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What are these itchy dark patches on my skin?

Q: I have 2 problems. First, I have a rash like thing on my left arm and it hasn't gone away in almost 4 years, sometimes it itches and at times it doesn't. I only get it on my left arm, neck and back of the neck. Doctors have given numerous creams and steroids and it goes away for a while but comes back. The other thing is that under my arm I have these little blackhead like things and the doctor said that he has never seen anything like that. I try to squeeze them and it comes out but how do I get rid of them for good? This is embarrassing because I have them in the inside of my thighs and it makes my skin look dark. What can I do?

A:It is unfortunate that three different doctors have not been able to make a diagnosis. It is also true, that at times it is not possible to make an accurate diagnosis on clinical examination alone. In such situations, one comes up with different possibilities which are then worked upon. Skin biopsy settles the issue in most cases. Without all the clinical details it is difficult to hazard the possible skin disorder you have. Round circles can be seen in number of conditions which can respond to topical steroids. Some examples: chronic eczema, neurodermatitis, localised psoriasis, granuloma annulare, etc. Dark skin in body folds can result from chronic friction, acanthosis nigricans etc. Prognosis depends upon the diagnosis.

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