Blog Article: A Mysterious Rash Uncovered – Managing Dermatitis, Scabies & Nerve-Related Itching in Katy & Houston, TX
By: Dr. Ashley Baldree
Introduction
Skin rashes can have a variety of causes—from allergies and infections to nerve-related issues. At Village Dermatology, we pride ourselves on delivering a thorough and patient-centered approach to diagnosis and treatment. In this case, we saw a 70-year-old woman from the Houston area with an itchy, red rash across her legs and trunk—which evolved into a multidimensional diagnosis and treatment plan.
Case Overview: Itchy Rash of Unclear Origin
Patient: 70-year-old female
Symptoms: Itchy, red rash for 2 weeks, primarily on the legs and trunk
Initial Treatment: OTC topical steroids (clobetasol and hydrocortisone)
Despite prior treatment, the patient’s rash had not improved. Upon clinical evaluation, we identified multiple overlapping causes contributing to her symptoms.
Differential Diagnoses Considered
Urticaria (Hives) – Red, raised spots consistent with allergy or histamine response
Allergic Contact Dermatitis (ACD) – Possible reaction to recent change in laundry detergent
Scabies – Due to rash distribution and clinical suspicion, despite a negative KOH scraping
Notalgia Paresthetica – Nerve-related itching due to a history of spinal disc issues and recent back surgery
Step-by-Step Management Approach
✅ 1. Dermatitis/Urticaria Treatment
Topical: Triamcinolone 0.1% cream applied twice daily
Oral: Hydroxyzine 25mg tablets as needed for itch
Lifestyle: Switch detergent to All Free & Clear
Counseling: Advised against prolonged steroid use and explained risk of skin thinning and hypopigmentation
✅ 2. Scabies Treatment (Empiric)
Despite a negative KOH skin scraping, treatment was initiated due to the possibility of early or atypical scabies.
Prescription: Ivermectin 3mg (two doses, one week apart)
Topical: Permethrin cream applied from neck to toes for 8 hours, repeated in 1 week
Hygiene Education:
Isolate bedding and clothing for 72 hours
Wash items on high heat
Treat household contacts
✅ 3. Notalgia Paresthetica Relief
Topical OTC: CeraVe or Sarna Anti-Itch Cream
Education: Provided a handout on the nerve-related cause of itching
Monitoring: Recommended further work-up if symptoms persist or worsen
Why This Case Matters in Katy & Houston, TX
With overlapping skin conditions and histories of nerve problems or allergy exposure, a single diagnosis isn’t always enough. This case highlights how Village Dermatology delivers thorough evaluations, considers all possible causes, and tailors treatment to each patient’s history and lifestyle.
Whether you’re dealing with rash, itching, or chronic skin issues, our dermatology team in Katy and Houston is equipped to help—from diagnostics to comprehensive care.
