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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes burning lesions on the upper arm?

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Dr. Dinah Levillard

Dermatologist

Practicing since :2010

Answered : 261 Questions

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Posted on Wed, 12 Oct 2016 in Skin Hair and Nails
Question: I have a rash that began on my right upper arm about the end of August. The lesions did not itch at first. It started with 3 that were slow to heal and burned to the touch. No white head appeared in any of the lesions. Eventually, the lesions would scab over, turn a light brown, and heal somewhat. I still have the brown spots from the first lesions. Last week I noticed that I was getting them in clusters of three or four on my upper arm and when I scratched them, they swelled, turned the entire area red, and spread even worse down my right arm.

I work in a prison and one of the inmates has scabies that is unresolved, yet they let her work, and she has been seen in the medical clinic where I work. My worry was that I had gotten it from her even though I wore gloves when I helped her and washed my hands and wiped down the equipment and area with bleach wipes afterward.

I went to my provider and she diagnosed shingles but the pain never got worse and the lesions then spread to my left shoulder where I had two. Still worried that my provider was wrong, I took a hot batch and added a small amount of bleach (folk remedy for scabies) and soaked for 20 minutes. After the bath my skin began to itch horribly.

The next morning I went to my provider again and asked if I had scabies since it had spread to my other side. She agreed and said to treat the whole family. I took 4 Invermectin tablets on Saturday and applied 5% permethrin cream that night. My husband applied his cream as well. The itch has lessened, and I'm still awaiting the second round of treatments.

Even though the itch has lessened, I still worry it will be hard to get rid of. My husband and daughter have not shown any signs of scabies even though it's been almost a month.

A provider in my clinic took a quick look at the lesions and said she feels I have Dermatitis Herpetiformis from Celiac Disease as I have a long history of difficulty digesting anything with gluten. She said scabies and DH are very similar in presentation, but she didn't think my lesions looked like scabies. She asked if I had any lesions on my backside. Indeed I do and I have never had that happen before. She said that makes her even more convinced that my rash is DH.

So, after all of that, is it Shingles, Scabies, or DH?
doctor
Answered by Dr. Dinah Levillard 3 hours later
Brief Answer:
Suggests Dermatitis herpetiformis. Requires biopsy to confirm and treat.

Detailed Answer:
Hello XXXXX, and welcome to HCM.com.
I am Dr Dinah and will be addressing your query today.
From your specific description of the rash and the way it has progressed, it seems unlikely to be shingles. Shingles would have resolved by now and typically would not have spread to different areas the way your rash has. Also you have not experienced severe pain, burning or fever. Dermatitis herpetiformis can be mistaken as shingles in early stages.
As for scabies, there are chances of you contracting it from your colleague. But your rashes are not much like a scabies infestation. They usually have pin point bumps and rashes along inner side of limbs, groin and skin folds. And you have already taken treatment. Do insist that your co-worker complete treatment, if possible as she can still spread the disease.
Your presentation of very itchy rashes, history, age, presence of Celiac disease definitely are more in favor of Dermatitis herpetiformis. They start on outer arms,elbows, knees, upper back and spread and are extremely itchy.
I would advise you to see a dermatologist and get a biopsy with immunoflourescence done, necessary to diagnose the disease. Then you can be started on specific treatment. You may also be referred to a dietician if required.
Hope this helps you.
Do feel free to get back to us any time with doubts or clarifications.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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