Does a Malar Rash, muscle pain & tiredness make L... - LUPUS UK

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Does a Malar Rash, muscle pain & tiredness make Lupus???

Chancery profile image
13 Replies

Hi, I have a rash - a VERY itchy, painful, raw, stinging, burning rash. I've got it above my right eye (inner side) under it and - without any visible signs - on my cheekbones and under my chin and on my collar bone. I am concerned that though this rash FEELS like Rosacea it is actually Lupus. And although half of it is not visible I feel it covers my cheeks and eye area and is just waiting to manifest itself.

A little history. I injured my back badly in May 2018, an idiot Dr gave me Voltarol, although I'd told her I was sensitive to NSAIDS, assuring me it wouldn't 'hurt my stomach'. I had a severe drug reaction (very bad urticaria in both ankles - I used to suffer from sunlight induced urticaria every year until I accidentally 'cured' it with antihistamines) and was given Prednisolone, a 5 day course. Second day of using, I got a big red balloon face which was with me for the duration and a few days after. It then reappeared 3 weeks later and although the redness went away the stinging and itching and pain in the areas listed above never has.

Other side of that coin - the steroids made me feel GREAT. Not an exaggeration. I felt human for the first time since I was in my 30s (I am now 62). All my (extensive) aches and pains went away, particularly in my muscles, and I lost my tiredness and breathlessness. However, there was the 'Rosacea'..

Now, more than a year later, I have developed this 'rash', which is really just a red discoloured area, going brown as it gets worse, with thickened skin and a little scaliness. It is not spotty or acne-like. I also had a teeny spot on my nipple. I gave in eventually, after trying every cream on the market, and used Hydrocortisone 0.5% on it. First time, for 7 days (2 days longer than you're supposed to use it!) and I got good results but it never felt truly healed. Sure enough, 10 days later it came back. I used it again, this time for 10 days, but only a week later it was all back (but not the nipple, yet).

I have always felt that my positive reaction with steroids was a kind of red flag, but I've never known if everyone feels really great on steroids. But my muscular, and to a lesser extent joint, pain, is really bad, and I can't seem to get it to ease up. I've started walking every day, even when exhausted. I've been doing it about 3 weeks now and not really seeing any results from it.

My exhaustion is erratic; some days it's an effort to do anything at all, others I feel less tired, but unfortunately they are much rarer. I have pain in ALL the muscles of my back, top to tail, and it aches just to bend my head to write or wash up. I am only really comfortable sitting with my back propped up. I have bad breathlessness, which I hoped exercise would improve but sometimes it is so heavy-going climbing a hill I feel like I need to stop to breathe. It makes my head pound and makes me light-headed. It also hurts my back! I’ve been fit, and less fit, over the years and I know I’m more sedentary than I should be now, but this just doesn’t seem to respond to exercise. In fact, I often feel worse after it rather than better.

Very long story short, I wonder if this rash is actually a malar rash and the severe muscle pain, and my reaction to steroids, might indicate lupus, rather than Rosacea. The only meds I take are Omeprazole and B12 injections. I've stopped the Omeprazole as I've been taking it a long time and thought this may be drug-induced lupus. I've had that before, on Anti-convulsants, but then I just had an erythema multiforme rash on my legs, nothing on my face.

I also have swollen lymph nodes in my neck and a sore-ish throat and it hurts to swallow quite often.

If anybody has any opinions or insights to offer, or wants to know anything else re my symptoms I'd be hugely grateful to hear from you. I have a Dr's appt for a month’s time (soonest I could get!) but I'd like to go to him with some idea of what might be wrong.

Also, one last thing, I'd like advice on whether it's safe to use the steroid cream on my eyes again while I'm waiting to see him. I feel concerned that it might be dangerous long-term and I may make this worse. If I DO have Rosacea then you're not supposed to use steroid cream because it can make it worse. The last thing I need is to make this face full of needles worse. Incidentally, I have a problem with flushing and have done for about 15 year plus. At first it was paut down to the menopause, but for many years now I’ve felt it was something different.

Many thanks for any help, and my apologies for the epic length of this!

P.S. I’ve had many potential triggers – a divorce after 40 years marriage, isolation (I have no friends or family), the severe back injury followed by UTI infections that wouldn’t clear, several courses of antibiotics, the drug reactions, steroids – the list is seemingly endless!

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Chancery
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13 Replies
Spikenmax profile image
Spikenmax

Sorry you are suffering so much, for so long. I am not a doctor🤨, but I was diagnosed with SLE the week before my 70th birthday. I have read a lot, and have 3 friends with SLE. What I have learned is that SLE seems to be different for each of us. You can’t point to one symptom and go “AHA! It’s SLE!” Hope your doctor can give you a diagnosis and appropriate treatment. Love from the US!

Chancery profile image
Chancery in reply to Spikenmax

Thanks, Spike. Can I ask, when do you reckon yours actually started, as opposed to when you were diagnosed? And can you remember what your earliest symptoms were?

Spikenmax profile image
Spikenmax in reply to Chancery

Diagnosed in 2017. Looking back, a couple of years before I was more tired than usual, but attributed it to old age. Then occasional cramps in forearms, tendinitis in feet and ankles, but not much joint pain, thankfully. Hardly worth mentioning. Then I got a baaad cold, a fever that lasted for weeks, dry eyes....my first flare. My pcp was great about ordering the correct tests, and I was diagnosed in just about 2 months after that first flare (what’s a flare? Who knew..such innocence).

While you are waiting for your appointment, take care of yourself. Naps are NOT an indulgent luxury - they are a necessity!

Chancery profile image
Chancery in reply to Spikenmax

I've had tendonitis in one ankle for 17 years now! Quite debilitating and never goes away. I got orthotics this year and they've been really good but they haven't cured it, unfortunately. I also get weird cramps in the fronts of my feet. That started about 2 or 3 years ago. And I had a really bad chest infection last winter, which came on top of a lot of other illnesses, as usual. I feel like I'm mirroring you! I've also had dry itchy eyes for many years, which is annoying along with the rash because you really want to rub them and can't! I have an appointment with the doc for a month's time. I maybe need to stick my neck out and ask to be referred to a dermatologist/rheumatologist!

HappySummer profile image
HappySummer

Hi Chancery I’m not a Doctor and I sympathise with everything you are going through. It sounds like you are self diagnosing. It would be best to be seen by a Specialist and I was seen by a Rheumatologist, referred by my GP and that’s how I was eventually diagnosed. The journey to a diagnosis can be a long process for some patients so It would be good idea to keep a journal of ALL your symptoms from all your whole body you are experiencing and take pictures of your rash since rashes can come and go and mention these to the Dr. As far as I’m aware with these conditions it can be very complex and every patient is unique, so it’s not as simple as you think it for me advise what condition you are likely to be experiencing. Best of luck on your healing journey! I hope you find some answers. Take care x

Chancery profile image
Chancery in reply to HappySummer

Thanks Summer, I'm not self-diagnosing so much as trying to get some clarity. I'd be more than happy for someone to say, no, not lupus! I just like to go the Dr's with some idea of what might be going on. If you have a lot of symptoms they don't have time to discuss them!

KayHimm profile image
KayHimm in reply to Chancery

It sounds like you have a lot of worrisome symptoms and have been sick for many years. The doctor will look at all your symptoms and see what tests you need to diagnose your condition. Lupus and other autoimmune disease are diagnosed on the basis if symptoms and evidence of autoimmunity. The whole process is very complex. So yes, a rash on the rash and muscle pain can be significant but, on the other hand, it may not be. The doctor looks at the features of the rash, does a thorough exam and will do appropriate tests.

It may take a while for your doctor to determine what is wrong. I hope you get answers soon, though.

Feel free to ask any specific questions here. Many of us have been through a lot of testing and may be able to help.

K

Chancery profile image
Chancery in reply to KayHimm

Hi Kay. Yes, I've been under par for many years now, which is very depressing. I'm always afraid that my complaints will just be written off as my age and/or my weight. But I had a lot of these while slim (itchy eyes, drug hypersensitivity, tendonitis and more), and the back pain and muscle pain started while I was just in the overweight range rather than in the obese range that I have now sneaked into. I am not huge by any means, but doctors seem to think everything is obesity related! Maybe it's convenient. Anyway, I have a doctor's appointment now so I will just have to screw my courage to the sticking point and ask for some referrals.

KayHimm profile image
KayHimm

I think it is best not to use the steroid cream on your face until you consult the doctor. They really hesitate to use steroids on the face.

Chancery profile image
Chancery in reply to KayHimm

I've tried! I'd been off it for ten days but my eye got so swollen and inflamed (it feels like very bad sunburn, or maybe just a burn once it gets really raw) that I gave in and started using it again. I've got to wait a whole month to see my doc - that was the fastest I could see any doctor! - and I just won't make it without some Hydrocortisone. I'm going to try to use it only in 5 day bursts then stay off it for as long as possible, then back to 5 days again. Hopefully I won't have ruined my face permanently by the time I get to see the doc. Bless the NHS....

Chancery profile image
Chancery in reply to KayHimm

Can I ask, Kay, is a rheumatologist (and maybe a dermatologist for this rash) who I should ask to be referred to? Is that the first line of inquiry for autoimmune conditions?

KayHimm profile image
KayHimm in reply to Chancery

Good question. Your GP will look at your total picture. They may have to send you for allergy testing, do initial blood work and a thorough exam. It would be uncommon to go straight to a rheumatologist without a doctor doing initial work up. Hypersensitivities may be common in autoimmune disease but they do not indicate autoimmunity. They look for inflammation in different parts of your body and marks in the blood. It is all very complicated.

I worry about your using the steroid cream around your eyes.

K

Chancery profile image
Chancery in reply to KayHimm

Thanks, Kay. I'll just give him a list of symptoms and tell him I'm concerned that it might be autoimmune since it's been going on so long and let him decide what he wants to do. And you and me both, as regards using the steroid cream. I don't want to use it at all but I have exhausted the world of creams & lotions, with most just making it worse (calamine lotion was surprisingly one of the more effective!) I just can't suffer the pain, itching and broken sleep for a month. One of the first things I'm going to do is see if he has anything else he can give me and, failing that, the best regimen for using it. (It is only 0.5%, prescription strength, so that's something!)

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