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Itchy body rash since a month, swelling on hips and elbow. Biopsy ruled out cancer, mention of spongiosis. Suggest?

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Answered : 2016 Questions
My wife developed a rash that started on her chest and has now moved all over her body. She has had the rash for almost a month. Her hips and elbows swell when it is on them and it itches really bad. Keeps her up at night and itching seems to be worse at night. We went to a dermatologist who prescribed prednisone and antihistamine. He took a biopsy and said the results showed no cancer but he mentioned spongiosis?? The rash has not improved and is now getting hot to the touch. It has spread to her legs, stomach, arms and back.
Posted Fri, 14 Jun 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 1 hour later
Thanks for writing to us.
Spongiosis is intracellular edema ie collection of fluid between two skin cells. There are many skin diseases with spongiosis as biopsy finding. So as such spongiosis alone does not point towards a specific disease. However clinically the description provided points towards acute eczema which also can have spongiosis as biopsy finding.
Now acute eczema is a broad term. The specific type of eczema can only be diagnosed by proper clinical examination.
Treatment required right now is a course of oral steroid like prednisolone along with topical steroid like mometasone. Also round the clock oral antihistamine should be taken like ceterizine or hydroxyzine to alleviate itching.
I would advise that you XXXXXXX a qualified experienced dermatologist, so that the diagnosis can be established and treatment can be provided.
Also I would appreciate if you could upload the biopsy report and pictures of your wife's lesions as it might help me in ascertaining the most probable diagnosis and assist you in a better way.
Hoping to hear from you soon.
Take care
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Follow-up: Itchy body rash since a month, swelling on hips and elbow. Biopsy ruled out cancer, mention of spongiosis. Suggest? 15 minutes later
Thanks. I uploaded a photo I just took. We don't have the biopsy report yet as he told us over the phone. He did prescribe oral hydoxyzine 25mg and the bottle says to take two at night before bedtime. He also put her on prednisone 5mg starting at 8 per day and tapering down. Se has been on them now for almost two weeks. Let me know what you think of the photo. Should we go get blood work done?
Answered by Dr. Kalpana Pathak 12 hours later
Thanks for attaching the images. Though you have uploaded four images but all of them are same.
The lesions are red excoriated raised bumps. In our words these are excoriated red papules. Now similar raised lesions which are extremely itchy and that too in night also points towards scabies. Sometimes scabies lesions gets eczematised too and hence can present with spongiosis. Other variants of eczema that we can think of is seborrheic dermatitis, air born contact dermatitis, contact allergic dermatitis or I'd eruption.
Firstly I would like you to upload pics of other involved areas too and answer below mentioned questions

If she has lesions over finger webs, wrist, arms, underarms, chest abdomen, inner side of thighs etc. Also if somebody in family or friends had such lesions. If there was a hospital or hotel stay prior to development of lesions

If her scalp is having greasy yellow scales or there is involvement of eye lids, nasal folds and area behind ear( retroauricular area)

If there is history of any drug intake

If there is history of exposure to specific plant or any field/ farm exposure

If there is history of any focal bacterial infection like dental caries, fungal infection over body, hands in between toes or any wound.

If these lesions are transient ie they come and go on daily basis

Answering these queries might help in reaching a particular diagnosis.

Hoping to hear from you soon.

Above answer was peer-reviewed by
Follow-up: Itchy body rash since a month, swelling on hips and elbow. Biopsy ruled out cancer, mention of spongiosis. Suggest? 39 minutes later
Thanks. I uploaded a picture of her arm at the elbow. Here are answers to your questions:

She has lesions on her arms (it started just on her underarms and has since moved) chest, abdomen, hips, back, bum, thighs and wrists. She get swelling on her hips and elbows. It has not shown up on her hands, finger webs, feet or face.

No involvement behind ears, nose, or eye lids. She does have the itch on her scalp but nothing yellow or scales.

The only drug intake she has had is the drugs mentioned in my last post and she frequently takes naproxen for her neck.

We do live on a farm and have horses, goats, chickens a cat and a dog. Se does not touch them very often and none of them are in the house.

No history of fungal infection, focal, hands in between toes or any wound.

The lesions don't completely disappear but they move and seem worse in certain areas than others each day. They are always bad on her arms, elbows, hips, back of her knees and chest.

The system only allows me to post the same pic for some reason. I can send more if necessary on next post.

Thanks for your help.

Answered by Dr. Kalpana Pathak 17 hours later
Thanks for writing back.

In the current scenario, I can think of two possibilities
contact dermatitis
scabies with eczematisation

Sometimes scabies can be contracted from farm animals. Similarly allergic dermatitis can occur due to animal dander.
As she is already on steroids which would broadly take care of all variants of eczema, so i would advise that she should empirically apply 5 percent permethrin cream. It has to be applied only once in night all over the body below neck and then she should take bath in morning. If she is still on tapering doses of steroid, she should continue with the same. Also hydroxyzine should be taken as advised. I would also advise her to apply any mild steroid cream as that would help in fast resolution of lesion.

kindly follow the same and do let me know about the response in few days. I shall be available for followup.
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