I was diagnosed with PMR in December 2016 and have been lucky to have had a fairly smooth course. However over the last few months I’ve developed an itchy rash on my neck and scalp, then chest and shoulders. Now it has migrated even further down, to my backside. It is really very uncomfortable. I’ve resorted to wearing my shirts inside out, bra over a shirt when I have to put one on....I have tried a bunch of different salves, lotions, ointments. I’ve changed my soap, detergent, etc.. I’ve started eliminating foods from my diet like almonds and eggs. A skin test for contact dermatitis was negative for the usual subjects; some thirty items were tested.
I’ve also noted that my skin has suddenly lost whatever elasticity and juice were left. I’ll soon be 78 but this is pretty sudden.
I’ve been to two dermatologists to date. The first didn’t seem impressed with the problem. The second did the patch test and has just sent two biopsies out to two different labs for evaluation. It will take three weeks to get the results back. In the meantime she suggested that I might want to take a “short course” of Pred. 40 mgs daily for a week, then 20mgs daily for a week then ten mgs for a week. It seems like an awful lot of Pred Just to control symptoms until the biopsies hopefully give more info to inform a treatment. I will check this out with my Rheumy. I told her that I suspected the dermatologist would prescribe a short course of Pred, but I had no idea how much or how long the prescription would be.
Has anyone here had anything like this develop in the late stages of PMR treatment? Do you think this is Pred related or PMR related. My suspicion is that it might be a different autoimmune condition that may have been cooking for a while and is coming out as I reduce my Pred. I hope it isn’t but I’ve never had anything like this, ever.
Funny thing. The worst time of day for the itch is exactly the same time of day my PMR would bring on weak Wobblies and other symptoms of fatigue. Also funny thing, my body really feels a lot better except for the itch. Shoulders and groin feel entirely normal. Inflammatory markers were low as recently as a month ago. In the past the markers have been a pretty good guide to my internal state.
Would appreciate any thoughts. I’m afraid that going on this three week course could set back the taper by months. I may not be reasonable. But I’m not sure.
Thanks for reading this long long question.
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Hindags
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I am sorry to hear you are itch, it is so damn annoying.
Did your GP consider 'Hives'..................one of the very rare side effects of pred? It can be dealt with.
In the meantime, here is how to help your skin..............Worth a go?
1. Has your pred been changed to a different manufacturer? Ask your chemist.
2. Are they enteric coated, if so wash the dye off before swallowing, the dye is one of the E numbers and can cause problems and it is totally unnecessary. Quite often one manufacturer uses one type of dye and another a different one.
3. Ask GP to prescribe Double Base Gel use it and follow the instructions to the letter.
4. Do not shower every day...................try no more than three times a week.
5. If you need to use soap...........make sure it is a good soap and not the hand gel etc which has micro plastic in it and also go back to washing powder,,,,,,,,,,,,,,,more micro plastic.
We really do not need micro plastic to keep clean - plain water does just as good a job. Think back to when you were a kid................bath and hair washed once a week, 'top and tailing' every day. Did you smell.................no I already know the answer..........you did not.
Hope you get an answer soon and get rid of the 'itch'.
Thank you so much. I have been following most of the suggestions you make. However, because of scalp itches I'm told to shower every day. I'm using CeraVE gentle facial cleanser and it seems to soothe.
What do they call doublebase gel in the USA? So far thick ointments seem to make things worse. My clothing sticks to me and that irritates more.
It's not sticky...it looks like Italian meringue and acts more like serum on the skin. I can't stand sticky cream/ointments and have no problems with this at all. My dry skin patches are cleared up and my hands not so crinkly.
I wonder why such a high dose - at what dose did the rash appear?
Have you tried eliminating anything from your diet? Wheat gives me a horrible rash since PMR started but it is far better at higher doses of pred. The local coeliac specialist was of the opinion it was part of the autoimmune thing but said it wasn't worth getting the full testing done for coeliac as the only difference it would make was getting the prescription foods - which in general are fairly disgusting! I can eat other "wheats", spelt and kamut are fine but as I eat low carb anyway it is a minor concern.
Nearly forgot: such a 3 week ongoing taper shouldn't make much difference to the overall taper unless you were well below 10mg. What is your current dose?
I was almost at one mg. Just a few days shy of 1mg. Rayos. I'm not gluten intolerant. I've tried cutting out eggs and almonds because I went low carb when I started Pred for the PMR.going low carb, I was eating more of these and was concerned that two eggs a day, and maybe as much as thirty almonds a day might be sensitizing me. I have been eating bread lately instead. LOL. But this condition has slowly been developing since I was at about 8mgs Pred, Got worse at 4-5. I tried 5 night before last and woke feeling a little better. Last night I took 3 DR Pred and then at about 9am I took 3 IR pred because not as good this morning.
Thank you, once again and forever for all your sage advice and thoughtfulness. I've tried allegra 24 hour antihistamine, non drowsy. I was told I could take it as many as four times a day. I've stayed away from benadryl, but might try it tonight. So far I can sleep. But when I wake, the first thing that hits me is the itching.
I think the itchy rash is related to the pred taper. I had a bout of eczema a few months ago when tapered to 7mg. I stopped the taper and treated with Benadryl antihistamine at bedtime and Vaseline Eczema [colloidal oatmeal] salve. The problem resolved in a few weeks. In your case I suggest increasing the pred, maybe to 15 or 10 mg, to see if that helps. Link:
"Usefulness of a short course of oral prednisone in antihistamine-resistant chronic urticaria: a retrospective analysis...............................
We studied 750 adult patients with CU and prescribed a course of oral corticosteroids (starting with prednisone 25 mg/day for 3 days) to those who reported little or partial response to antihistamine treatment. The corticosteroid treatment was considered effective if it resulted in long-term control of the disease with antihistamines only. " Another link:
ncbi.nlm.nih.gov/pmc/articl... Update on the management of chronic eczema: new approaches and emerging treatment options
"In clinical practice however, systemic corticosteroids are not uncommonly used as short-term “rescue-therapy” for severe flares of disease.89 Often, oral prednisone (1 mg/kg/day, or equivalent) tapered over a 2-week period will quell a flare and allow ongoing topical maintenance therapy. Somewhat surprisingly, there have been few clinical studies to formally evaluate this therapy method."
Thank you so much for this information. My doctor doesn't know what the rash is from or about yet. She does agree with my theory that it probably been kept at bay by the pred and is emerging as I've gone lower.
I'll road those articles with a lot of interest. I'm not opposed to going up on pred to get some relief, but three weeks and such high doses scare me. I'm speaking to my rheumy on Thursday.
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