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Noticed red itchy scaly welt after wearing tight dress. What should I do?

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Dr. Sujoy Khan

Allergist and Immunologist

Practicing since :1999

Answered : 584 Questions

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Posted on Wed, 2 Jan 2013 in Skin Rash
Question: Hi. Last night I wore a tight skirt that had thick stitching in several bands. When I got home from the play I was at, I noticed a red, itchy, sort of scaly welt where one of the bands was. The welt is long and skinny. It's about 1.5 inches long and .5 in thick. It's on the back of my thigh, slightly underneath where my butt and thigh XXXXXXX What do you think it is? It's my only XXXXXXX I'm always concerned of bed bugs, as I live in a very touristy area of Hawaii and was in a public theater and cab yesterday. Do you think it was from the tight skirt? Any help would be great. Thanks.
doctor
Answered by Dr. Sujoy Khan 3 hours later
Hello,
Thank you for writing to Healthcare Magic and also for uploading the picture.

This skin rash looks benign (i.e., not infected or one that could be caused by bed bugs) and is most likely a pressure-induced itchy lesion, sometimes called pressure urticaria. This diagnosis is more relevant if the rash is itchy and is obviously red.
The other possibility is a scratch from say, a sharp projection from the seat for which a mild antibiotic cream like neosporin should suffice.

If the rash is itchy, you can apply calamine lotion or take an antihistamine.

If the possibility of scratch secondary to say a nail is very unlikely, then you would not need a tetanus jab. If however, you have had a tetanus jab in the last 5 years, then there is no need for it either.

I hope this helps.
Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sujoy Khan 1 hour later
How long will it take to go away?
doctor
Answered by Dr. Sujoy Khan 4 minutes later
Hello,

If this is pressure urticaria, antihistamine tablets (like fexofeadie 180mg or cetirizine 10mg) for 2-3 days is sufficient.
When applying neosporin cream, you can see the effect also in 2-3 days, the redess goes down in 24 hours.

Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sujoy Khan 7 minutes later
Will more appear? Should I still go see a doctor? Will it come back or is it just a one time deal due to tight clothing?
doctor
Answered by Dr. Sujoy Khan 50 minutes later
Hello,
If you have had urticaria before, then this is just another manifestation of the same problem.
However, if this is the first time, and there is good response to antihistamines, recurrence is usually not the rule.
Triggers of further urticaria include: itching or scratching (physical), infections, pre-menstrual state, thyroid abnormalities.
If there is no benefit from either antihistamines or neosporin cream, or if you developed more lesions, please see a doctor straight away.

I hope that helps.
Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sujoy Khan 10 minutes later
I got my thyroid levels checked recently and they came within the normal range. However, I have had peeling nails and a small circular loss of patch of hair (now regrown). Do you think that these things in conjunction with the urticaria points to a thyroid problem even though my levels were normal (3.77 on a scale of .27 - 4.20 testing my TSH w/reflex to Free T4)? In October, I had something similar, but the doctor thought it was a contact dermatitis issue--red itchy welts on my buttock after a night of dancing in ill fitting underwear. Should I follow up with more thyroid testing?
doctor
Answered by Dr. Sujoy Khan 8 hours later
Hello,
The only test that seems worthwhile doing in urticaria (especially when it comes to th thyroid, and normal TSH) is TPO antibodies (thyroid peroxidase). This, if positive, is an indication of autoimmune hypothyroidism that can manifest years later (and hence a normal TSH).
It now becomes relevant given your past history that you are getting urticaria secondary to tight fitted clothing, and to it a component of physical urticaria. You should also note that secondary issues like alcohol consumption, pre-menstrual states that worsen urticaria or make it 'suddenly appear'.
Reflect testing with fT4 is not indicated with a normal TSH, unless you are on thyroxine replacement therapy.

Peeling nails and loss of hair can also sometimes mean there is an autoimmune component, and XXXXXXX test with C3 C4 levels will be helpful.

Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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