you may be able to reduce your risk of “catching” it by wiping down your dogs’ fur each time they come back inside during the spring, summer and fall months, unless you live in an area of the country that stays warm enough year-round for the offending plants to remain plentiful. Remember to wash your hands and exposed skin with soap to remove any offending oils from the leaves.
Because you say you do not get outside, you may also benefit from having a gardener review the types of plants in your backyard. If you have poison ivy, woodbine or other offending plants, you may wish to have them removed.
My final suggestion to you is to lose weight. You claim to be overweight and unable to get around because of bad knees. You may find that after losing weight, you are better able to ambulate. If your knees have deteriorated, you may be a candidate for joint-replacement surgery if you lose some of those excess pounds. It would also help you get out of the house to enjoy the fresh air and to manage your backyard and its maintenance.