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Can anyone identify these symptoms? Desperate.

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  • Can anyone identify these symptoms? Desperate.

    Hello all-
    I was referred here by a friend as a last ditch effort in figuring out what is going on with my skin. It's a rather complex story so I will dry to condense it into a concise time line with symptoms. I know it's still a lot of info, but I am at the end of my rope with this and was hoping someone might be able to offer some insight. if you don't have time to read, just have a look at the pictures attached, they are from 2 separate outbreaks to illustrate how this condition is manifesting itself. the final image ("normal.jpg") is simply a control to show how my skin normally appears, it was taken a few days before the outbreak in the "legs.jpg" image) I am starting to think I have seb derm (which seems pretty obvious) but then also some other condition on top of that which is not being properly diagnosed as most dermatologists see the seb derm symptoms and stop investigating right there and prescribe the stardard cortisone regimen (which I don't want to do as it's not really good for me in the long term to be using steroids all the time)

    quick background: 31 year old male. no existing medical conditions although I would consider myself as having itchier than normal skin for my whole life, if that makes any sense. I live in San Francisco (somewhat cold most of the time, don't get much sun, work from home so don't get out as much as I should) previously lived in sacramento, CA where I got out a lot and got a lot of sun with no symptoms ever aside from mild seb derm on face only. used over the counter cortaid for 3 years on face only when flare ups occurred. father has very mild seb derm. I had shingles at age 24 (not sure if that's relevant but thought I would mention it in case it's some sort of precursor)

    - used to get a lot of sun (way too much I am sure) in sacramento, but never developed symptoms. was not good about using sunscreen, basically never used it since was very dark back then.

    - moved to san francisco at age 28 in the month of january (winter).

    - 2 weeks after moving went on vacation to hawaii. during trip developed a bad rash similar to "body.jpg" (see attachment). this was the very first time I had seen anything like this. was over most of the areas that were exposed to sunlight. symptoms included a rash of red welts which itched and then later became flakey and dry after drying up.

    - went to first dermatologist. was told I have some sort of infection on my skin and was prescribed an antimicrobial cream (I think, maybe antifungal?) to use. symptoms cleared , although I think they did on their own since I had later problems.

    - started developing same symptoms next time I went in sun. went back to new dermatologist. was told I had seb derm and given pandel (hydrocort) and metrogel. told to take for flare ups or every week. this was not really a good solution since it was over all of my body and clearly deb derm doesn't behave like this typically.

    - tried holistic route, changed diet took fish oil etc.. this helped a bit, but I was still breaking out after heavy sun exposure. also tried pyro zinc and other dandruff shampoos (even prescription strength). they seeemed to help somewhat, but wouldn't prevent the major flare ups.

    - travelled to thailand and have worst reaction yet (see picture "legs.jpg" in attachments) this time the welts developed into actual sores on my legs, but the ones on the body weren't as severe. this reaction was after a day of heavy sun exposure (with sunscreen) and long distance swimming (heavy physical exertion). this time the welts on my legs were so bad that they began to hurt, sharp pains as opposed to only itching. some or the larger ones scabbed over.

    - 3 weeks after returning home I laid out on a sunny day in february in san francisco after a long bike ride with heavy physical exertion. laid out for appox. 30 mins with no shirt. the result was a very bad and very sudden flare up. see "body.jpg" and "side.jpg". both were taken approx. 4 hours after sun exposure.

    - this summer I have been trying to get more gradual sun to see if it's just an issue of too much sun all at once after a prolonged period of no sun at all. it seems to be working a little, but if I go to the beach for a couple hours I will break out, particularly on my face if I don't use pandel + metrogel after.

    The worst flare ups seem to occur under these circumstances: Heavy sun exposure, heavy physical activity (sweating particularly), and lack of recent prior sun explosure. the red rash is usually confined to the face, legs, and front of the trunk (body) (even when the back has been exposed). there is itching on the scalp as well.

    I really don't know where to turn now. I have an appt. at a supposedly great dermatologist next week, hopefully that will help. but I wanted to go prepared by checking in here and seeing if anyone had any clues or recognized any symptoms from their own experiences.

    Thank you in advance for any help, I really appreciate it.

    Attached Files

  • #2
    It seems pretty clear to me based on your description, at least in my opinon. As you have determined your reaction is always related to sun exposure and I would start my research and thoughts in that direction. Whatever it is, it ain't seb derm in my book. Have a look at this and go from here.
    Last edited by boyandhisdog; 28 August 2008, 11:22 AM.


    • #3
      thanks so much for the info. this PMLE sounds like a dead on diagnosis. I really appreciate your reply and I'm very relieved it isn't something more serious. funny how all those doctors couldn't get it right but I got an answer from this forum in a half hour.


      • #4
        Yikes- that looks so painful! I'm so sorry that is happening to you.

        I was going to say it sounds/looks like chronic urticaria due to a sun allergy. That link Rob gave you is very informative. I hope it helps you out.

        You can also check out this website

        They have a lot of great info and a wonderful Yahoo message board community. I spent a lot of time there last year when I was going through something similar.

        I would also recommend getting the ANA test (which is mentioned in the link Rob posted). It's a simple blood test and would be good to have to make sure what you are getting isn't some autoimmune issue masked as a sun allergy.

        Good luck!



        • #5
          Hi and welcome to the Forum.

          I had PMLE because of the doxycycline I am on. It can cause photosensitizing reactions. I just applied a steroid to the affected areas (arms mainly) for a few days and it went away. What I can't understand is why a derm was unable to properly diagnose you. My derm took one look at my arms and said that's what it is and it was a big relief because as you know it is very stressful not knowing what the heck is going on with your body.

          In addition to a topical steroid on the affected areas an antihistamine may help the itchiness. As J pointed out you should be tested for autoimmune diseases just to rule them out as other conditions can mimic PMLE.
          Just find a good derm as that is critical in diagnosis and correct treatment. You might want to check out a teaching university as they usually have sharp doctors who keep current.

          Best of luck!

          PS Good job Rob...maybe a career switch is in your future?


          • #6
            Originally posted by melissawohl View Post
            Just find a good derm as that is critical in diagnosis and correct treatment. You might want to check out a teaching university as they usually have sharp doctors who keep current. :
            A good derm is key, but also find yourself a good allergist. It took 10 months for anyone to finally figure out what was going on with me. My allergist finally did patch testing and determined I have become allergic to five chemicals very common in many products I was using. Once I stopped using them, things go so much better! A derm can do patch testing as well, but not all of them do.



            • #7
              Sometimes I feel like we need a whole team of good doctors to really figure out what's going on so we can get real help.


              • #8
                Originally posted by melissawohl View Post
                Sometimes I feel like we need a whole team of good doctors to really figure out what's going on so we can get real help.
                Oh yeah, I've got my derm, allergist, gastro doc, nutritionist (although I only saw him once, he was a huge help), and now the D.O. I feel like I'm FINALLY getting somewhere!