Can you help me identify a skin condition??

[Rabbitheadlights]

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We are 7 years down the line with GP, dermatologists etc and the only explanation ever given is eczema, nothing works, it's extremely painful often cracks and bleeds present on hands, inner arms and under arms. DP is a chef while on furlough it disappeared completely ?? Any ideas??

Was his diet different? It could be dermatitis hepetiformis which only clears up by not eating gluten

Does he wear a chef uniform? What's it made of? If something is getting majorly irritated and he is hot and sweaty, some cheap man made fabrics will make it a million times worse. He needs something that can allow air flow, wick away moisture etc. Worth trying anything really?

To answer a few things I do think the heat plays a part the air conditioning and fans at work don't work and haven't done for a long time, he wears cotton gloves, with latex gloves over the top when working @viperatthegatesofdawn agree re the change of jobs but it's all he's ever known and he's scared of the change he's 47 this yr, and somewhat socially awkward the thought of such a drastic change terrifies him.

@hamandcheeselife he definately ate a better diet while on furlough but not different really certainly he ate gluten

Thankyou @jajabanks will look into the balneum oil, can I ask have you ever tried potassium permanganate?

Perhaps he could look for a job as a chef in a daycare centre/school/homeless shelter or staff canteen. He would still be cooking but maybe not have such high pressure. Very cool showers with a cold blast at the end helped my husband when his skin reacted with a bad rash. Also Moogoo are great products for sensitive skin.

Could it be Contact Dermatitis? Does he use special handwashes, washing up liquids or anything else that could cause irritation at work?

Had he tried Eucerin? All the usual GP suggested emollients are useless on me but the magic ingredient is urea . Sound like stress is a strong possibility.

I wouldn't say urticaria either. I'd say a sweat rash caused by the conditions he works in, possibly fungal.

[quote Rabbitheadlights]@jewelGarden there's no smell, should I just buy the daktacort cream?[/quote]
Well it's not expensive, works wonders on a range of skin conditions so I would give it a go especially if nothing else has worked so far. I was wondering if it might be fungal which would sometimes have a smell.

This is how intertrigo looks in the armpit, I can't tell from your picture if it's similar or not, but daktacourt will clear it if that's what it is.

Sounds like he needs a different job.

Oat baths are great for problem skin. Load a handful into an old sock and wash with it. If it helps and you need to use it regularly, put oats in a blender till they're ground to a powder and you can put it straight in the bath like bath salts rather than faff with the socks.

Well for a start his employers have a duty of care to sort out the air conditioning and fans.

I was going to suggest aqueous cream or even sudacrem but im guessing you've tried those?

If he can tolerate it, I'd also see how he gets out with using a gentle baby powder on affected areas before going to work. Fresh uniform every shift, with a cool/tepid shower immediately before and afterwards.

He might also find a quick freshen up in gents helps too - wipe down the affected areas with a flannel or baby wipe, followed by powder.

I'm not casting aspersions on his hygiene, btw, I hope that's not what is coming across, but if it is heat related then this might help manage the temperature of the areas and give his skin a break.

If it is heat related, my approach would be to tackle it gently and consistently before opting for stronger products. Aloe Vera might help too. Oat baths (cool) are a good idea.

Again, apologies if you've already done all of this!

Do not use aqueous cream it has a detergent in it check out this link to see what it does to skin
www.bbc.co.uk/programmes/articles/1DjRTHSCZK3h7V6dlxyHRdP/are-my-wash-products-damaging-my-skin
Most things that bubble that you put on your skin contains sls or the milder sles.
I used to have guttate psoriasis over most of the top half of my body. I stopped using commercial products and when I started using my own soap, my skin cleared up and the psoriasis has not returned 10 years later. I don't even need to use any moisturisers and have not done so for all of that time. I won't say soap is what cleared it up but I do believe stopping any products with sls or sles in is what helped.

I’d guess he is either allergic to something at work or it’s heat induced. Antihistamines can’t always overpower allergens. For my skin allergies, I have to avoid direct contact, get a shot every 2 weeks, end still regularly have to take prescription antihistamines and use prescription topical steroids because of airborne exposures.

Has he had allergen testing?

If it’s heat induced or exacerbated
make sure his clothing is always freshly washed in hypoallergenic detergent and avoid fabric softeners . Never rewear anything

If he has a break, wiping down his skin to clean off, just with water can be a good idea.

If you know it’s allergen free, a powder to keep his skin dry may also help, but that can be tricky.

Following as I'm having burnt skin that cracks and peels with no answer as of yet.

Has all this treatment been with the GP only? If not then surely a referral to a dermatologist is warranted, to get specialist help and diagnosis? He should push for this if the GP is resistant.

I’m so sorry, it sounds so painful and debilitating.

My daughter has had similar & she ended up going private to get a diagnosis of Atopic Dermatitis from the Dermatologist ( who thankfully after a few appointments sent a letter to her NHS Dermatology consultant, telling them the diagnosis & what was needed next) steroid injections helped but only short term & now she is going to be taking an immunosuppressant as she has gone through everything else. He really needs to be referred back to dermatology, it’s taken my daughter years to get to this point & she is a chef to trade but gave it up due to this. This is the chart that details the levels & treatments.

Try Cavilon spray and cream on his hands. It is amazing stuff.

can I ask have you ever tried potassium permanganate

Potassium permanganate (or Condys crystals) is drying and will stain skin brown. I've used it for a fungal condition my dog had with his paws (vet prescribed) and it did the trick. You could give it a try if you think it's fungal, maybe only do one patch to compare if it improves. I'm not sure if it stings on broken skin.

I'd hazard a guess it's a combination of heat and damp and possibly friction in the armpit area. Has he tried a light undershirt to see if it helps the underarms? You'd want it close fitting, but not tight, and light cotton tshirt type material. I have to do that sometimes for a similar looking rash over summer and find it really helps. I also find plain Vaseline can be very soothing - worth a try as it's cheap and shouldn't do any harm. I apply very frequently.

I would have thought that if it was urticaria or anything else suggested here that a dermatologist would have spotted it.

Oh wow I just googled intertrigo and the causes and that really fits the bill. And the rash looks incredibly similar to urticaria.

I must admit, I said urticaria but the fact that you didn't mention intense and torturous itching and did mention pain and cracking - tells me that it isn't urticaria.

But surely a dermatologist could diagnose intertrigo?

You'd have thought!

My first thought was intertrigo as that’s what I suffer with on and off under the boob area. I use Caneston hydrocortisone which is steroid and anti fungal mix and that helps a lot.

It’s worse in this heat. Pure cotton clothing is a lifesaver too helping the skin to stay cool.

Ok ...

Thanks @mrspelligrinopetrichor I will look into eucerin

@jewelgarden that really looks like it under the arms, but under the arm is a very recent thing this tends to start on his hands like hundreds of tiny blisters, insanely itchy then the inner elbow and down the inner arm. It then morphs into the massive red patch and begins to crack and bleed and blister.

DP wears a clean fresh uniform every shift and changes his cotton gloves around 4-5 times during. I will look into maybe getting him allowed time to wash and change during shift.

@castlepeak can I ask what the shot is ?

He has had allergen testing which picked up contact dermatitis reactions to raw chicken, chili and onion.

DP also suffers anaphylactic reactions to ingested raw tomato and lettuce and carries an EpiPen this complicates things further.

Thanks @knittinglikemad

@pixxie7 you would think so but tbh the dermatologist is useless he prescribed hydromol and basically told DP to learn to live with it and the discharged back to GP.

@biggerbetterhealthier thanks for your responses they are really helpful DP Does have intense burning itch all over pretty much constantly I don't know why I didn't mention it, the pain is the most difficult thing to manage at the moment but is probably not helpe by constant scratching