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Wednesday, March 17, 2010

Dear Dr Internets: (* updated)

A little help, please. Ree has a scaly, peely thumb that has been getting worse by the day. We've been to her pediatrician twice now and the next step is a pediatric dermatologist. I'm calling tomorrow for the appointment, and crossing my fingers that we can get in quickly, but in the meantime, does anyone have any clues what it could be? I don't want to gross anyone out, so if graphic pics or health details bother you, just click away now.

Ok, so here are the facts:
1. Ree's thumb hasn't looked right for about two months now.
2. It started as a small, dry-looking peely patch on the edge of her left thumb.
3. It progressed a little and started to affect the corner of her nail. The nail got a little thick and kind of crumbly looking in the corner.
4. In the last few days, the peeling has really spread, and it looks pretty bad. An entire layer of skin is gone, and it looks like pieces of skin are cracking off, leaving red skin below.
DSC_2463LR

5. We've had three different plans of attack: Cortizone-10 cream (1% hydrocortisone, otc) and Lotrimin-AF cream (otc), then heavy hand cream and prescription Mupirocin ointment, and today's new plan of prescription Mometasone Furoate ointment (which Ree says stings when applied) along with Aquaphor. The first two combos had no effect, and it's too early to tell about the third.
6. Ree says it doesn't hurt anywhere, even when pressed on, and it doesn't itch. She doesn't pick at it, doesn't scratch it, and she doesn't suck that thumb.
DSC_2466LR DSC_2480LR

Any ideas? Like I said, I'm calling for the pediatric dermatologist appointment tomorrow (because I'm pessimistically thinking that the new medicine won't work and this will continue to get worse). But in the meantime Google is just freaking me out and not really providing any information that looks like it fits. If you've seen anything similar, especially if it was something reallyreallyreally minor and easily treatable but just hard to diagnose (heh heh), please share. And if you've got no idea, well just send some good thoughts Ree's way.

~~~~ Update on Thurs 3/18:
Well the pediatric dermatologist squeezed us in for a last-minute appointment tomorrow. So hopefully she'll take one look at it and know instantly what it is and, more importantly, how to fix it! I'm going to bring the info I wrote down in this post, as well as some of the suggestions you guys made, to the appointment, since I tend to get nervous around doctors and forget to mention important stuff.

37 comments:

  1. Anonymous3/17/2010

    My right thumb looks very similar. I'm finally getting it cleared up by periodically (qid) cleaning it with peroxide and then wrapping very loosely in gauze for cleanliness. It was not getting a chance to dry with topical creams, touching the moist outside of a glass of ice water, frequent handwashing, etc. I've had this before and, as long as there's no inflammation, this works best for me. Are you sure there's no thumbsucking during the night? Good luck!

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  2. Our eldest son had the same thing on his thumb several months ago. It started out as a dry patch and then he just kept picking at it with his teeth, keeping it wet all of the time. We finally kept band-aids on it and putting Neosporin (sp?) on it constantly and eventually it went away.

    Mommy to Two Busy Boys

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  3. It certainly does sound like a fungal infection, which is what your doc is trying to treat with the Lotrimin; the mupromicin is for impetigo; the Mometasone Furoate is for eczema or psoriasis. I'd try some further anti-fungals, frankly, but I am not a doctor. There are some good medical pages on anti-fungal treatments, like this one on the web.

    How long have you been treating this? The pages I've looked at have said expect to treat a fungal infection for a month with a particular cream/ointment before seeing any relief.

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  4. The dermatologist is a good idea. I get the feeling your ped is sort of bouncing from diagnosis to diagnosis; a dermatologist is likely to take one look, one sample to analyze, and know exactly what it is.

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  5. it looks/sounds like a fungal infection. My feet have looked like that if I get athlete's foot and don't treat it quickly enough. It takes about 6 weeks to clear.

    I hope it heals quickly!

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  6. I'm no dermatologist but it does look like a fungal I had a long time ago. I cannot for the life of me remember the name of the med, but it did clear it up and it never hurt.

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  7. Anonymous3/17/2010

    I've seen lots of kids with similar looking skin. Try to keep it clean and dry. Avoid stuff like hand sanitizer for a while to see if it is contributing to the problem. I'm glad you're going to a dermatologist.
    :) Debbz
    ps- Where did that hour go last week?!?

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  8. Victoria3/17/2010

    My daughter had the exact same thing on her thumbs when she was around 3 years old. I took her to a dermatologist and he said it was eczema. She had eczema on her legs that looked totally different, so I had a hard time believing it. But sure enough he gave her a perscription (which I can't remember the name of right now) and it cleared up in a week or so. She hasn't had is since! It was a strange "one time" thing! Good luck! I hope it clears up soon.

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  9. blogging mama pharmacist3/17/2010

    You know me from blogging, but I don't reveal online that I'm a pharmacist as a way to help protect our family's privacy. :)

    This really really sounds fungal to me. Especially the "thick and kind of crumbly" comment. The strongest antifungal that you can get OTC is Lamisil cream. Even used to be Rx only until 5-10 years ago. I would like to see you try applying this twice daily for two WHOLE weeks. Here's a link for the product: http://www.drugs.com/pro/lamisil-at.html

    Fungus likes to grow in warm most places. I've seen several women get fungal infections under their wedding rings. It can make the skin look dried out and very peely. If there is involvement under the nail, topical antifungals don't work because they can't penetrate the fingernail.

    If this doesn't work and it is fungal... and especially if she has under the fingernail involvement, a derm may have you guys to oral antifungals. Oral antifungals are no fun because they come with liver issues. One would have to have liver enzymes monitored to watch for signs that the oral antifungals are starting to hurt the liver. Outside of a hospital setting, I see Diflucan suspension used most often in children requiring oral antifungals.

    Hope this helps!

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  10. Anonymous3/17/2010

    Sounds like a fungus.

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  11. Something else to consider- does she suck her thumb at night? It doesn't look like it up close, but that was my first thought, it can definitely cause irritation and if picked at, create other problems.
    Good luck, hope it clears up fast.

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  12. My kids have had some weird rashy things. Cheeks, chest, diaper area, etc. When the cortisone and other anti-fungals didn't work we tried a new cream called Vusion. It is an anti-fugal and although it is primarily used for the diaper region it worked great for my kids' cheeks and chest. Just another idea.

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  13. It looks fungal, but my last dermatology rotation was in residency, a very long time ago.

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  14. Not to press the issue, but the RN in me says fungal, along with the crowd. The problem with fungals is that they take forever to knock out. I treated one on my face for 4 solid weeks, and I still battle it from time to time. You just need something stronger than OTC, and you'll probably treat for 3-4 weeks, and maybe more than once a day. Waiting to see the dermatologist, I might try triple paste. It's diaper cream with cornstarch in it, and solved our worst fungal diaper rashes in this house. Crazy idea maybe, but if it doesn't hurt delicate baby bottoms, it probably won't hurt her thumb.

    Good luck!

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  15. Will has similar issues on his hands - not just around the fingers, but his entire hands. His derm told him his is psoriasis. He gets a prescription for Aquaphor with a steroid in it. It is a monster for us to deal with, but I'm going with some of the others who think it may be fungal since it affects her nail like it does. His hands just crack and bleed, but his nails have never been affected.

    If it were me, I'd still make and keep the ped. derm appointment even if it shows some signs of clearing with the new med.

    Good luck!

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  16. Anonymous3/18/2010

    If it is fungal it will be hard to treat. I had something like that on my toes, i treated it with apple cider vinegar and peroxide.

    i was told that fungal infections are hard to beat because people don't realize that fungus doesn't stop growing.

    if you go 12 hours w/out treating it the new growth overtakes the the treated growth and it's like starting all over again.

    once i got this through my head it actually took about two weeks to see improvement and another two weeks to beat it.

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  17. Looks like fungal to me. Need to be treated immediately. dermatologist.

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  18. Ah the internets - a great way to start hyperventilating. :)

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  19. I'll echo everyone's comments and say mine had the same thing. It was fungal and after lots of wrapping, (because keeping an 8 year old boy's hands clean is next to impossible) and cleaning

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  20. Anonymous3/18/2010

    looks fungal-- yes, go see a ped derm.

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  21. Honestly, it looks like eczema to me. I've had similar patches on my hands around my nails, too (I have bad eczema). If the fungal creams are stinging (they always did for me, too!), then I don't think it's fungal. Going to the derm is a really good idea, actually. They will take one look and identify it immediately.

    Here's what works for me when my hands get that bad: aquaphor at night and sleep with a sock or something on my hand to keep it on my hand. During the day, I put aquaphor on it, then cover with a bandaid (to keep aquaphor on and it clean). Mine does hurt when I use an antibacterial gel..and in fact, I steer clear of them as much as possible b/c they dry my hands out SO BADLY. Heck, I really shouldn't even be using the soap in public bathrooms...and for a long time brought my own. Strange, I know, but it worked. Speaking of my own, I can pretty much only use goat milk soap (that I get from goatmilkstuff.com) and CeraVe (found at CVS/Walgreens). I also am using CeraVe cream exclusively now, but have used Eucerin Calming Creme which is good too. Neither are greasy, but very gentle & very moisturizing.

    It's no fun...and likely something she'll fight her WHOLE life (if it's eczema)...I remember being SO embarrassed in high school because I had a horrible patch on my palm forever. I just couldn't get it cleared up b/c we didn't know what it was...but then my mom never took me to a derm until I was out of high school and pretty much said I needed to go. And she's a nurse...go figure! ;-)

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  22. ah bless her little heart!!

    looks like it hurts!

    sending good thoughts to you and your sweet girlie!

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  23. samcarter3/18/2010

    It could be psoriasis; nails can be affected in psoriasis. I have had psoriasis since I was a kid, and a few of my toenails are affected. Psoriasis can provide a good environment for a fungal infection, as well, so it's good to take a sample and test it for a fungal culture.

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  24. Indeed it looks fungal to grandma here too, and I have noticed that when I have used antifungals on my children and grandchildren, the area always looks worse for a day or two before the improvement starts.
    But, one of my granddaughters has had similar looking fingers after an unrecognized strep infection. No sore throat, no fever, but a wise pediatrician said peeling fingers can come after strep has gone on a while, so she performed a throat culture which turned out positive. This happened three times with this child, once a year for three years. We called it "strep finger" aftr the first two times. I don't think that's usual--the smart money is on fungus. Once we had a diagnosis of a viral infection, a "whitlow," but it did clear up with antibiotic all three times.

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  25. Hope the apecialist appt goes well and you can feel better soon! Glad its not bothering her too much.

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  26. Michelle3/18/2010

    Perhaps a fungal infection? Tea Tree oil might help or an antifungal cream available from a pharmacy.

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  27. Anonymous3/18/2010

    Definitely looks fungal. Make sure you tell the derm what fungal creams you have used so far. I had a fungal infection that I got from traveling in central america, and it took almost 6 months to treat. I had to be put on oral antifungals because the creams and sprays (even prescription) did not work.

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  28. My oldest daughter has what appears to be same thing on her finger and it is eczema.

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  29. contact dermatitis? I have had it and it looked exactly like that. Will be interested in what it ended up being.

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  30. I am leaning towards fungal or instant steroid intervention.

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  31. IT looks like a fungal infection to me, in which case the Cortizone is probably feeding the fungus. I hope you got some answers today.

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  32. Psoriasis??

    Branden had that on his fingers and knees for the longest time. Our doctor gave us some cream...but I dont remember what its called and said LOTS AND LOTS of sun!!!

    Hope you know what it is by now!

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  33. Ouch. Poor little Ree. Praying it heals up quickly and that the doc was able to give you something to clear it up quickly. Sure looks sore. So glad it isn't!

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  34. Anonymous3/19/2010

    If it's fungal, I used cheap vinegar on my toenail. It takes awhile and has to be done 2 - 3 times a day. Mabybe it's something to try instead of the oral anti-fungal meds. prayers for Ree!!

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  35. Poor little thumb, It looks like the same kind of infection that causes athletes foot. Have you tried remedies for that? Lemongrass essential oil is an antifungal / antibacterial that might help (health food store). Mix a few drops into a cortisone cream and keep it bandaged over night.

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  36. My son (half Vietnamese) gets this on his feet. It is bad. I found a product at the health food store, of all places, called "Thera NEEM". NOTHING cleared up his foot prior and I mean nothing! This? It did the trick and the peeling, red patch that was spreading like wildfire and causing a deep crack between the folds, disappeared. Fast! (It was a cheep and non-medical fix) I'd try it first before going full pell mell on the medicated ointments.

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  37. Anonymous12/19/2010

    I am asian and I got this all the time in my younger days. I am now 39 years old and the last time I had this was in my early 20s. What worked for me is dipping the finger in cold water with lots of salt (per order of my pediatrician) I would do this many times a day and it clears up in less than a week. God bless you and your twins. Merry Christmas.

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