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  • Dr Jonathan Gui

Grumpy as Snow White's Dwarf

Scratch, scratch and scratch,

Skin stretch and stretch,

Doctor assess and assess,

Treat with no luck of success.


It is horrible to be plague with itching skin. Constant scratch and bleeding as the result of the scratching. You get creams, steroids and anti-histamine but still scratch, scratch and scratch. Day in and day out the scratching becomes addictive and feels so good. Your skin starts to peel and the itching become painful as the skin bleeds. Doctors will tell you to stop scratching and you feel like giving them a piece of your mind. Your response will be “Stop telling me not to scratch. I cannot help scratching because it is itchy!” Easy for the doctor to say unpractical things like that but never give solutions to reduce the itch.

Here’s a good story and I hope you enjoy it.


Itching Papular lesion of the skin

Today we have a patient named “Grumpy”. Grumpy is named Grumpy because he was indeed grumpy. Lack of sleep and horrible itching just annoys him. So he is a Brit who has a business here in Malaysia, unmarried and travels a lot.

So Grumpy came to me with incessant scratching for the past 8 months. He has taken multiple medications from multiple clinics and skin specialist in Malaysia and Singapore. Grumpy was started on anti-histamine, steroids and creams as he was treated as contact dermatitis or some allergy.


Grumpy’s condition worsened every time steroids was given. The first clinic treated him with aquaeous creams and treated as eczema. Later on everything went downhill for him. He suffered at night and when he sweats as the itching worsens. I saw him suffering with very painful scabbing, skin started getting thick and almost leathery. He could not even sleep because he is woken up by the intense itching. Now with my practice we had to look at all the possible history and contact.


Itchy, Peeling, Flaky Skin

His problems started after he traveled to Ninh Hòa, Vietnam to set up a beach resort there. He was staying at an Air BnB, which is located close to his project. He started having multiple bumps on his back and arms about three to four days after staying in the Air BnB, which he booked. It progressively worsened to spread to Grumpy’s entire body and privates. The skin later on because flaky and keep on peeling. He does not have any history of allergies.


Fattening out papule and reddish pigmentation after treatment

Deductive thinking: Unlikely to be allergy as Grumpy started having complains during his stay in the Air BnB at the third or fourth day being there. He was treated with allergy medication without avail. Eczema was possible but the spread was too fast and diffused. According to his history I deduced that it may be possible of Scabies and specifically Norwegian scabies. Scabies is a skin infestation caused by a mite known as the Sarcoptes scabiei. Untreated, these microscopic mites can live on your skin for months. They reproduce on the surface of your skin and then burrow into it and lay eggs.


I gave Grumpy a lotion for a single night use and we need to prevent recurrence of the scabies. The trick to remove scabies from your matters or cushions, is to use a hot iron and iron the fabric a few times. In a matter of a few hours the itching reduced, redness reduced and no new lesions appeared. The next day he only had residual skin discoloration which disappeared after 2 weeks.


The treatment was a success and he was very grateful. Since then he has brought numerous of his own friends over for any medically related cases. Thanks Grumpy!


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