Not convinced it's eczema

Posted by steves2 @steves2, Feb 14, 2023

I was to a dermatologist about a year ago for the pictured rash that started a couple years prior with the occasional red spot on my lower legs above the ankle. Over time, it has spread so that it can be anywhere on my legs as well as being more common on my arms. It does not itch nor is it painful. If I didn't see it, I wouldn't know it's there.

I thought it might be chlorine in the water (since it worsened after I moved to a city with heavy chlorination), but that ended up being a red herring. Sun exposure *might* have made it better, but it was kind of erratic until after the summer was over regardless. It seemed to get dramatically more widespread while I was doing an elimination diet to figure out silent reflux/food allergy triggers. However, that could be a coincidence. Topical steroids did nothing, which is very unusual for me since I could basically watch them work on contact dermatitis when I was a kid. Switching to unscented soaps, applying lotion heavily, Most any of the common blood tests came back normal; I'm still waiting on some results. It might be one of my meds, but skin issues are a very rare occurrence and I hadn't had a prescription/dosage change for at least three years prior to the onset of the rash.

I have other symptoms that suggest EDS, and my PCP will evaluate that should all of my blood work come back normal. I also am getting a second opinion from another dermatologist in about a month. I'm just curious if anyone else has had something like this.

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Wow @steves2! That doesn’t look like eczema to me!

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A doctor should evaluate and from superficial take looking at photos:

The photo on the right looks like squamous cell skin cancer to me, but it could be lots of things.

The purple spots look like purpura. For instance https://www.mayoclinic.org/diseases-conditions/henoch-schonlein-purpura/symptoms-causes/syc-20354040

general info: https://dermnetnz.org/topics/purpura
-Petechiae are small, purpuric lesions up to 2mm across
-Ecchymoses or bruises are larger extravasations of blood.
-Palpable purpura is purpura than can be felt, due to inflammation of the blood vessels (vasculitis)
-Pigmented purpura is a sign of petechial haemorrhages associated with capillaritis

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Maybe Grovers Disease. Mine looks different on different parts of my body.

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I’ve had very similar lessons. They come and go. I’ve had 3 biopsies, all coming back with different diagnosis, depending on the “age” of each lesion. Psoriasis, Guttate Psoriasis and Eczema. Always located legs and arms. Don’t hurt or itch and like you say, wouldn’t know one cropped up until I saw it. They start off red and rough and evolve to scaly patches like yours. It’s like excess skin I can’t shed. I peel mine off when they get crusty. Do yours peel off like that? I’m not convinced mine is Eczema either. Seems more autoimmune, with flares after being sick or stressed. How about you? I’ve never seen lesions that look the same as mine, until I saw your post!

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I've dealt with 3 types of eczema and as rashida mentioned it doesn't look like eczema to me. Also the fact that it isn't painful and doesn't itch, common symptoms of eczema makes me doubt the eczema diagnosis.
If you were told it was eczema, don't just settle for a doctor identifying it as eczema without a specific eczema diagnosis as there are a dozen eczema types and many are treated differently. If your doctor told you that it was cancer, wouldn't you ask for the type of cancer?
It looks nothing like any of my types: Grover's Disease or Perioral or even the Allergic Contact Dermatitis when they were active.
If your papules were clustered, itchy, painful and more rash like I would suggest the 5 Day Extended Patch Test to identify allergic contacts.
What you should do is keep searching, go to dermnetnz.org and look though their skin site at their collection of photos for each type of eczema and all other skin diseases. In fact, that is how I identified my Perioral Dermatitis which my doctors were treating incorrectly as Allergic Contact Dermatitis.

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@windyshores

A doctor should evaluate and from superficial take looking at photos:

The photo on the right looks like squamous cell skin cancer to me, but it could be lots of things.

The purple spots look like purpura. For instance https://www.mayoclinic.org/diseases-conditions/henoch-schonlein-purpura/symptoms-causes/syc-20354040

general info: https://dermnetnz.org/topics/purpura
-Petechiae are small, purpuric lesions up to 2mm across
-Ecchymoses or bruises are larger extravasations of blood.
-Palpable purpura is purpura than can be felt, due to inflammation of the blood vessels (vasculitis)
-Pigmented purpura is a sign of petechial haemorrhages associated with capillaritis

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The first dermatologist took a biopsy on my leg (which took months to heal and is still fading almost a year later) and that came back with basically nothing, so the default seems to be eczema.

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@griffin1120

Maybe Grovers Disease. Mine looks different on different parts of my body.

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It looks like Grovers appears most often on chest, neck, and back... about the only places (other than feet and head mine are not appearing.

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@larayne

I’ve had very similar lessons. They come and go. I’ve had 3 biopsies, all coming back with different diagnosis, depending on the “age” of each lesion. Psoriasis, Guttate Psoriasis and Eczema. Always located legs and arms. Don’t hurt or itch and like you say, wouldn’t know one cropped up until I saw it. They start off red and rough and evolve to scaly patches like yours. It’s like excess skin I can’t shed. I peel mine off when they get crusty. Do yours peel off like that? I’m not convinced mine is Eczema either. Seems more autoimmune, with flares after being sick or stressed. How about you? I’ve never seen lesions that look the same as mine, until I saw your post!

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That does sound very, very similar to what I'm experiencing. I'm lazy and don't peel them off, and they hang on for quite a while (week+) despite lotion, showers, rubbing against clothes.

Mine don't seem related to stress/sickness, as it got worse once stress at work calmed down and I saw no difference during/after COVID (sickest I've been since they started appearing).

I tend to lean autoimmune as well or some environmental allergy. Or EDS, as the more I look into that, the more my unexplained collection of symptoms seem to make sense. I may be wanting one ring to rule them all too badly.

My blood tests came back fine, and I think they are all back (my PCP ordered quite a few). I see another dermatologist in about a month and my PCP is eager to know what they think since he doesn't think it looks like any of the common skin issues either.

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@gardeningjunkie

I've dealt with 3 types of eczema and as rashida mentioned it doesn't look like eczema to me. Also the fact that it isn't painful and doesn't itch, common symptoms of eczema makes me doubt the eczema diagnosis.
If you were told it was eczema, don't just settle for a doctor identifying it as eczema without a specific eczema diagnosis as there are a dozen eczema types and many are treated differently. If your doctor told you that it was cancer, wouldn't you ask for the type of cancer?
It looks nothing like any of my types: Grover's Disease or Perioral or even the Allergic Contact Dermatitis when they were active.
If your papules were clustered, itchy, painful and more rash like I would suggest the 5 Day Extended Patch Test to identify allergic contacts.
What you should do is keep searching, go to dermnetnz.org and look though their skin site at their collection of photos for each type of eczema and all other skin diseases. In fact, that is how I identified my Perioral Dermatitis which my doctors were treating incorrectly as Allergic Contact Dermatitis.

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Thank you so much for the that website. I will definitely dig into that, especially knowing that helped you straighten things out.

Yes, eczema seemed to be the default diagnosis when the lab found nothing.

I had had a second derm appointment last fall, but cancelled due to this temporarily getting better. Once it flared substantially (and has shown no sign of letting up, though it may have leveled-off for the moment), I knew I needed to be more proactive. Fortunately, my PCP is very onboard with me making suggestions for possible causes.

I had contact dermatitis a lot growing up on the farm. Some of those things no longer bother me, some I've not intentionally tried to touch. And yes, this is nothing like that both in symptoms and in treatment.

I've wanted to get allergy tested, but they only seem to want to see me if I could go into anaphylactic shock. My PCP may be amenable to making a reference if progress can't be made in figuring out what this is.

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@steves2

That does sound very, very similar to what I'm experiencing. I'm lazy and don't peel them off, and they hang on for quite a while (week+) despite lotion, showers, rubbing against clothes.

Mine don't seem related to stress/sickness, as it got worse once stress at work calmed down and I saw no difference during/after COVID (sickest I've been since they started appearing).

I tend to lean autoimmune as well or some environmental allergy. Or EDS, as the more I look into that, the more my unexplained collection of symptoms seem to make sense. I may be wanting one ring to rule them all too badly.

My blood tests came back fine, and I think they are all back (my PCP ordered quite a few). I see another dermatologist in about a month and my PCP is eager to know what they think since he doesn't think it looks like any of the common skin issues either.

Jump to this post

I’ll be anxious to hear what the dermatologist has to say. I’ve looked at a ton of pictures of lesions/conditions on the internet and nothing looks like the lesions you or I have. Good luck!

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