Healing cuts while on Prednisolone

[hwigston]

I have been on Pred for 5 years and now slowly dropping to 6 mg. Twelve months ago I knocked my leg while cycling, and since then the nurses at my GP surgery have been trying to heal it, every week trying a new dressing. It now looks much worse than in the beginning. I am aware that while taking Prednisolone one's immune system is affected and the skin becomes very thin, but my surgery does seem to take any of these into consideration. Has anyone had lesions of this nature on their legs, and if so can you let me know how they were healed. Any other information to help the healing process would be very helpful. I use Aqueous Moisturiser Cream on them twice a day. I have asked to be referred to a Dermatologist, and a photo of the lesion has been taken and sent away to the TeleDerma Dept. It takes up to 12 weeks to be looked at!! Help.

[PMRpro Ambassador]

Have you at any time had any investigations for blood flow in your legs? I think your GP surgery is out of its depth and you need to see someone who knows what they are doing.

A couple of years ago there were reports about a study in 3 west Midlands hospitals using sugar to heal long standing wounds - maybe contacting The Queen Elizabeth Hospital or Wolverhampton Uni might produce some suggestions.

There has also been some success using oxygen to encourage healing but I don't know if anyone in the UK does anything,

[hwigston in reply to PMRpro]

Hi PMRpro. I have had a doppler test, and flow of blood was ok. I will certainly consider contacting The Queen Elizabeth Hospital to see what they recommend. I contacted the Tissue Viability Nurse in Bristol and she recommended washing them in Potassium Permanganate and it did certainly help but my nurse said not to use them.

[Celtic PMRGCAuk volunteer]

hwigston, I'm wondering whether the aqueous cream you are using is actually aggravating the wound. It contains Sodium Lauryl Sulphate and I remember reading an article about creams such as aqueous not being recommended for some skin problems because of this chemical. Aqueous cream also contains parabens. Doublebase cream or gel doesn't contain such ingredients and is much kinder to the skin, especially for those of us suffering from steroid-thinned skin. It is available both on prescription and over-the-counter.

I am also wondering if your surgery is treating your leg with Manuka honey dressings? It is a special medical-grade Manuka honey and has been proving very successful in treating wounds and leg ulcers where other treatments have failed. Perhaps you can enquire of your surgery if they are using such dressings, if not then I would ask for them to be tried.

[hwigston in reply to Celtic]

Hi Celtic I didn't use the Aqueous cream on the cut only on the unaffected area of the leg because the skin is so dry. I will take your advice and invest in Doublebase cream. As regards honey dressings, these were used initially, and the wound did appear to be healing, but they were then stopped because of the cost. I wanted to buy them privately, but it seems the nurse has to use what they have in the surgery.

[Celtic PMRGCAuk volunteer in reply to hwigston]

hwigston, words fail me! For a treatment such as medical-grade Manuka honey to be proving successful only to be stopped due to cost, leaving you suffering and at risk is tantamount to neglect.

[Hidden]

Hi hwigston,

You are right, I don't think they know what they are doing! Apart from anything else no dressing is going to work in a week and it's not good practice to keep chopping and changing things.

Can you ask the nurses to either get the District Nurses involved or to contact the Tissue Viability Nurse Specialists? Neither of these require a 12 week wait!

Celtic is right, Medihoney apinate dressings are great for de sloughing wounds but I am confused at how you manage to put Aqueous cream on the lesions if they are covered by dressings?

If you want to PM me a photo of the lesions I can have a look and offer an opinion. I hope the lesions have been swabbed to make sure there is no underlying bacterial infection which is delaying healing?

[hwigston in reply to Hidden]

Hi Keyes. I will certainly send a photo of the lesions. You can't see a Tissue Viabilit Nurse in Maidstone. The Nurse has to take a photo and then e-mail it to the TVN. She will then decide what to use. So far we have not had a response. Photos were taken 4 weeks ago. As you will see above I have washed them in Potassium Permanganate several times, and they certainly seem better. I only see the nurse every 2 weeks and in between I change the dressing myself. I don't put the Aqueous cream on the lesion only on the surrounding area not covered by the dressing.

[Hidden in reply to hwigston]

I am speechless. I have just spent 3 months in a community nursing job and we had almost instant access to the Tissue viability nurses. Its a false economy to stop Medihoney dressings due to cost if the wound then takes much longer to heal. Can you ask the GP to give you a prescription for them? Sometimes I despair of the NHS! ( I realise this is not helping you but just had to say it ).

Have they ever suggested 4 layer compression bandaging or support stockings given that your blood supply is ok?

[hwigston in reply to Hidden]

Hi Keyes. I wear compression stockings or if I'm cycling tubigrip and knee-length socks. If I ask the GP for a different dressing he phones the Nurse to ask her advice. So I'm stuck. I can only buy them myself.

[PMRpro Ambassador in reply to hwigston]

Just to be sure you see my reply that was supposed to be to Keyes - this forum is nuts about some things...

PS - If I lived in Maidstone and was getting that sort of treatment I'd request to be treated in France.

[PMRpro Ambassador in reply to Hidden]

The Wolverhampton study is using just granulated sugar! If I were in the UK I'd contact them for further details. But the bit about "too expensive" is the biggest piece of drivel I've heard! The mind boggles what they've spent in time and tripe in the meantime. As I understand it it is possible to submit anything for a special payment. And I suspect "can't have it" is used in the knowledge the average patient won't contest the word of the nurse or doctor.

After the last few weeks and the rubbish I've come across in terms of GP services in the UK I'm left speechless - and believe me, that doesn't often happen.

[Hidden in reply to PMRpro]

Wow, I can't believe you are speechless either PMRpro!

I am afraid I have run out of ideas hwigston. It seems totally crazy to me that they won't supply you with Medihoney and that the tissue viability nurse hasn't got involved in your case ( the practice nurse obviously doesn't have a clue ). I can only hope that the Dermatologist comes up with something quickly.

I would say that GP and community services are really variable. I have just spent 3 months with a wonderful District Nursing team who wrote their own prescriptions, none of our patients were treated like that!

[PMRpro Ambassador in reply to Hidden]

I would be inclined to ask have they really contacted the tissue viability nurse - I have a very nasty and suspicious mind. It is certainly something I'd be asking and expecting answers to.

Specialist nurses can be wonderful - but they can be t'other thing too. I wonder what a conversation with the practice manager would achieve?

[hwigston in reply to PMRpro]

I initially contacted the Tissue Viability Nurse and was told that a referral had to go through my GP this was before Christmas. The Practice Manager is aware because she took the photos and sent them via e-mail to the TVN.

[hwigston in reply to Hidden]

Many thanks Keyes. I will see how things go at my next meeting on Friday, if I don't get the right answers I will see the Dermatologist privately.

[hwigston]

Many thanks everyone for your prompt replies. You've given me light at the end of the tunnel.

[maria40]

I too am having a healing problem. I have been taking Pred for 15 yrs now and am currently on 16mg following a flare of GCA and my skin is like tissue paper. I saw a nurse 2 months ago who prescribed Daktacort which did nothing, was then transferred to a GP with some dermatological expertise - I am told - who assured me it was not carcinogenic and first prescribed Efudix to no effect and has now given me Betamethasone. She is reluctant to take a biopsy - which she says she would normally do - as it would take so long to heal because of the condition of my skin and my steroid treatment and that she would need to put in a stitch. I am a little concerned about applying topical steroid cream and also because just yesterday I heard some rather disturbing negative reports about this particular GP misprescribing. Like you hwigston, I'm also considering a private dermatologist but would welcome advice.

[PMRpro Ambassador in reply to maria40]

I'd certainly change my GP. If your skin is thin and like tissue paper to start with then topical steroid creams will potentially make it worse not better and shouldn't be used unless it is the right treatment for the problem. I'm sorry - but I personally would not trust a doctor who assured me something was not cancer and in the same breath admits under normal circumstances she'd do a biopsy. Pred can increase the risk of squamous and basal cell carcinoma. Anything that isn't healing needs an expert to look at it.

[jinasc]

Well, I came to this late and am appalled at the treatment you are receiving.

The Manuka Honey cream can be bought at Holland and Barrets but you need to ensure it is the same as the one developed at Addenbrookes Hospital for the treatment of MRSA in open wounds (and it works).

If MHC does not work, Green Lipped Mussel Ointment (used by our District Nurses to treat stubborn varicose vein ulcers) is also excellent.

Finally, you need to go and see your Practice Manager and tell him he story and ask him to contact the TeleDorma now. If he does not sort it out contact PALS at your nearest hospital and ask for their help.

Failing all else, you have an MP and it does not matter which party he is in, they have a weekly surgery so ring and make an appointment or just turn up.

[paddyfields]

Considering their neglect led to the loss of the sight in your eye you would think you might get better treatment. The word "arrogant" springs to mind. I don't know what age you are, but when my mum developed a tiny sore place on her shin, probably an insect bite,, her doctor slapped penicillin powder on (she has been hospitalized for reaction to penicillin in the past) and then went in to what I call "old ladies leg scenario" talking about an ulcer which it was not -. The one leg had swelled up like an elephant and the shin skin had split. They couldn't seem to see what they were looking at - she had a rash of what looked like blood blisters all over her body - and my impression was that they had no real anticipation of curing the leg just maintaining the status quo. The good thing was that at last I managed to persuade my mother to change doctors and then her leg and the rash was treated properly. She had in fact amazing powers of healing right up to her death at 99 as long and no bed sores as long as she didn't go into hospital whereupon within 24 hours she had a bed sore. Your doctors have probably spent more not continuing with the successful treatment than if they had continued with the Manuka honey.

I should try the PALS angle as you really have had a lot to put up with .

Best wishes

[venezia1]

Hi. I 've been on pred for nearly five years, and still on 12.5mg. I had two consecutive wounds on my shin a couple of years ago which were quite deep and failed to heal. I was under the car of the District nurses, who were brilliant. One wound responded very well to honey dressings, but after a while they were stopped and they used something else - can't remember what - because the healing had gone "as far as it can" with honey. Overall they took about a year. Talk to your Practice Manager - cost should not be an issue.

[Hidden]

Hi.

Yes, pred makes skin thinner and more liable to damage - don't I know it, but no matter what our age or how thin our skin, our body's ability to repair itself is governed by the nutrients we put in.

I eat a diet packed with protein and vitamins, a multivit suppliment and vit b suppliment + lots of calcium. I have had some beauties when it comes to rips and bruises, ( by the way into my 5th year on pred and on 4.5mg at the mo).

When an injury occurs, I wash it with plain soap (Simple Soap) and water. Then cover with a piece of clean kitchen towel. Then secure with Micropore. This is done every day until it dries up. It doesn't take long to dry. Then I leave it to the air. I have used tubular bandage as well if things look really fragile.

I wash or shower my whole body every day and moisturise with lotions that sink right in to the skin itself. I don't like the ones that just sit on top. Personally, I think the trick is to moisturise a lot - the massage helps. Keeps the blood flowing. I always elevate legs in the evening when resting.

Your injury sounds rather nasty and you maybe think my suggestions rather too basic, but hope I may have offered something to think about.

All the best, Pats.

[hwigston]

Many thanks everyone for your very helpful suggestions. I am hoping to go on a retreat/spa holiday to Iceland in October, so I will have to get it healed by then.