求助：皮肤问题

入冬以来，脖子上开始一块块出现粉色的斑像rash，很痒，如果抓了，就又痒又痛，看了皮肤科医生，说是皮肤干燥引起的，没有什么能够彻底治愈。医生倒是给开了处方外用药，但明确告诉不能使用超过两星期，里面含steriods，副作用很大（听说皮肤会变薄，颜色也会有变化，很难恢复）。

症状是从11月初开始，起初就一两小块，同事推荐了over counter的hydrocortisone, 还好用，抹两三天会好，但过后又起，off and on，这几天大概天冷的缘故，公司和家里的heater 都在continuously run, 可以感觉到空气的干燥，症状越来越严重，痛痒的六神无主，抹药治疗的速度还不如发病的速度快。

请网友提供帮助和建议。


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感谢ELIZA热心细致的诊断 (see below):

First I need to know a little more about your history.
*travel to the woods (tick bites) back in Oct/Nov, your dog/cat had tick infection? Lime disease is unlikely since you rash is <5cm in diameter and doesn’t have the typical bull-eye appearance. But I thought I should ask.
*Any recent joint pain/significant fatigue/sun sensitivity/flu-like symptoms
*do you have asthma, allergic rhinitis ( 过敏性鼻炎 )
If your answer to the above is no, 我觉得你的皮肤可能是接触性皮炎和神经性皮炎 .

There are old and new rashes on you neck. I assume the old ones are treated with hydrocortisone cream. They look well healed with only some dispigmentation ( 色素沉积）， which is normal and might take a while for them to go away. I see some rubbing/scratching marks. This together with what you told me, I think there is a high chance that you are suffering from a persistent contact or irritant dermatitis. Some of them got better with the cream; some of them develop due to continuous exposure. Scratching or rubbing can hurt the nerve terminal and as a result, the irritated nerve will send out intense itching and pain signal. At this stage, the dermatitis is called neurodermatitis ( 神经性皮炎 ). It takes quite some time to get better because of the vicious cycle between being itching and pain, and rubbing and or scratching.
So, what could be the culprit(s)? If we can identify it/them, then we will be in a good position to cure your skin condition. There is a fair likelihood that we can ’ t find any. Sometimes it is things we can change such as the weather and a couple things you need to recall are as follows:
Have you recently switch to use

• New wool /synthetic fiber clothing, linens (sheet, pillow cases),
• Hair dyes, soaps,
• Cosmetics, perfumes, scented lotions
  

Treatment wise, may I suggest:

• Change the new items you have acquired recently to hypo allergic, non-scented items. Missionallergy.com might give you some ideas.
• Wear 100% cotton and soft material if possible. Wear your hair up and leave your neck naked if possible. At work, you can try silk scarf to cover your neck.
• No scratching/rubbing. Trim your fingernails short and wear gloves during sleep so that you won ’ t rub your neck during sleep. I have to say this is a bit hard to do.
• Continue to use hydrocortisone cream but take anti-histamine at the same time because cream only works on the spot you apply. Try to take anti-histamine regularly even your itching is better. Take it at least 2 weeks.
• Try Claritin during daytime and Benadryl at night.
• If the above fail to improve your condition, one drug I think you can ask you doctor to prescribe is called Atarax. It is powerful anti-histamine and also has a calming effect. Anxiety can make the rash worse.
  
• If you try the above and still no improvement, it is time to go back to your dermatologist and perhaps an allergist for hypo-allergic products and skin test.
• Forgot to mention moisturizer. Lotion won't help in your case because it is too diluted. You will have to try cream or ointment. Vaseline Petroleum Jelly Cream, Deep Moisture, is a good choice. Eucerin is really thick and might be hard to apply. But you can try them out and stay the one your skin likes.