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Suggest Treatment For Severe Itching In Buttocks And Upper Thighs

Posted on Mon, 9 Nov 2015

Question: I have been having ongoing itching problems. I get a bad outbreak about once per year. Because it tends to be along my buttocks, back of the legs, around the fingers, waist, I always assume it is scabies.

But I can't believe I'm getting scabies every year. I am not very sexually active, however I am a massage therapist so I come in contact with a lot of people. I don't use soaps with fragrance, etc., and cortisone creams help a little but the rash is continuing.

I am worried about something systemic because I've been taking psych and HIV meds for quite some time. I know kidney problems can create itching on the legs and metallic taste in the mouth, which I have also had sporadically.

I know to watch for "the rash" on lamictal but I've been taking it for 10 years and this doesn't seem to be life threatening.

It is hard to diagnose or rule out scabies without at least one treatment. this time it is really focused on my glutes and upper legs. Any idea about how to proceed?

Answered by Dr. Dr. Kakkar (32 minutes later)

Brief Answer:
Possibility of tinea; Kindly upload an Image

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your query and I have noted down your concern.

This does'nt seem like a drug reaction.
I will keep a possibility of a fungal infection i.e Tinea, specially considering that it is mainly localised to buttocks and uppe legs/thighs which is a common site of tinea.
You say that you have a rash in that area. I request you to kindly upload an Image so that I am able to guide you better. You may uploaad an Image either at "Reports Section" Or You may mail me an Image at YYYY@YYYY with the subject line of this mail as Attention:Dr.Kakkar.

Regards

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

Follow up: Dr. Dr. Kakkar (3 hours later)

I uploaded pics. It actually started on my trunk and hands. They are definitely itchy red bumps as opposed to what I think of with a scaley "ringworm" infection which I have seen before.

You don't think it's a result of kidney toxicity or allergy from long term med exposure huh?

Answered by Dr. Dr. Kakkar (5 hours later)

Brief Answer:
Prurigo is a possibility

Detailed Answer:
Hi.

Thank you. I have reviewed the Image. The image does'nt seem to suggest Tinea so I rule out that possibility. Neither is it due to a drug allergy.
I can see a few bumps in this Image. 'Nodular scabies' is a definite possibility considering that it is itchy and affects buttocks, upper thighs.
Another possibility is that of 'prurigo simplex' which can present as itchy, excoriated bumps on extensor surfaces like buttocks, thighs, arms and trunk. Prurigo has been reported as a side effect of drugs, including lamictal.
If I was the treating doctor I would suggest that you use a moderately potent topical steroid e.g tiamcinolone acetonide 0.1% cream Or mometasone furoate 0.1% cream, twice daily at affected sites.
I also suggest a tablet of cetrizine 10 mg once daily for symptomatic relief from itching.

Regards

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

Follow up: Dr. Dr. Kakkar (10 hours later)

Thank you...it sounds like these will treat the symptoms, but will they address the underlying problem or will that resolve itself.

Also worth noting (which always makes me think scabies) is that the itching is always MUCH worse at night and mornings, and during a hot shower.

Answered by Dr. Dr. Kakkar (4 hours later)

Brief Answer:
I would treat empirically for scabies followed by steroid cream along with cetrizine tablets for a few days

Detailed Answer:
Hi.

Nocturnal itching, of course is a feature of scabies but it is not exclusive to it. A point to note is that even scabies is one of the causes of prurigo.
Therefore, the way to go here, is to also treat empirically for scabies with a single dose of Oral Ivermectin 12 mg and thereafter using a moderately potent topical steroid i.e triamcinolone acetonide 0.1% cream or mometasone furoate 0.1% cream, twice daily for a few days.
An tablet of cetrizine once daily will provide you symptomatic relief from itching.

Regards

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Dr. Kakkar (45 hours later)

thank you I've forwarded this info to my doctor

Answered by Dr. Dr. Kakkar (21 minutes later)

Brief Answer:
You are welcome

Detailed Answer:
Thank you for writing to us

Regards

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

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