Ezcema / Ringworm / Fungal Infection ? Doctors are not sure themselves, neither am I

[olly330]

Would really appreciate any advice you can offer. I am a 30 year old male, generally good health although did have persistent eczema when I was a child which did clear up by the time I was 12 or so.

Last few years I have had a few occurrences of ringworm around my neck and athletes foot.
Skip to the present, I currently have this problem on my neck for the last 5 weeks, gradually getting worse. I have been to GP’s 3 times now. First one thought it was eczema, gave me hydrocortisone which I took for around 2 weeks, didn’t work.
Last 2 GP’s I have seen have said it is most likely a fungal infection / ringworm, and have prescribed me Nizoral 2% which I have now been using around 3 times a day for 15 days. It has gradually gotten worse around my neck. So I am thinking maybe it is not ringworm, and could be eczema.

Currently it feels very dry, so I have to keep it heavily moisturized using Hydromol ointment, otherwise its quite painful. Its quite raw in places, and just light spots in others. I have also been trying a tea tree & olive oil mix on it for the last few days but its too early to say if its working.
I am very keen to diagnose it properly, and more importantly try to change things in my life/diet so that I can prevent it coming again. My doctor did say I have a weak immune system to this now which is why I break out with athletes foot/rashes quite often. I have been reading and am now taking apple cider vinegar, 2 garlic cloves a day, and have order some acidophilus tablets to take. I think the insides are really weak to this sort of thing so need to sort it out!

Its strange though, as I have only started these breakouts in the last year or so and am generally healthy going to the gym 3 times a week and running.

Any advice, or if you can work out what it is would be appreciated as GP’s don’t give me more than 5 minutes are very disinterested.

[olly330]

Just to add, im aware of possibly bed bugs / dust mites flaring this and have always been extra careful about clean bed lined and am washing all sheets in hot cycle at least once a week - so I think it cannot be due to dust mites.

[Dr.Saiyan]

Hi olly! Welcome to our forum. Sorry to hear about your condition. Firstly wanna ask you few questions , are the lesions itchy or painful? Do you have white lacy lesions in mucosa of mouth or annular lesions in glan penis? How are your nails? Do you have any lesions in the scalp? You seem to have two different skin condition one on neck and nape of neck other in wrist ,which seemed manipulated by different medication used by you. Hope you answer the my questions patiently.

[olly330]

Hiya Saiyan. I greatly appreciate you taking the time out of your day to reply to my post, so kind of you. So I will try and give some more information, and I have taken pictures today when skin feels slightly calmer.

Are the lesions itchy or painful?
No, not particularly. As long as I have a shower every day, apply the Nizoral cream then Hydromol ointment on top to keep it moisturised it wont feel itchy. However, if I have a moment of stress throughout the day it does instantly feel itchy and my hand will just want to go and itch it, I try to not do this though. They are not painful, sore feeling and quite tender but not constant pain. If I dont keep the area covered with Hydromol to moisturise, it will get extremely dry and look different, dry/cracked looking and then its painful. The moisturising Hydromol will be fully absorbed/rubbed off by 2/3 hours so I will need to re apply as the skin will be very dry by this point. I have also noticed my whole body is a lot more dry, especially my penis – I have applied Doublebase Gel and Hydromol to try and lock some moisture in.

Do you have white lacy lesions in mucosa of mouth ?
I have not noticed any of this, the mouth is ok.

Annular lesions in glan penis?
No ring like or annular lesions on glan penis. Only notable difference on glan penis is a lot more dry than usual and a little flaky skin, so I am making sure it is kept moisturised.

How are your nails? They are normal, no problems.
Do you have any lesions in the scalp? Scalp is normal.

You could be correct that the wrist and neck conditions are different. The wrist condition seems to not be as dry/flaky and no itchy at all, and does look different. The neck and below seems to be spreading quickly, and fills out the skin. I am really not sure if the 2 GP’s I have seen have correctly diagnosed my neck as being ringworm. As it is not getting better, I have another appointment at the GP on Friday 30/11/12, and may ask for a referral to a dermatologist in the hope that a dermatologist would have more insight.

Any further opinions or thoughts are welcome.


Pictures taken today:

[pepsimax]

Hi Olly. Sorry I cannot help specifically with your issue but I am from the UK so know how our health system works. Usually GP's have to exhaust all avenues before they refer you but I would suggest you push for one at least so it can be examined by someone experienced in dermatology and possibly a biopsy done (a painless skin scraping). This is often done at a neighbouring surgery rather than a hospital to save on costs.

Saiyan is very experienced so please keep in touch here for further advice and help.

[Dr.Saiyan]

Hi friend!
Though the lesions are not very typical which may be due to manipulation, by trying different medications. You seem to have history of atopic eczema caused by dysregulated immune system developing antibody to many normal antigens. Your present condition seems like mixture of two different subtypes of same disease lichen planus i.e actinic lichen planus and follicular lichen planus. The condition is self limited which may take months or sometimes years to heal itself. The cause of this disease is not clear also assumed to be immune mediated. the histopathological diagnosis is confirmatory for the disease. So I would suggest you to see a dermatologist undergo a biopsy test to confirm it and treat accordingly.

[aromatherapist]

Saiyan are you a nurse or something? You seem to know alot of medical type terms.

Olly330 so sorry to hear what you are going through. diagnosis of many conditions is not really very easy because so many different conditions share similar symptoms.

[olly330]

Pepsimax & Saiyan & Aromatherapist
Thankyou so much for your replies, they were great as you have me a base to start researching and good tips to present to my GP.

I went to see the doctors on Wednesday as I couldn't wait any longer, and saw a different GP to the initial unhelpful one. Luckily, the GP I saw was very patient and gave me time to break the history of how it has got to this stage.

And Saiyan with your fantastic insight that it could possibly be Lichens Planus I was able to do research before I went in, the GP looked and said this is not a matter for him or other GP's in general, and said its important to see a dermatologist asap, so he is going too refer me with urgency - although i know this will probably still take 2 weeks at the earliest to be seen. Im thankful that I have a hospital with fantastic dermatology department close to me, I opted to go their.

In the meantime the doctor did agree with you Saiyan that it is possibly Lichens Planus which can be very difficult to treat, and was pleased I had done some research on the issue before I went in, im thankful for these brilliant forums. He advised me to stop using any anti fungal cream on the neck (ketazol) and just to keep the area heavily moisturized with hydromol to stop it drying out and becoming irritated. He also advised to stop using all shower gels and handwash as it could be aggravating the area and prescribed me doublebase shower gel to use in the shower along with hydromol as a soap substitue. I have to say since the 2 days i have stopped using ketazol the skin is slightly calmer and feels better, I truly believe ketazol was making it worse.

At least I feel I am going to see the right people, and will just have to monitor the condition while I am waiting.

Thankyou to all.

[olly330]

I also started a course of Flucloxacillin 500mg x 4 for 7 days, doctor said its worth trying these to kill any bacteria that is growing within the bumps.

[pepsimax]

Olly I am so pleased we could offer you some help and finally your doctor referred you. I know a couple of weeks can seem a way off but with our health system you could wait 6 months for a non urgent appointment. At least at the hospital you will see a specialist and they wont discharge you until a treatment has been found that works.
I hope you stay in touch to keep us updated and maybe this thread will go a long way to helping others in the future. Its good when people respond to posts, like you have, to update us.
Hope things continue to ease for you and we are always here if you need any advice.