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Discussion

advice on rash

I have a young patient with COPD. He drove a concrete truck for several years and apparently breathed in the dust. The pumlonary doc says there is nothing he can do for him. Somehow, C-pap and Bi-pap is contraindicated for him. In any case he is on high doses of steroids.

This weekend, he had a backyard party to renew his wedding vows. He followed that up with the races. He tolerates these things poorly, but does them anyway. You can just guess why.

Anyway, he presented this morning with a rash which started over the weekend. He tried to say it started Friday, but I think he's fibbing. We have already spoken about his being out in the sun with the steroids thing. He does it anyway. We can't come up with any other explanation for the appearance of the rash, except for a dermatitis. I think it was the sun.

The rash is on his back and his legs. He is having severe itching. I have paged the doc all day, and faxed, and get promises that he'll call me back.

I just know he will ask me what to recommend. I figure a topical cream or lotion is in order, but I'm not sure what.

Does anyone have a suggestion for this poor guy?

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Lots of support to allow him to keep doing the things that he wants--for as long as he can is the first order of business. Was there any types of poison Ivy, Oak or Sumak in the back yard? Has he recently had any type of strep infection-- but strep rashes are usually not "itchy". Benadryl, maybe for the itching? Odd that it came on all of the sudden and, if it is in open areas that are not hidden or moist, it probably doesn't have a fungal origin and, may very well, be related to the steroids. Good Luck!

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Well, it turned out to be a fungal rash that sort of "exploded" and it is due to the high dose prednisone he is on. When he is active and perspires, it encourages the growth. This came as a surprise to me somewhat, because he was already taking fluconazole for thrush (which he gets quite often). They are treating it with a higher dose of fluconazole and some nystatin powder.

A co-worker has suggested switching to decadron because there seem to be fewer abdominal, skin and bone complications, as well as less fogginess. The pharmacist does not agree with this theory, but even some patients have told me they tolerate the decadron better.

My poor guy wants to change doctors, because the pulmonary specialist he's had has been shrugging him off, not addressing his issues and this has been frustrating for me as well. I finally got a hold of him on call and he ordered him to the ED. How ridiculous was that when he could have seen him in the office? :banghead:

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