Skin Rashes and Non-Allergic Causes

Recently I saw a number of skin rashes of the hands and feet and legs that were not caused by allergy but due to infestation by mites. Mites can be transferred from human to human or from pets to human.

Itchy rashes can be caused by parasites and fungal infestation. Each of these have their particular manifestation. Psoriasis can be at times itchy. So is a very particular skin condition called dermatitis herpetiformis which is extremely itchy.

So remember, not all itchy skin rashes are caused by allergy and therefore a diagnosis is not always straightforward.

And my learning continues...

Same Allergies, Different Symptoms

There were two patients who saw me on the same day with latex or rubber allergy who presented with different manifestation on their legs and feet.

One with his lower limbs with red, angry looking, wet lesions with skin infections.

The other with dry, thickened and scaly lesions.

The lesson:

Our bodily reactions manifest differently from persons to persons when exposed to the same allergic substance. I have observed this time and time again.

My learning continues.

Allergy in Piety

I had an interesting case of a middle age Malay lady who came to see me because of an extremely itchy thickened lesions at both of her knees and some parts of her ankle. My investigative skills were challenged, but I finally solved it.

Turns out, her allergy was due to her prayer mat which she use to kneel and the cause of the allergy was due to the new detergent she uses to wash her mat. Asking her to revert back to her old detergent solved her problem.

You never know where allergy can pop up!

My learning continues....

*Cough* *Cough*

Chronic cough can be caused by allergy, but it's not always the case.

Recently I saw a young man who had a chronic cough. I did a chest X-ray, and it showed a tumor that was eventually diagnosed as germinal cell cancer. Luckily for him, this tumor is very treatable.

Another case was a middle age man who was diagnosed with tuberculosis from the chest X-ray. In another case, a man with a prolonged runny nose turned out to have a cancer of his throat.

The lesson is to do at least some simple tests to rule out other conditions before thinking of allergy.

My learning continues

More Work-related Allergies

Imagine that you are a masonry worker and if you have developed contact dermatitis due to cement, you would have to choose between continuing with your work or to be extremely careful to avoid contact with cement. That is a difficult thing to do.

There are many such work related allergies, each with it's dilemma. One teacher patient of mine had hand allergy due to the use of chalk (I thought we dont use chalk in the classroom anymore!) and another young school girl had allergic conjunctivitis (itchy red eyes) who was also allergic to chalk. She got much better when she went to university. I suppose they don't use chalk there anymore.

Grass pollen allergies are common in farmers and are difficult to manage.

There are also many work-related allergies occuring in factories such as chrome allery of hands (especially in cement factories), work dust allergy (for work that have a lot of dust), paint and turpentine allergy (common in furniture workers) and the list goes on and on.

Lesson: IT IS NOT UNCOMMON FOR YOUR WORK TO CAUSE YOU ALLEGIES

My learning continues.

Work-related Allergies

I saw a patient many years ago with allergy of his hands and discovered his allergy was due to the chemical he was using to soak his bean sprouts in. Asking him to use gloves stopped his allergy. That one was simple enough.

Another interesting case was a farmer who had a cough for months and had seen many doctors including a respiratory doctor but he did not get any better.

I asked him to bring to my clinic all the pesticides and fungicides that he used on his vegetables and watermelon and lo and behold, he was found to be allergic to a number of these. I advised him to avoid going to the farm and so his son went instead and eventually, his cough disappeared.I advised him to wear a particular mask if he ever wants to go the farm.

I have kept the pesticide and fungicide solutions but interestingly, except for a few patients, most were not allergic to them.

Lesson: BEWARE OF PESTICIDES AND FUNGICIDES

and my learning continues...

Chinese Herbs and Jaundice

Today, I want to highlight two quite similar and extremely interesting cases.

First was a patient who was referred to me by her brother-in-law who is a close friend of mine and another the father of one of my dance instructors. Both came to see me rather ill with severe jaundice, meaning their livers were not functioning and their skins were as yellow as pumpkins.

Both of them were admitted to private hospitals and the doctors were puzzled as to the cause of their condition as the blood tests showed their liver was inflammed but the cause was not known (most these cases are due to hepatitis A or B).

Their problems were quickly resolved when I asked them whether they were taking any chinese herbs or medicine. The lady was taking a kind of Chinese pill for a long time for her knee pain, and the old man was taking a Chinese herb for general good health. I tested them against their respective Chinese herbs and true enough, they sensitivity to the herbs proved positive. I then made them antidotes and within a week, their jaundice disappeared and they were smiling when they came back to see me, not yellow anymore.

Lesson: BEWARE OF THE DANGERS OF CHINESE HERBS AND MEDICINE

My learning continues.