# Recurrent Hand Skin Changes and Treatment Record

Date: Friday 30 October 2026

Last Updated: Friday 30 October 2026

Type: Letter

## Summary

1. **Repeated skin changes:** Similar raised or itchy changes have returned within or near the same area on the back of the right hand since the original wound in February 2026. The original wound closed after treatment with flucloxacillin. Later episodes improved during courses of Elocon or Fucibet and subsequently recurred.
2. **Separate rash during earlier medication use:** Numerous itchy red spots developed from the wrist towards the elbow while naproxen and flucloxacillin were being taken in February–March 2026. The more widespread rash improved markedly after naproxen was stopped on 3 March, while flucloxacillin continued. The GP subsequently obtained dermatology advice and advised avoiding naproxen. The localised hand changes later recurred without further naproxen use.
3. **Episode timing:** Some observed recurrences followed the end of topical treatment by approximately 17–18 days. Earlier cycle dates were reconstructed from recollection rather than independently verified.

## Clinical Timeline

### Cycle 1 (Monday 23 February – approximately mid-March 2026)

Initial right-hand wound and recovery, with two overlapping treatment stages.

- **Stage 1 (Monday 23 February – Monday 9 March):** Medicines prescribed on Monday 23 February:
  1. **Flucloxacillin:**
     - **Monday 23 February:** 500 mg four times daily.
     - **Friday 27 February:** Increased to **1,000 mg four times daily**.
     - **Saturday 7 March:** Final dose. Total recorded course: **84 capsules of 500 mg = 42,000 mg (42 g)**.
  2. **Naproxen:**
     - **Monday 23 February:** 500 mg twice daily.
     - **Monday 2 or Tuesday 3 March:** During a GP consultation, reducing naproxen to once daily was suggested.
     - **Tuesday 3 March:** Final dose in the morning; evening dose omitted.
     - **Wednesday 4 March:** Rash markedly improved the following morning; naproxen discontinued.
  3. **Omeprazole:**
     - **Monday 23 February:** 20 mg once daily.
     - **Monday 9 March:** Final dose.
- **Stage 2 (Wednesday 4 March – approximately Thursday 12 or Friday 13 March):** Wound closed; follow-up treatment:
  1. **Elocon 0.1% w/w ointment:**
     - **Wednesday 4 March:** Prescribed for residual skin changes after wound closure.
     - **Thursday 5 March:** Pharmacy label date.
     - **Friday 6 or Saturday 7 March:** Estimated first use.
     - **Thursday 12 or Friday 13 March:** Approximate final use after a recalled seven-day course.

### Cycle 2 (reconstructed, approximately 4–11 April 2026)

Similar skin changes recurred; Elocon used for seven days.

### Cycle 3 (reconstructed, approximately 2–10 May 2026)

Similar skin changes recurred; Elocon used for seven days.

### Cycle 4 (reconstructed, approximately 30 May – 8 June 2026)

Similar skin changes recurred; Elocon used for seven days.

### Cycle 5 (approximately Saturday 4 – Sunday 19 July 2026)

Recurrent raised and itchy right-hand skin changes; assessed at UTC on Monday 13 July.

1. **Fucibet cream (fusidic acid 20 mg/g; betamethasone 1 mg/g):**
   - **Monday 13 July:** Prescribed at UTC, twice daily for seven days; first applied that evening.
   - **Sunday 19 July:** Final application in the morning; skin smooth, with residual colour change.

### Cycle 6 (Thursday 6 August – Wednesday 30 September 2026)

Recurrent skin changes reviewed on Thursday 6 August, 18 days after the Fucibet course ended; exact recurrence onset not recorded.

1. **Elocon 0.1% w/w ointment:**
   - **Thursday 6 August:** Eight-week tapering course started.
   - **Wednesday 30 September:** Prescribed course completed; symptoms had largely settled.

### Cycle 7 (from Saturday 17 October 2026)

Itching and small spots recurred on the right hand, with similar spots observed on the right forearm.

- **Saturday 17 October:** New skin changes appeared, 17 days after the Elocon course ended.
- **Monday 19 October:** GP advised intermittent Elocon use, avoiding prolonged continuous use; Elocon applied that evening.
- **Wednesday 21 and Friday 23 October:** Elocon applied again using the existing tube. The changes were less pronounced than in earlier episodes and, according to the patient, had fully settled after these three applications. No further application has been confirmed.

## Timeline Clarifications and Additional Clinical Observations

- **Reconstruction basis:** Cycles 2–4 are approximate working dates based on a recalled pattern of recurrence about 18 days after the previous final application, several days of symptom development, and a seven-day treatment course; they are not verified episode dates.
- **Cycle boundary:** Each treatment course successfully resolved the visible skin changes before the final steroid application. A new cycle begins when similar skin changes subsequently recur.

- **Recurring distribution of skin changes:** Since the early episodes in 2026, the patient recalls that small spots on the right forearm and skin changes on the back of the right hand appeared together and resolved together following topical treatment. During a GP consultation, the doctor noticed the forearm spots and asked about them.
- **Daily variation:** During an active episode, the skin changes could appear less noticeable after sleep, with some itching remaining, and become more noticeable again towards evening.
- **Reduced right-hand function:** Since July 2026, the patient has been unable to lift a frying pan that was previously manageable with the right hand alone. Further details are in **Right Upper-Limb Symptoms and History**.

## Background

Before 23 February 2026, the patient had a persistent wound or skin lesion on the dorsal aspect of the right hand.

By the night of 22 to 23 February:

- the area remained unresolved;
- itching and irritation had increased;
- the skin felt increasingly sensitive;
- the symptoms had become difficult to ignore.

Severe low-back pain was occurring at the same time. The combined effect of the back pain, lack of sleep, and symptomatic hand wound led the patient to seek urgent medical assessment on 23 February 2026.

The hand wound was subsequently treated with flucloxacillin and reviewed during GP appointments on 27 February and 4 March 2026.

After the original wound closed, recurrent raised skin changes later developed within or near the same dorsal-hand area.

The recurrent changes appeared to improve after short courses of Elocon 0.1% w/w ointment but returned after treatment was stopped. Similar changes recurred in or near the same area, including a further episode beginning on 17 October 2026.

## Details

### Before Monday 23 February 2026 – persistent wound on the back of the right hand

- Before 23 February 2026, the patient had a wound or skin lesion affecting the dorsal aspect of the right hand.
- The exact date and cause of the original wound cannot currently be confirmed.
- The wound had remained present for a period of time and had not fully closed before urgent medical assessment.
- By the night of 22 to 23 February, the affected area was:
  - itchy;
  - irritated;
  - increasingly sensitive;
  - difficult to ignore.
- The patient was also experiencing severe low-back pain and had been unable to rest or sleep properly.
- The combined symptoms made the situation difficult to manage and contributed to the decision to seek urgent medical assessment on 23 February 2026.

### Monday 23 February 2026 – MIU and UTC attendance for the hand wound

- On the morning of 23 February 2026, the right-hand wound remained unresolved, itchy, irritated, and increasingly sensitive.
- Severe low-back pain and lack of sleep were also present at the same time.
- The patient first attended a Minor Injuries Unit.
- According to the patient's recollection:
  - treatment was not provided for the presenting problems;
  - the patient was advised to obtain an over-the-counter product from a pharmacy.
- The patient did not consider this sufficient because the hand wound remained unresolved and symptomatic.
- The patient therefore attended an Urgent Treatment Centre for further assessment and treatment.

UTC prescription labels dated **23 February 2026** recorded:

- **Flucloxacillin 500 mg**:
  - **28 capsules** supplied;
  - label instructions: **take one capsule four times daily**.
- **Naproxen 500 mg**:
  - **28 tablets** supplied;
  - label instructions: **take one tablet twice daily**.
- **Omeprazole 20 mg**:
  - **28 capsules** supplied;
  - label instructions: **take one capsule once daily**.

- Flucloxacillin was prescribed for the right-hand wound.
- Naproxen and omeprazole were supplied during the same attendance, when severe low-back pain was also being assessed.

### Late February 2026 – widespread itchy rash during concurrent medicines

- During the period when naproxen and flucloxacillin were being taken concurrently, the patient developed numerous itchy red spots.
- The spots extended from the wrist towards the elbow.
- The reaction was separate from the original localised wound on the back of the hand.
- Naproxen was subsequently discontinued while flucloxacillin continued.
- The widespread itchy rash then improved markedly.
- The GP later sought written dermatology advice and advised avoiding further naproxen use.

### Friday 27 February 2026 – first GP follow-up for the right-hand wound

- The patient attended a pre-booked GP appointment at approximately **10:30 am**.
- The consultation focused mainly on the unresolved wound on the back of the right hand and whether the remaining antibiotic supply would be sufficient.
- The original flucloxacillin prescription supplied on Monday 23 February consisted of:
  - **28 capsules of flucloxacillin 500 mg**;
  - label instructions to take **one capsule four times daily**.
- Before the GP appointment, the patient had taken:
  - two single-capsule doses on Monday 23 February;
  - four single-capsule doses per day on Tuesday, Wednesday, and Thursday, totalling 12 doses;
  - one single-capsule dose on Friday morning.
- This amounted to **15 capsules** before the appointment.
- Based on the condition of the hand and the number of capsules remaining, the patient raised concern that the original supply might not be sufficient.
- The GP supplied:
  - **56 additional flucloxacillin 500 mg capsules**;
  - two packs containing 28 capsules each;
  - label instructions to **take two capsules four times daily for seven days**.
- After the appointment, the patient took one further single capsule so that the total already taken became an even number before changing to two-capsule doses.
- A total of **16 single-capsule doses** had therefore been taken before the revised dosing schedule began.
- The revised dose of **two capsules four times daily** began on Friday afternoon.
- The total flucloxacillin supply across the two prescriptions was **84 capsules**.
- After the first 16 capsules had been taken, **68 capsules remained**.
- The remaining 68 capsules provided:
  - **34 two-capsule doses**;
  - equivalent to **8.5 days** at four doses per day.
- The full treatment course therefore comprised:
  - **50 doses in total**;
  - taken four times daily;
  - equivalent to **12.5 days of treatment**.
- The patient reports that all doses were taken according to this schedule without missed doses.
- The wound remained under review after this appointment.

### Wednesday 4 March 2026 – second GP follow-up, wound closure, and Elocon prescription

- The patient attended a further GP follow-up on **Wednesday 4 March 2026**.
- By this stage, the original wound on the back of the right hand had fully closed.
- The skin had not yet returned to a normal appearance:
  - residual marks remained;
  - the surface appeared uneven or layered;
  - small indentations and spots were still visible.
- **Elocon 0.1% w/w ointment was prescribed for the recovering skin condition.**
- The patient could not collect the ointment immediately because the pharmacy did not have it in stock.
- Elocon was collected approximately **one to two days later**.

### After wound closure – recurrent raised skin changes in the same area

- After the original wound had closed, recurrent small raised skin changes developed within or near the same area on the back of the right hand.
- The changes repeatedly appeared in the same location or nearby.
- They were sometimes easier to detect by touch than by sight.
- At times, the area also became itchy.
- The recurrent changes were later treated with short courses of Elocon 0.1% w/w ointment.

### Previous Elocon treatment courses and recurrence pattern

- The recurrent dorsal-hand skin changes were treated on several occasions with Elocon 0.1% w/w ointment.
- The patient recalls **three separate courses of approximately seven days** of Elocon before the July 2026 recurrence; individual dates were not recorded.
- During each course:
  - the raised changes became less noticeable;
  - the itching or irritation improved;
  - the affected area appeared to settle after several days of treatment.
- On each occasion, treatment was stopped only after the visible skin changes had cleared completely.
- Similar skin changes later returned in the same area or nearby.
- This pattern of improvement followed by recurrence happened several times.
- On the reconstructed pattern, early skin changes appeared approximately **18 days after the final Elocon application**, then developed over another **four to five days**, approaching skin breakdown before another approximately **seven-day Elocon course** was started. These intervals are retrospective estimates, not contemporaneously recorded dates.
### Saturday 4 to Friday 10 July 2026 – partial Elocon treatment before clinical review

- Around 4 July 2026, the recurrent skin changes became more noticeable again.
- Because a GP appointment had already been arranged, the patient initially wished to preserve part of the untreated appearance for clinical examination.
- Elocon 0.1% w/w ointment was therefore applied:
  - on one occasion only;
  - to only part of the affected area.
- The intention was to reduce symptoms while leaving part of the skin untreated so that the original appearance could still be reviewed.
- By 10 July 2026, the appearance had changed and no longer fully represented the untreated episode.
- Photographs taken before treatment therefore provide the best record of the untreated appearance.
- On 10 July, the remaining abnormality was appreciated mainly by touch rather than by obvious visible skin changes.

### Friday 10 to Monday 13 July 2026 – changing and worsening recurrent skin changes

On Friday 10 July 2026, the earlier partial Elocon application had changed the appearance of the affected area, which no longer fully represented the untreated recurrence shown in the earlier photographs.

At that stage:

- the remaining abnormality was easier to appreciate by touch than by sight;
- the affected skin still felt uneven rather than completely smooth or normal;
- the photographs taken before treatment provided the best record of the untreated appearance.

After Friday 10 July:

- small raised spots became noticeable again within the affected area on the back of the right hand;
- the same area also became itchy;
- by Monday 13 July, the raised and itchy changes were more pronounced than they had been on Friday 10 July.

The itching remained tolerable, and the patient did not consider separate anti-itch treatment necessary at that stage.

The patient would normally consider washing the area with warm water and applying Elocon 0.1% w/w ointment again. However, because the skin changes have repeatedly returned after previous short courses, the patient wished to obtain clinical advice before beginning another course.

### Friday 10 July 2026 – GP appointment arranged

- On Friday 10 July, the patient arranged a GP appointment for Monday 13 July.
- The appointment on 13 July was with a GP who was not the patient's named GP.

### Monday 13 July 2026 – GP consultation and UTC attendance

- The patient attended the arranged GP consultation on Monday 13 July.
- Later that afternoon, the patient attended an Urgent Treatment Centre for assessment of the recurrent right-hand skin condition.
- The UTC clinician prescribed **Fucibet cream**.
- The packaging and dispensing label recorded:
  - fusidic acid 20 mg/g;
  - betamethasone 1 mg/g;
  - apply to the affected area twice daily for seven days.
- The first application was used on the evening of Monday 13 July.

The UTC clinician advised that:

- the seven-day course should be completed;
- if the condition had not completely cleared after the course, further review would be required;
- if a GP appointment was unavailable, the patient should return to UTC.

### Monday 13 to Saturday 18 July 2026 – response to Fucibet

- Fucibet was applied according to the label instruction of twice daily.
- Treatment began with one application on the evening of Monday 13 July.
- By Saturday 18 July, the patient was on approximately the sixth day of treatment.
- Only the first daily application had been used by the time of this update because the evening application was not yet due.

The skin condition gradually improved.

However, by Saturday 18 July:

- it had not completely cleared;
- residual changes remained visible;
- residual unevenness or raised changes could still be felt by touch.

Before the first Fucibet application:

- the area was washed with warm water at approximately 37°C;
- it was dried using kitchen paper;
- pale-yellow, watery fluid was already present.

After Fucibet was applied:

- a small amount of pale-yellow, watery fluid was still visible;
- no definite odour could be confirmed because the cream had already been applied.

During approximately the first one to two days of treatment:

- some fluid continued to discharge from the affected skin.

After those first one to two days:

- no further fluid discharge was noticed.

### Before Thursday 16 July 2026 – pre-existing reduction in right-hand ability

- Before 16 July, the right hand or arm already felt less capable than normal.
- The change did not begin as a single sudden event.
- The precise degree of reduction had not previously been objectively established.

### Thursday 16 July 2026 – reduced right-hand lifting ability became objectively apparent

- On Thursday 16 July, the patient attempted to lift a frying pan by gripping its handle with the right hand.
- The patient had previously been able to lift and hold the same frying pan with the right hand alone.
- On this occasion, the patient was unable to lift it with the right hand alone.
- There was no pain during the attempt.
- The patient stopped the attempt when it became clear that the pan could not be lifted safely.
- The frying pan was not dropped.

The patient regards 16 July as the date on which the reduction became objectively apparent, rather than necessarily the date on which the underlying change began.

### Saturday 18 July 2026 – further reduction and mild altered sensation

By Saturday 18 July:

- the patient remained unable to lift the frying pan with the right hand alone;
- the lifting ability felt worse than on Thursday 16 July;
- mild intermittent numbness or altered sensation had developed;
- the sensation was most noticeable when making a fist;
- it was mainly centred in the palm and extended towards four fingers;
- no definite tremor had begun;
- the patient stopped lifting attempts before an object could be dropped.

The patient could still:

- make a fist, although the grip felt weak;
- open a bottle cap;
- hold a cup;
- use a spoon or chopsticks;
- type.

However, compared with before, the patient found it more difficult to:

- open a packet of crisps;
- open an instant-noodle packet.

The left hand remained normal.

### Right upper shoulder-blade pulling sensation

- The sensation was located near the upper-right part of the shoulder blade when viewed from behind.
- Raising or using the right upper arm caused a pulling or tight sensation near the right shoulder blade.
- The sensation remained mainly localised around the right shoulder-blade area and did not clearly extend down the arm.
- The same pulling sensation was not present on the left side.
- The patient did not describe pain while gripping or attempting to lift the frying pan.

### Sunday 19 July 2026 – completion of Fucibet and clinical review

- The final scheduled Fucibet application was used on the morning of Sunday 19 July 2026.
- This completed the prescribed seven-day course.
- At that time:
  - the treated skin was smooth;
  - the surface was no longer raised;
  - the colour remained different from the surrounding skin.
- The skin was reviewed and no further immediate treatment was advised.
- The right hand and arm were also assessed.
- The patient was advised to follow up through Musculoskeletal Services.
- Physiotherapy was recommended as the likely next step for improving the reduced right-hand and arm function.

### After Sunday 19 July 2026 – hand sensation and function

- The mild intermittent numbness or altered sensation recorded on 18 July later disappeared.
- The patient regards this as a brief or isolated event.
- No continuing numbness was present by 6 August 2026.

However, right-hand function had not returned to normal:

- the patient still could not lift the same frying pan with the right hand alone;
- opening food packets remained more difficult than before;
- the right hand continued to feel less capable than previously;
- the left hand remained normal.

The patient recalls dropping an object once approximately two to three months earlier. This was not a new event during the July episode.

### After Sunday 19 July 2026 – shoulder-blade symptoms and exercise frequency

- Around the time that abdominal symptoms began later in July, the pulling sensation near the upper-right shoulder blade became almost completely absent.
- A mild pulling sensation later returned.
- By 6 August 2026, it remained less noticeable than before.
- The patient reduced the frequency of the Musculoskeletal Services exercises.
- Longer intervals were left between exercise sessions.
- The patient did this because the hand and shoulder symptoms were less urgent than the later abdominal symptoms.

### Approximately early August 2026 – further recurrence of the skin changes

- Approximately two weeks after the Fucibet course ended, the skin in the same area began to become abnormal again.
- By 6 August 2026:
  - the skin remained unbroken;
  - residual marks were present;
  - the surface felt rough;
  - raised changes were present;
  - the area felt different from the surrounding skin when touched.
- The recurrence did not appear severe enough to prompt further photographs.
- The latest photographs available were taken around 20 July 2026.

- Including the previous recurrences and the recurrence after Fucibet, this appears to be approximately the fifth recurrence after treatment.

### Earlier widespread itchy rash during medication use

- During the February 2026 acute episode, numerous itchy red spots developed between the wrist and elbow while naproxen and flucloxacillin were being taken concurrently.
- The rash improved markedly after **naproxen was discontinued while flucloxacillin continued**.
- The GP later obtained written dermatology advice and advised avoiding naproxen.
- No further naproxen use has been reported since 3 March 2026.

### Thursday 6 August 2026 – eight-week Elocon tapering plan

Following clinical review on Thursday 6 August 2026, the treatment strategy for the recurrent hand skin changes was changed to a structured eight-week tapering course of **Elocon 0.1% w/w ointment**.

Start date: **6 August 2026**

Planned taper schedule:

- **Week 1 (6–12 August 2026):** once daily.
- **Week 2 (13–19 August 2026):** every other day.
- **Weeks 3 and 4 (20 August–2 September 2026):** every 2 days.
- **Week 5 (3–9 September 2026):** every 3 days.
- **Week 6 (10–16 September 2026):** every 4 days.
- **Weeks 7 and 8 (17–30 September 2026):** once per week.

The prescribed course was completed on **30 September 2026**. The skin symptoms had largely settled after treatment began in August, and no significant further problems were noted before the new episode beginning on **17 October 2026**.

A separate right upper-limb history is recorded in **Right Upper-Limb Symptoms and History**.

### Saturday 17 October 2026 – renewed itching and visible spots

- Itching returned on the back of the right hand, in or near the area affected during earlier episodes.
- Small spots were visible to the naked eye, although they were less apparent in some photographs.
- Similar small spots were also noticed along the right forearm, between the wrist and elbow, during this new episode. The precise time when the forearm spots first appeared has not been established.

### Sunday 18 October 2026 – changes observed over the day

- The patient described a recurring pattern in which the spots became less visible after sleep, with mild itching still present, and became more noticeable again towards the evening.
- Photographs were taken when the changes were more apparent.
- The patient was concerned that the skin might not be returning fully to its earlier baseline after each night, although this possible trend has not been confirmed.
- The exact observations and photographic times attributable specifically to 18 October have not been separately established; the points above describe the pattern reported during this episode rather than a confirmed day-specific sequence.

### Monday 19 October 2026 – ongoing symptoms and GP consultation

- The patient reported that the pattern of improvement after sleeping and increased visibility towards evening had continued during the new episode.
- The affected area had only been cleaned gently with warm water; no medicine had been restarted for this recurrence.
- Elocon remained available from an earlier GP prescription, but the patient preferred to seek clinical advice before using it again.
- Based on earlier episodes, the patient was concerned that the skin might break down again within approximately three to four days. This was an expectation based on experience, not an established outcome.
- The patient estimated approximately six episodes of similar recurring skin problems since the original wound in February 2026; the count is approximate.
- At the GP consultation, the patient asked about reusing Elocon for recurrent symptoms. The GP advised that Elocon could be used intermittently, avoiding prolonged continuous use.

- **Elocon 0.1% w/w ointment:** Applied once on **Monday 19 October (evening)**, **Wednesday 21 October**, and **Friday 23 October**, using the same tube as before. The patient reported that the symptoms were relatively mild, treatment began before significant deterioration, and the changes had fully settled after these three applications; the patient therefore did not continue frequent applications.

## Notes

- Pale-yellow, watery fluid was present before the first Fucibet application in July, persisted briefly after treatment began, and was not noticed after approximately one to two days.
- During the July frying-pan lifting attempt, the right-hand weakness was not accompanied by pain; the object was not dropped because the attempt was stopped when lifting felt impossible or unsafe.
- Mild intermittent altered sensation was noted in July and later resolved. No definite tremor had begun at that time.
- Photographs provide supporting evidence of skin appearance at different stages, though some visible changes are less apparent in photographs than to the naked eye.
- Medicine packaging and dispensing labels remain the primary evidence for the prescribed product and instructions.

This document reflects the information the patient has been able to identify and organise as relevant. It may not contain every detail that could be clinically useful.

### Please ask me about any additional details that may help with the assessment.