Dermatitis

[Watercolorist]

Haven’t posted anything for a long time but am a daily consumer of your wise words.

My question is whether reducing prednisolone can result in triggering dermatitis and intense itching. Over 2.5 years I have slowly reduced to 2 mg without too many problems and from June last year stayed on 2 for 4 months as I was undergoing some stressful surgery.

In October last year had two teeth removed under local anaesthetic and the next day developed a rash and intense itching. Whether the dental work triggered the rash is difficult to say but probably unlikely.

My GP prescribed mometazone - another steroid which I am reluctant to use as the rash is extensive but have tried on small areas with very little effect. I am trying to get an appointment with a dermatologist but in the meantime wondered whether my theory that the reduction in prednisolone has triggered this effect.

I would be extremely grateful for your thoughts.

With thanks for this fantastic site without which I would not have managed this far.

[PMRpro Ambassador]

That is something that has been discussed a bit recently - a few of us think it is that the autoimmune part of PMR has also caused allergies to develop. I developed an allergy to something in wheat starch, not gluten although it did manifest a bit like dermatitis herpetiformis, but it doesn;t happen with any other grains than the highly commercialised stuff used for pasta and bread. Spelt and kamut and rye are fine. At higher doses of pred I have no problems, I can eat proper pizza, but as the pred gets lower the problem, itching and rash, returns as the immune system is less suppressed.

I am always sceptical of doctors who dismiss immediate reactions to any drug as unrelated. This may help you make a differentiation:

sps.nhs.uk/articles/allergy....

Local anaesthetic containing adrenaline used to make me very unwell although I don.t remember a rash. Switching to using the version without adrenaline resulted in a "cure" but I have also to say - recent dentistry with LA but at higher doses of pred have also been fine and I assume he did use normal LA.

[Watercolorist in reply to PMRpro]

Many thanks for your swift reply. I think it was your mention of dermatitis in a previous post that made wonder about mine. I should have added that I am continuing the reduction of prednisolone by .5 mg over a 5 week period and am currently on the 1.5 to 1mg transition. So far I without return of PMR symptoms.

I have tried all the duobase/ doublebase emollients and find jojoba oil/ aloe combination most soothing but am open to suggestions. I have in the past (about 50 years ago) had one allergy - to shell fish but haven’t touched it since. Am at my wits end as to the cause having changed laundry detergent 3 times all of which were low in additives, washed pillows and duvets etc. but after 6 months have run out of ideas. All suggestions gratefully received. Also wondered whether a return to a higher dose might help?

Thanks again

[PMRpro Ambassador in reply to Watercolorist]

I don't suppose you know whether your pred tablets changed in any way about the same time? Manufacturer, same manufacturer, change in the fillers they used? That can cause allergic reactions too. Have you tried a washing ball thingy? The various detergents are likely to have some things in common and you might have been unlucky?

ecohome.net/guides/3621/do-....

A higher dose might help - but it is a hardly what you want is it? You have my sympathy - itching all the time is soul-destroying. I had a few days when they gave me an ACE-inhibitor drug - I complained constantly but none of the ward staff recognised it until the weekend duty consultant did his ward round - I was off it in a flash! Suppose I was lucky it wasn't a full blown reaction!

[Watercolorist in reply to PMRpro]

As you can imagine willing to try anything at this point so will give the washing balls a go. My only other medication is a blood pressure pill amlodipine which I have been on for many years with no Ill effect as far as I know. Very grateful for your input.

[PMRpro Ambassador in reply to Watercolorist]

Ah - but an allergy doesn't always appear at the start - never the first meeting, it can be the second or the thousand and second ...

You might find this interesting:

consultant360.com/amlodipin...

And it is also possible there were changes in it you were not aware of.

[Watercolorist in reply to PMRpro]

Indeed I did find that interesting and am in awe of the breadth of your knowledge. Early on I managed to make contact with the practice pharmacist and asked just that and he assured me that there was no chance of developing an allergy to amlodipine after so long without problem. Guess which link I am sending him after the holidays!!!

[PMRpro Ambassador in reply to Watercolorist]

It is less likely - but delayed reactions DO happen. They are usually weeks or a couple of months later. But it could be something other than the drug itself - and there are cross-reactions in some cases.

[jinasc in reply to Watercolorist]

If your tablets are enteric coated, wash off the dye..............does no harm to contents.

As PMRpro says some times a change of maker can cause problems, I ran into a problem with A/F tablets, pharmacist made a note of it so they know and try to ensure the same manufacturer - if they cannot supply them, they warn me.

[SheffieldJane]

An itchy rash is one of the side effects of Prednisalone. Not sure why the reduction of your dose should make it kick off. Are you taking any pain relief at the moment? I was prescribed Tramadol at one point and this caused the worst itching I have experienced. I occasionally use a thin layer of mild steroid cream for the Psoriasis on my feet coupled with base cream for the dryness. This keeps the condition at bay.

[KCRoyals in reply to SheffieldJane]

Started to itch badly a few months ago, prickly feeling on face and top of chest. Also small round marks on hand. Been on Pred 10 years and am now taking a small dose of 1mg / day for a couple of years. Been wondering if it could be related to the small doseages of pred. GP keeps giving me Cetraben and says to lash it so I now feel like slippery eel.

[PMRpro Ambassador in reply to KCRoyals]

Quite a few of us have found allergic reactions have diminished at higher doses of pred but then return at lower doses. Pred is a powerful anti-allergy medication but like everything, you need a high enough dose to work.

[SnazzyD]

As has been said, it does come up regularly that people are getting allergy symptoms when they get to low doses. I had the same but it wore off after some months. My theory is a bit different in that I think it is a reaction to the reduced suppression of the process of allergies by steroids, like a rebound. I got all sorts of funny food intolerances, skin sensitivity and hay fever.

[Watercolorist in reply to SnazzyD]

At what dose did you get allergy symptoms. ??Don’t think I had any idea why reducing pred caused a rash but your theory is certainly plausible. Used to be sensitive to birch pollen but haven’t had that for a few years so masked by pred ??? However till taking steroid with the thinning skin effect I have never had any skin problems. On steroid I have had a few small red patches which faded to brown freckles but they didn’t itch. Thank you very much for your thoughts.

[PMRpro Ambassador in reply to Watercolorist]

Those were purpurae or petechiae (name depends on the size) a common effect with pred and due to fragile capillaries in the skin.

[SnazzyD in reply to Watercolorist]

Had lots of those throughout and as PMRPro describes

[Janstr]

My husband developed an intense itch after the 2nd pfeizer vaccine & often scratched until it bled. He was given numerous creams & anti-histamines, & eventually saw a skin specialist. He was told that it wasn’t a vaccine reaction, but his immune system responding. He was advised to stop using soap or pinetarsel ( prescribed by his GP) to wash with & use aqueous cream instead. Cetomacrogol is used after showering on any itchy areas. He was also advised to stop showering every day. This worked & he had the pfeizer booster with no problems

[Watercolorist in reply to Janstr]

Thankyou for telling me about your husband’s experience. I checked back and I developed a rash two weeks after a Pfizer jab so probably didn’t trigger mine. I have had several good suggestions from health unlocked members which I will try and implement but like your husband ultimately I need to see a dermatologist. Waiting list is 23 weeks so will have to go privately.

Appreciate you taking the time to pass on your experience.

[Janstr in reply to Watercolorist]

My husband developed the itch a few days after the vaccine

[PMRpro Ambassador in reply to Watercolorist]

It takes up to 2 weeks for the immune system to respond fully to a vaccine.

[Menno1525]

If it came on after going to the dentist it's worth checking the obvious things like were they wearing latex gloves and what cleaning fluids were they using - I always used to come up in a rash after treatment until I made the connection with latex. Also worth asking about the anaesthetic as adrenaline based ones can cause problems - they send me tachycardic. Combination of antihistamines and a topical steroid for the face did the the the trick. You can get hydrocortisone cream over the counter which you can use on the body, but it's not meant to be used on your face. GP should be able to prescribe Synalar ointment which is safe for use on the face and elsewhere and much more effective than simple emollients.

[PMRpro Ambassador in reply to Menno1525]

Had you noticed this thread is over a year old?

[Menno1525 in reply to PMRpro]

Yes I had but thought, if like me any other reader was going over older threads related to issues they had, this bit of info might be useful.