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Vesicle type rash on my husband's legs


Sent to Health Experts September 27, 2006 9:42 a.m.

I don't want to waste anyone's time so please only answer if you recognize and have a fairly confident idea of what could be going on with my husband. I'm hoping to post pictures but not sure how to do that as a customer!

My husband has spots that break out on his legs, usually below his knees. He's had these for years but usually only one or two every month or so. The spots start out looking like a bug bite of some sort, then erupt and scab over. They are never more than 1/2 inch in size. The past month, though they have become much worse and is now having a spot or two break out everyday and has a total of 24 or 25 on both legs.

I used to think this was folliculitis because he is a road cyclist and will shave his legs during the times when he is riding the most. But, when he doesn't have time to ride and stops shaving the spots still occur.

About 5 weeks ago he got into some chiggers and for about a week had some pretty bad chigger bites. Those seemed to clear up but that's also when the usual spots started erupting with more frequency. He went to the doctor this past Sunday and was given the cream for scabies which the doctor said didn't look like typical scabies but to try the cream anyway. There is no rash between his fingers or toes or any other place scabies usually like to inhabit. Also, these are single vesicles, not clustered together.

The vesicles sort of remind me of large chicken pox but without the obvious blistering. I used to wonder if they are a kind of shingle.

I hope to post pictures to give y'all a clear idea of what this looks like. I've scoured the internet trying to find pictures to compare it to. There's no big hurry to answer so I'll just keep relisting for a few days. We're more concern with accuracy than time.

Thanks,
Vicky B.

Optional Information:
Male , Age: 46

Already Tried:
Doctor visit on Sunday and given Permethrin cream for scabies but this is NOT scabies.
Customer (name blocked for privacy)
Status: Closed   Value: $10   
Answer
September 27, 2006 9:50 a.m. (7 minutes and 58 seconds later)
REPLIED Check Mark

It is possible that your husband has a herpes virus on his legs. The fact that you describe them as shingles appearing or vesicles is a big clue to the diagnosis. The fact that they continue to reoccur is also a big clue.
An easy way to find out would be to have the doctor culture one of the vesicles when they are active. The doctor would unroof one of the blisters and take a sample of the liquid or puss inside.
I have had quite a few patients over the years have herpes viruses on their legs as strange as this may sound.
Other clues to confirm this diagnosis would be if your husband experiences any signs of the rash coming before it actually breaks out such as a tingling in his legs or an itching in his legs. Similar to the feeling one would have before a cold sore on the lip comes out. Also he would experience an itching or burning pain with the rash.
Blood work would not be helpful in determining if this is a herpes virus. He needs culture of the vesicles.
If it is herpes virus there are medications such as valtrex that he could take the minute he feels the rash is going to come out and this would prevent an outbreak from even occuring.

__________________
Sincerely, Jennifer. I hope my answer helped you. If it did please be sure to give me a good rating. If it did not please contact me as I would be happy to help you further.
Jennifer PA-C  -- PA -- 100% Positive Feedback on 140 Health Accepts
Physician Associate, Masters of Health Science, 7years exp Internal Medicine
Reply to Jennifer PA-C
Sent September 27, 2006 10:27 a.m. (37 minutes and 6 seconds later)

Hi, Jennifer,

I've been looking at herpes rashes on Derm Atlas and it looks similar but not exactly like what is occuring on my husband. I suppose everyone is different and maybe he could still have some form of herpes and it just manifests differently.

I would like to post the pictures in this reply but apparently they are too many megabytes or something like that. I will PM them to you. They aren't the best but maybe you will be able to tell if this is something you have seen before.



__________________
Vicky B. RN

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Customer (name blocked for privacy)
Answer
September 27, 2006 10:37 a.m. (9 minutes and 48 seconds later)

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Jennifer PA-C  -- PA -- 100% Positive Feedback on 140 Health Accepts
Physician Associate, Masters of Health Science, 7years exp Internal Medicine
Reply to Jennifer PA-C
Sent September 27, 2006 10:37 a.m. (30 seconds later)

Well, I tried PMing them to you but they were too big for that also. I'm not sure how to make them smaller.

__________________
Vicky B. RN

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Customer (name blocked for privacy)
Answer
September 27, 2006 10:46 a.m. (8 minutes and 50 seconds later)
REPLIED Check Mark

Unfortunately I do not know how to help you with the picture sending. I do still think however that his best bet is to have these lesions cultured and if necessary even biopsied. The fact that they continue to occur really makes me believe they are some sort of herpes virus.
Does he get cold sores? If he used the same razor from his face on his legs this would be one way to transmit the virus.

__________________
Sincerely, Jennifer. I hope my answer helped you. If it did please be sure to give me a good rating. If it did not please contact me as I would be happy to help you further.
Jennifer PA-C  -- PA -- 100% Positive Feedback on 140 Health Accepts
Physician Associate, Masters of Health Science, 7years exp Internal Medicine
Reply to Jennifer PA-C
Sent September 27, 2006 10:53 a.m. (6 minutes and 53 seconds later)

No, he has not ever had cold sores and uses an electric razor on his face and a regular razor on his legs.

__________________
Vicky B. RN

If my answer was helpful to you, please click the "Accept" button. If you would like additional information, please choose "Reply" and I will be glad to help you further.
Customer (name blocked for privacy)
Answer
September 27, 2006 11:34 a.m. (41 minutes and 32 seconds later)
REPLIED Check Mark

There is a type of herpes, called herpes gladiatorum, usually found in wrestlers or other people who are in close contact sport. It is caused by the hsv 1 virus. I know you said your husband is a cyclist but perhaps if he wrestled in high school or college this is a possiblity.
Also, dermatitis herpetiformis is rash that can specifically appear on the legs. This is actually not a herpes rash. It is believed to be caused by a gluten sensitivity or digestive tract disease such as celiac. Sometimes this would be the only manifestation of the disease. This rash is intensely itchy and can wax and wane as your husbands does. Just some more thoughts as to what may be occuring.

__________________
Sincerely, Jennifer. I hope my answer helped you. If it did please be sure to give me a good rating. If it did not please contact me as I would be happy to help you further.
Jennifer PA-C  -- PA -- 100% Positive Feedback on 140 Health Accepts
Physician Associate, Masters of Health Science, 7years exp Internal Medicine
Reply
Sent September 27, 2006 8:52 p.m. (9 hours and 18 minutes later)

Reply to Jennifer PA-C's Post: Yes, I have researched these as well. The rash looks the closest to the dermatitis hepetiformis but I really hope that's not what it is! Images available only to Customers.



__________________
Vicky B. RN

If my answer was helpful to you, please click the "Accept" button. If you would like additional information, please choose "Reply" and I will be glad to help you further.

Customer (name blocked for privacy)
Answer
September 28, 2006 10:32 a.m. (13 hours and 39 minutes later)
ACCEPTED Check Mark

The stress the chiggers caused to his skin and to his overall well being may have triggered the rash as herpes or the dermatitis herpeteformis as you probably know is triggered by sun exposure and stress. So I do think it is probably related.

__________________
Sincerely, Jennifer. I hope my answer helped you. If it did please be sure to give me a good rating. If it did not please contact me as I would be happy to help you further.
Jennifer PA-C  -- PA -- 100% Positive Feedback on 140 Health Accepts
Physician Associate, Masters of Health Science, 7years exp Internal Medicine
Reply to Jennifer PA-C
Sent September 28, 2006 10:46 a.m. (13 minutes and 53 seconds later)

Okay, Jennifer,

Thanks for all your dialoging with me. It has been a frustrating situation for us because I haven't been able to research a good answer for us. My own experience has been in pediatrics and nothing I've seen compares to it. I know it isn't scabies so I'm somewhat put out with his doctor trying that route first, but I wasn't there to argue that case Images available only to Customers.



__________________
Vicky B. RN

If my answer was helpful to you, please click the "Accept" button. If you would like additional information, please choose "Reply" and I will be glad to help you further.

Customer (name blocked for privacy)
Answer
September 28, 2006 10:57 a.m. (11 minutes and 21 seconds later)

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Jennifer PA-C  -- PA -- 100% Positive Feedback on 140 Health Accepts
Physician Associate, Masters of Health Science, 7years exp Internal Medicine

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