Wednesday, March 30, 2011
Don't Be Rash (PSA)
I know I haven't been blogging much lately. There's actually a reason for it, in addition to the general busy-ness of life with two under three. It all started with an oval patch under my bra line on my left side. I first noticed it in January. It didn't itch, burn, or really feel like anything. It was just there, about two inches long and a half inch wide. I ignored it for a few weeks, but when it was still there in mid-February, I started wondering what it could be. I showed a girlfriend who told me it looked like a patch of ringworm her son had on his leg a year ago. Of course, I consulted Dr. Google, and indeed, my patch looked like ringworm patches that I found online. I bought a tube of otc antifungal cream and put it on the patch. While it didn't go away, it didn't seem any worse. The first week in March, I noticed some small (pea-size), light brown to pink, oval patches that extended under my left breast and a bit down my side. There were maybe six or seven patches and, unlike that first spot, these itched. Not a lot or anything, but just more noticeable. I applied the cream to those, too. At this same time, I had an appointment with my primary care physician to discuss my post-partum anxiety (that's a whole separate post). As an aside during that visit, I had her look at the rash. After a cursory glance, she confirmed that it was ringworm and told me to keep applying the ointment to it and that it should go away in a few days to a couple of weeks. It was after that visit that the rash started getting worse. It started on my forearms and on my other side. I went from having less than ten spots to having 20 or 30. And instead of being mildy itchy, they were extremely itchy. And a new spot was cropping up all the time. First, I would get this horrible itchy place on my skin. I would try, try, try not to scratch, but eventually, I would get distracted doing something else and forget that it was a no-no, and I would itch. Then a spot would show up seconds later, red, angry, and welt-like. I e-mailed my doctor and let her know that the rash was getting worse. She prescribed a stronger antifungal and some cortisone cream. I dutifully applied both creams to no avail. I started using tea tree oil soap and not putting any normal lotion on. My skin was drying out, which was what everyone told me what necessary to rid myself of the fungus. By this time, several of the patches had gotten red, oozy, and were painful, especially on my forearms and stomach. I was so afraid of passing on my fungal infection onto my family, especially Emma, who was still nursing. I would take a sheet and wrap it around my breast so that only my nipple was showing. I would wash the sheet immediately after nursing. I also was washing my bedsheets every morning and never wearing a shirt or bra for more than two hours. I had to wear long sleeves all of the time and avoided touching the kids as much as possible. The thought of them contracting this horrible, itchy rash was enough to make me break out in more spots. After a week of the prescription cream and things only getting worse, I went back to my doctor. She was stunned by my rash and took skin scrapings to do a KOH test to make sure it was fungal. She saw lots of fungus in the scrapings so prescribed a third type of antifungal cream. She said she was at a loss, because ringworm doesn't usually spread like it was on me, but in cases where it was resistant to topical ointments, she would usually prescribe an oral antifungal. But oral antifungals are no-nos for lactating women, so my choice was to wean Emma and take the medications or keep suffering. I opted to try this last cream and see if I could beat it with that. This was a Friday. By Sunday night, I was ready to do whatever it took to get rid of my rash, even if it meant weaning Emma. I was covered from hip bone to collar bone in these angry red patches. They burned, they itched, they oozed, they bled. Where I didn't have the patches, I had a fine, red, bumpy rash that itched more than anything I have ever experienced. And as the patches crept upward, I had nightmares about the fungus getting into my hair and losing chunks of it. Forunately, they didn't creep up my neck, but I was still miserable. Showering was the worst. They were sting so much that I cried as the water hit them. I could barely stand drying myself off. Then I would rub the antifungal cream in and it would feel like I was burning my skin with a blow torch. Then, the very worst thing of all happened: I noticed two spots on Emma's cheek. I burst into tears and called my doctor's office, begging for some help. I couldn't imagine her having to endure this horrible rash. My primary care doctor finally referred me to a dermatologist. This doctor took one look at me and told me that she would "eat her shirt" if what I had was a fungal infection. She said that KOH testing is very unreliable and that if a person with no rash whatsoever was tested, it would show positive for fungus unless taken and intepreted properly. She did a skin biopsy in two places, a swab for staph infection, and a scraping. She prescribed a heavy-duty cortisone cream and told me to stop applying all of the creams. She said that I very likely had eczema and that all of the harsh creams and soaps had basically "burned" my poor suffering skin. I questioned how Emma could be getting the same thing and she said that she probably was just having a reaction to all of the creams and such that I'd been using and not the same thing at all. I was skeptical of that, but it was a relief to know that it might not be a communicable disease after all. She told me I was the first person she'd ever seen happy to receive a diagnosis of eczema. I was so desperate for relief that I applied the cortisone cream in the drive-thru at the pharmacy. Within five minutes of the first application, I was crying tears of relief. It was the first time in three weeks when my skin wasn't burning and itching. This was a Thursday. By Sunday, the rash was so noticeably better that I was willing to wear short sleeves and was no longer worried about the kids catching what was obviously not a fungus. I had done some research on eczema and though I didn't really feel like it sounded like my rash, I figured it must be it, because the steroid cream was clearly working. I didn't care. I was just so glad to be freed from the "rash prison" I had found myself in. On Monday, the dermatologist called me. Turns out, what I had was definitely not a fungal infection and wasn't even eczema. It is something called pityriasis rosea. No one is exactly sure what causes this very benign skin infection, but it is most noticeable (and often confused with ringworm) because of what is called the herald or mother patch. It is generally not contagious (though sometimes it can be in the very young with immature immune systems, explaining Emma's little rash) and thought to be the result of a virus, though no one has isolated the exact cause. I was a textbook case of this skin rash, except for that I kept putting on all of the caustic creams and soaps, which basically gave me a chemical burn and that was why it became more difficult to diagnose. The reason that I put this all here is because if someone is googling "rash that looks like ringworm but won't go away with antifungal creams", they might just end up here and save themselves three weeks of what I went through. I never imagined a rash could be this painful, inconvenient, or altogether horrible. I am just so very glad that Emma's few patches went away without incident and I can now stop doing laundry morning, noon, and night. Moral of the story: Always go to a specialist when things are "funky".