Is this psoriasis?: I have developed this rash on my... - NRAS

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Is this psoriasis?

Lolabridge
Lolabridge

I have developed this rash on my limbs, it's particularly bad on my thighs in the knee area, but also it's on my legs, feet and arms. (It started with a few papules on wrists and ankles but also rough patches in my mouth which were confirmed to be lichen planus that I had recognised as I had it over 10 years ago.)

I sent photos to the GP and had a telephone appointment, and sent the same photos to the patient advice line at my hospital with some other information. The GP isn't sure what it is but wonders if it could be psoriasis and asked me to contact my rheumatologist for advice as their are having problems using the usual contact number to get advice and guidance. I managed to get a message to the rheumatology consultant's secretary who showed the pictures to my consultant and his reply was "tell her to contact her GP".

So it seems I'm going to go around in circles ... but meanwhile the rash is sooooo itchy and affecting my sleep. I'm having to keep out of the sun too as the heat seems to make it worse.

What do you think it is? Has anyone else developed psoriasis subsequent to an RA diagnosis? Is it likely that this rash could be the result of my Rituximab infusion having been postponed? How to cope with the itching? Any creams you would recommend? I've taken a cetirizine (antihistamine) at suggestion of GP as an interim measure but no relief apparent yet.

Help! All suggestions welcome!

41 Replies
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I'm so sorry you are going through this. Itching is a nightmare - I use Childs Farm cream (made for babies with eczema) for the itchy rash I get on my arms and it's really made a difference - it might not help - but just a suggestion. Good luck in getting this sorted asap. It really annoys and astound me when Rheumatology just say contact your GP (mine did that too) without considering whether medication THEY have prescribed might be the cause...

Thank you I will look for that cream.

Ouch, that looks painful 😢

Hopefully someone more informed will be along soon but just to mention that when I showed my GP a rash and admitted to being concerned that I was developing Psoriatic Arthritis she said that it is was unusual for it to happen that way round - not sure if she was right but hopefully so. 🤞

It does look like psoriasis. My son has it and tends to get flare ups just like yours.

I have psoriatic arthritis but no psoriasis - my son does have psoriasis though.

Hi Lb, have a look at this website. There is a slide show and yours looks very similar, if not the same, as slide 4/11 - Guttate Psoriasis.

webmd.com/skin-problems-and...

Thank you will look.

Definitely try to contact the Biologics clinic where you have your infusions.

I had a mega rash ( but not like yours ) after a Rtx infusion,but mine turned out to be a post viral rash .....but there is a type of dermatitis that you can experience after a rituximab infusion...but I don’t know if that would be the case because of a delayed infusion.....but the Bio nurses will be the best ones to talk to if nobody else can give you any help.

Failing that try to see a Dermatologist....but I know that won’t be easy right now.

It couldn’t do any harm to ask your Rheumatologist’s secretary to send a Photo to the Dermatology department asking for an opinion.

Have you tried calling 111.....they might be able to get you some help?

Even try a pharmacist...they see all sorts of rashes.

I hope it calms down soon.

Schonlein purpura... after Rituximab.

I had a Vasculitis rash once after a Rituximab infusion and my Rheumatoligist called it that.

But def not what this poor lady has on her arm.

Thank you AC. I’m going to ask my GP for a referral to Dermatology. My Rheumatology consultant has said it’s nothing to do with my Rituximab and go to my GP 🙄☹️

As I’m shielding it’s tricky to see the pharmacist.

Could you email the photo to your pharmacist...give him a call & explain your predicament?

Yes a friend went to see the pharmacist for me with photos to show him. He phoned me and was concerned that he couldn’t provide much of any use to clear it up. But he also insisted I should ask my GP to refer me to a dermatologist. He gave me some advice and my friend brought some creams back for me to use.

Thanks will do.

It does look like psoriasis. My dad started off with just a few itchy papules that quickly spread. A referral to a dermatologist would be able to diagnose it as the gp didn't know what it was as no cream would help it. Although with the current situation it could be a long wait so definitely phone your gp tomorrow and get a referral.

Yes will do. Thank you.

Hello Lolabridge

I’ve had psoriasis all my life and I think it could be, although there are probably other skin diseases like that too. I had a form of rosacea once which was similar.

I’m on RTX too and after my infusion last time I had a slight flare of psoriasis, so I believe there is a link in some way - after all they are both inflammatory diseases. I often get a flare of another AI condition too - scleritis, after RTX and after a course of steroids.

BTW Sunlight normally helps psoriasis, but the treatment is usually steroid creams.

I think you need to see a dermatologist for a DX. Unfortunately there’s not much cross-discipline collaboration between hospital departments so I’m not sure how much shared info there is about the way treatments affect us.

My non-professional thoughts are that the inflammatory outbreak might be because your T cells are returning and your immune system is gearing up into fight mode again...

I’d ask the rheumatologist you show the pic to a dermatology for an opinion.

Thank you for your reply. Your idea that it could be the RTX wearing off and my T cells getting frisky makes a lot of sense. I’m going to ask GP to refer me to a dermatologist as Rheumy has been rather dismissive.

I meant B cells, sorry! (T cells are on my mind, Re Covid).

Yes with B cells repopulating (they are the “directors” apparently) the T cells get their instructions where to attack from them.

I also saw that news report from the BBC this morning about T-cells. ☹️

That’s interesting. I did not know that. I have to make tricks to remember things

B= Boss

T= Trudge/ carry out duty

Can you reference the BBC link ? Copy/ paste it here?

I will try but got to find it first ...

Thank you.

This must have something to do with the cytokine storm response.

Yes it would seem so.

Yes I agree, it looks very much like Guttate psoriasis. I had a few flare ups of it prior to suffering from Psoriatic Arthritis covering mainly my feet and legs. Took maybe a. Month and then cleared up on its own each time. Dermatologist would be a good idea though. Good luck with it, hope it passed soon.

Thank you. I hope so too!

PS Forgot to say - if the itching is driving you crazy have a look at What Allergy’s website. She has bad eczema and is an expert on non-steroidal treatments so there’s tons of info there on how to calm skin.

My recent outbreaks, although much smaller than yours, have always self resolved, so hopefully yours might too X

Thank you will take a look.

I have chronic psoriasis & psoriatic arthritis. Suffered the psoriasis my whole life.

I'll leave diagnosis to the experts that seem to be sending you in circles. The advice on trying to get GP/ rheumatologist to forward photo to dermatology is good.

A wee note on psoriasis from my experience:

Not surprised I have a bad flare with my skin at the moment, I have barely been out in 6 months due to the arthritis & COVID, before that the short winter days.

Sun light helps psoriasis, specifically UV B light is used by demeritology clinics in treating large flares of psoriasis.

A sign UV B treatment is working is the feeling of your skin being itchy/ over exposed to the sun, however I would caution trying to sit out in the sun to much, assuming you can sit out. I've been stuck in a wee flat for months...

Best cream I've used is Silkis (calcitriol ointment 3mg/g). As a booster there is a moisturiser called Double Base. That can help as well. I was told to stay away from E3 as it can irritate the skin.

I would say try to moisturize as much as possible while trying to get a diagnosis.

Is the rash approximately mirrored on your limbs/body? That can be a sign its psoriasis.

If it is a psoriasis flare you have, the red skin will possibly join into 1 large patch & begin the dry & flake, sometimes in large flakes. Moisturiser is important is that happens to stop the skin splitting.

It looks like you could have some dry skin forming at the moment, 1 patch top of thigh, a few nearer the knee.

Good luck & best wishes.

Lolabridge
Lolabridge
in reply to Maloc97

Thank you so much for your reply.

I will try some sun therapy and ask my GP for some of that Silkis ointment which looks as though it's prescription only. I've got some ZeroBase cream from a couple of years ago which I will try too. This morning I used Aveeno moisturiser which did feel nice but has not made any lasting difference.

Yes the rash is almost completely symmetrical, like my RA joint issues!

Hi, I'm just coming out of my second 3-year period of psoriasis on my legs - previous we 12 years ago. I don't have RA. I've been to senior consultants and used all of the latest expensive creams and sprays - they only provide brief topical relief. Nine months ago I researched probiotics - having decided that psoriasis must have an internal source/cause. I started taking Yakult and UDO's 8 - within 6 weeks I had huge improvement - much reduced scaling and itching. Separately, in November, I had a routine colonoscopy to monitor my Barret's Oesophagus condition. I asked the consultant gastroenteroligist to look at my legs!! He examined and said "You have hit the nail on the head - the skin is a map if the gut and many auto-immune inflammatory conditions emanate from problems in the gut; he also said that high use of antibiotics ravages the normal gut bacteria populations and probiotics can go in restoring gut flora. This was a penny drop moment, because I have had a few periods of repeat antibiotic use for kidney/urinary tract infections. He told me to add Kefir (fermented high-probiotic drink - Polish food shops) to my regime - one glass a day; I now have no scaling, just some residual red patches that are fading as well - and my digestive system has also improved dramatically. I asked the Consulant why weren't skin problems referred more to gastroenterologists instead of topucal skin treatments and he smiled and replied "we all have to make a living!!". I don't know whether your rash is psoriasis, but if it is you have my sincere sympathy and U suggest you try the probiotic route.

All the best,

Tom.

Lolabridge
Lolabridge
in reply to tomcard

Hi Tom. Thank you for your reply. I found very interesting the skin/gut connection and your own experiences. I too have had rather a lot of antibiotics in the past so have always eaten live yoghurt but about a year ago I started having kefir. I now make my own kefir and have it daily as a smoothie for breakfast. I shall also start taking a probiotic again and see if that helps.

StormySeas
StormySeas
in reply to tomcard

Couldn’t agree more! I was lucky to have an enlightened GP when I was at college who warned me about the long-term damage topical steroids would do and I haven’t used them since.

Have you read The Diet Myth, by Tim Spector? If not it’s a fascinating read about modern diets, scientific and evidence based, confirming much of what you say about gut flora.

It does look like Guttate Psoriasis :(

I have been treated for RA (sero negative) since I was 23 (39 now). Last summer I developed Guttate Psoriasis on my trunk and legs, it disappeared after a few months, but I’m now on a biologic (Secukinumab) specifically for PsA and responding better (so far) than to the previous 5 biologics I have had.

My rheumy said it’s not unheard of for the psoriasis to never appear or to appear once, or for the PsA to be in addition to RA. You must be so frustrated for your consultant to fob you off like that. I was prescribed Betnovate cream and an antihistamine that I can’t remember the name (I think it started with an ‘F’) Hopefully another chat with the doc can get things moving in the right direction..

Thank you for your reply - love your username!

Others have also suggested guttate psoriasis and, from looking online, I agree it does look like that. Yes I was rather cross with my Rheumatology consultant for not taking time to respond properly or provide information. I'm hoping my GP will be more helpful and refer me to a dermatologist.

I've taken another cetirizine today and am using what emollient creams I have at home to moisturise the rash. I'm expecting a call from the GP later and will ask for other more suitable creams. Someone recommended a calcitriol cream called Silkis - have you been given that one?

Thanks Lola, it’s my email that predates children and RA/PsA, I can’t bear to stop using it - reminds me of my youth 🤗

I’ve not been offered Silkis, probably because the betnovate and anti histamine kept the discomfort at bay, the psoriasis lasted only around 6 months on me, and hasn’t came back. Fingers crossed! I hope you find some relief soon and a proper pathway to a specialist with his brain engaged...

G x

Many years ago I was misdiagnosed by four doctors for shingles. The fourth doctor did send me to a dermatologist who after six months of suffering finally gave me a steroid ointment that finally cured the breakout. It left me permanent nerve damage. But my thought is see a dermatologist. They do know the skin. 😊

I got psoriasis from Cimzia taken for RA. A dermatologist verified it was psoriasis. It did look like your picture. I also had an allergic rash from Simponi.

Thanks very much for taking the trouble to reply. Very interesting. I’ve asked to be referred to a dermatologist as my Rheumy doesn’t want to know and GP undecided !

Glad to be of some help.

I had a rash like this all over when I had a reaction to my meds. I’ve got psoriatic arthritis without the psoriasis and was on sulfasalazine and came out in a painful and itchy rash. Hope you find something to ease it as the heat we have had lately certainly won’t help xx

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