Purpura?

[Miserere]

At least, I think that's what it might be called. I am getting purple patches under the skin on my forearms. They are not very big so far and they fade over a few weeks and then disappear. They've only started over the last couple of months and I don't seem to need to bruise myself to get one. Is this down to the prednisolone? I am now on 6mg and reducing .5mg every 3 weeks if I can. Should I be trying to reduce every 2 weeks? I tried that at 7mg but had a short flare. My skin does seem thinner but I am only 67 - does it improve once you reduce the pred further? I have just emailed the surgery to let them know but they are not quick at responding these days, so any advice gratefully received.

[piglette]

I started getting purpura pretty soon after starting steroids. I sometimes looked as if I had been in a fight with a wild animal. I still get them mainly on my arms and hands, but definitely fewer. Everyone coming across my skin says it is very thin. I have been told that there is not much you can do to improve thin skin. If you find something let me know. I only try to reduce every four weeks, two weeks does not give you time to ensure that the reduction has worked, so you can get a flare more easily.

[Miserere in reply to piglette]

Thanks for your response, piglette. So is it getting better as you reduce the dose? I have been OK until now so perhaps for me it is the length of time - I have been on them just over a year.

[Miserere in reply to piglette]

Someone has also said the red marks can be caused by chronically elevated blood sugars but I have got my self out of the pre-diabetic range via diet so not sure it can be down to this. However, I shall be particularly vigilant now. If it's not one thing ...

[Dambusters in reply to Miserere]

It wasn't me that said it but it did happen for me. I was a mess when test showed high sugars. Fading now that I have cut the carbs.

[piglette in reply to Miserere]

I had not heard that about blood sugars causing purpura for people taking steroids. I have a normal range HbA1c result and I have that checked yearly. I don’t know if that would show it? My purpura has got much better at lower doses. I sometimes think it has gone away then an odd spot or two appear!

[HeronNS in reply to Miserere]

That's interesting. The one test result which the doctor felt worth mentioning to me this morning was my blood sugar. He does that test which measures something which tells you what has been going on over the past few months and apparently my number is the very top of the okay range, and we need to keep an eye on it. Maybe that is a factor, didn't know. Sigh.

[Kendrew]

Hi Miserere,

It's not possible to 'rethicken' skin once it's become thinner, but you can take measures to either slow the process down or to improve the appearance and healthiness of the skin.

So.......

- no smoking or reduced smoking. Smoking is known to cause damage to skin, particularly speeding up the development of wrinkles and 'crepey' skin.

- no excessive alcohol consumption

- stay out of the sun whenever possible but always wear a protective sun cream if you have to be or want to be in the sun.

- eat a healthy diet with minimal processed, fatty or sugary foods.

- drink plenty of water every day. It's important to keep well hydrated.

- clean/wash/bathe your skin daily with a body wash that's gentle and not full of parabens, etc. There are several good ones to be purchased from a well known High Street pharmacy. Keep the skin clean and use a sponge or similar to clean as this will gently stimulate the circulation and therefore increase the blood supply to the skin.

- moisturise, moisturise, moisturise! Use a moisturiser that both nourishes and protects. Dry skin will damage more easily and looks and feels unhealthy.

I've been on pred for 3yrs now and all things considered, my skin has remained pretty good. I've always moisturised daily anyway but after developing a bad case of Urticaria last January, I began to pay much more attention to my skin health!

I'd addressed all the other side effects of pred that I'd been experiencing but completely neglected to consider my skin.

[Miserere in reply to Kendrew]

Thanks, Kendrew. I do all those things except moisturise and sun cream as current advice seems to be avoid it and get vitamin D naturally - heard this from more than one nutritionist. However, I can try to remember to use moisturiser on the arms. Thanks again.

[Kendrew in reply to Miserere]

It's ok to spend a short amount of time in direct sunshine for your vit.D fix...the problem with exposing your skin for too long is that pred also makes your skin much more susceptibile to burning, so you're likely to experience sun damage much quicker than normal, burn much more easily and possibly develop an elevated risk of some skin cancers. It's true that Vit.D is best sourced and absorbed from direct sunlight but when on pred, we have other factors to consider too. I'm not sure that a nutritionist would necessarily be aware of or know what these are.

I take a really good Vit.D supplement and stay out of the sun as much as possible. My current blood tests showed my Vit.D level was right at the top end of what's considered to be within normal parameters, so it is possible to stay sun-safe and maintain healthy Vit. D levels.

I obviously don't know exactly how you execute your own self-care strategies but I would definitely be a little concerned at being advised to not use sunscreen.... particularly when taking steroids.

I hope you don't mind me saying all this, but having experienced a few sun-related skin issues myself when I first began pred, I now have a more informed understanding of the processes involved and just want to make sure you're fully aware of all the different considerations.

[HeronNS in reply to Miserere]

I believe during the summer months we only need about twenty minutes of sun exposure to make sufficient Vitamin D.

[DorsetLady PMRGCAuk volunteer]

Can be induced by Pred and very common, but it does improve as you reduce/stop the drug. But doesn’t necessarily disappear completely, as can be age related as well.

Unsightly for sure, but usually harmless, and as you say soon fade.

[SnazzyD]

I had that and it got better with dose. My skin is thinner since Pred but has definitely regained some of its resilience in the year after stopping Pred. I never had particularly thick skin in the first place and bruised easily, even at 54 when I started on Pred.

[Miserere in reply to SnazzyD]

Thank you, SnazzyD. I wonder why it has just started now I am down to 6mg but must be due to the build up over the last year. I do wish I could get off it altogether and will continue slowly. I don't cope with stress as well now as I used to, that's for sure. At least there may be some hope once the pred stops.

[SnazzyD in reply to Miserere]

I certainly found it was cumulative to start and not instant. I also think the effects are delayed so I wouldn’t start getting impatient about reducing because the effects have been made already by the buildup. Your stress reaction is probably due to low adrenal function now you are at 6mg. It is around this dose that your Pred is no longer more than your normal natural cortisol required output. Therefore your adrenal glands need to work a bit. However, because there has been so much of the artificial version of cortisol sloshing about, they have not needed to work. This can have the effect in some of them not being responsive for a while until your system cottons on to this. Do go to the FAQ’s on the right and read about Adrenals because this bit can be a challenge and more so if not managed properly.

[Uke1]

This is uncanny, I was literally going to post the same question myself today! I’ve had the same problem for a while but the “purple patches” seem to be getting worse, just as some have almost cleared up, another few are there the following day and they do take weeks to fade, as you so rightly say.

I am currently carefully tapering from 3mg down to 2.5mg. I would say the patches have got worse the lower the dose of Pred. I’m 63.

I have found a good concealer works very well applied directly to the patches if I’m going out anywhere in particular.

Thank you for bringing this up!

[Miserere in reply to Uke1]

At least we are both experiencing this when doses have reduced - I was beginning to wonder.

🙃

[herdysheep in reply to Miserere]

I experience the purple patches too and only really noticed at lower doses, but I am 10 + yrs in with pmr and 10 years older!! Cumulative doses may outweigh low dose.

[Miserere in reply to herdysheep]

Oh, wow herdysheep - 10 years ...

💕

[herdysheep in reply to Miserere]

I'm not the longest at this game by any means

[Miserere in reply to herdysheep]

Well, I feel for all of us on long term PMR.

[Seacat30]

Mysterious small purple mini 'bruises' appeared on my limbs every so often. This seems to have stopped now - I didn't notice when but it was somewhere between 7mg and 5mg.

[Miserere in reply to Seacat30]

Good to know, Seacat30 - maybe if I drop below 5mg then they might stop although Uke1 is suffering at 3mg. It makes me feel older. Take care.

[diana1998]

I get about 3 or 4 on hands or forearms every time I do a drop. They fade quickly after a week. I'm now on 3mg and still happens! Never get them otherwise.

[Miserere in reply to diana1998]

I shall look out for that when I drop again next week, but seem to be getting them now.

[diana1998 in reply to Miserere]

Just ignore them. It's the pred

[Exflex]

I don’t know if what I’m going to say is related. I’m on Pred (currently 3mg but have been higher) and take Aspirin 75mg. I suffer frequent bruising mainly to my right hand, but on the left also (right handed). The dark pigmentation is the iron in the blood that seems to have permanently discoloured my skin and layers underneath. That’s what the doc said. Nothing to worry about and nothing can be done to alleviate the problem.

[Miserere in reply to Exflex]

Thank you

[PMRpro Ambassador]

Yes, purpurae, the larger ones, or petechiae, smaller ones. Due to fragile capillaries in the skin leaking. Doesn;t take much of a scrape for them to appear rather than a proper bruise.

It may happen with raised blood sugar (don't know, would have to look it up) but when on pred it happens anyway. It also tends to happen with aging and pred does accelerate the aging processes.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Yes raised blood sugars can cause -had a look earlier…

[Miserere in reply to PMRpro]

Right, I shall ensure that I don't eat sugar and I keep my carbs as low as possible. I discovered I was pre-diabetic last year through joining an online workshop with Dr Sarah Myhill. My GP must have known but said nothing. Had a blood test last month and no longer pre-diabetic but I feel I have further to go so strong attention to diet, just in case. Many thanks.

[HeronNS]

Yes. Oddly enough in my case they've always been worse when at a low dose, where I am now. Sometimes I feel so sensitive about them I dab a little makeup on the spot, makes it a bit less noticeable.

[Miserere in reply to HeronNS]

It seems we are all different ... I need to reduce again next week so will see what that brings.

[HeronNS in reply to Miserere]

Yes, I've never heard of anyone else finding they are worse when dose lower. I guess I just like being different! 🤷‍♀️

[Koalajane]

Mine are bad at the moment. I think it has a lot to do with wearing short sleeved tops. I always get them from putting my rucksack on and off. Whenever I knock myself they appear. I just hope people don’t think my husband is physically abusing me!

[AyJayBass]

I'm almost 79, been on Pred for 15 months now (5mg presently). I have been using an Asthma reliever inhaler for many years as well as a steroid nasal spray. I've also been on blood thinners for just over 3 years. I started getting the "purple patches" on my arms several years back - well before oral corticosteroids. They are now a bit larger than before and the large ones (around 5cm across) are confined to the backs of my hands and wrists. I believe they are a bit larger in the hotter weather. The worst ones I had were in Florida 4 years ago when it was around 30C. (I was doing Disney with the grandsons).

They are unsightly but heigh ho, they are part of who I am!

And to avoid skin punctures when I am pruning in the garden I wear welders' suede forearm protectors.

[Miserere in reply to AyJayBass]

Welders' gloves would be a good idea - my gooseberries and loganberry as well as some of my roses can be viscious! And perhaps the warm weather is adding to the problem. Hope you manage to stay cool this week! Thank you!

[Bfp1]

Hi I am 63 and have been on pred for a long while. I regularly get these exact same blotches on my forearms. They hang around a while and seem harmless. I also have very thin skin and, at one appointment when I mentioned them, I was told I had typical steroid user’s arms. Sometimes they are deep purple and slightly raised -Touching them forces them to spread. We are all in this together. I am down to 4.5 again, having been in for a pneumonia and lung issues, straight after a knee replacement surgery. They put me on 9for 10 days and said go back to 4.5 at home. So I did. Finally my swollen face looks much better than it has in a while - so I really don’t want to increase them. Anyway - didn’t mean to digress - apologies - don’t fret - and feel good d

[Miserere in reply to Bfp1]

HI Bfp1 - sorry to hear you are going through so much. I, too, can see that my skin has thinned considerably. After a couple of flares and by using the guidance on this site given freely by experienced members I am now down to 6mg and tapering slowly to 5.5mg. I have learned not to rush it. A neighbour who is also suffering got down to 6mg and although I told him to slow the decrease to at least only .5 mg each time he pushed it at 1mg and has now gone back up to 15mg. He is not computer savvy, so although I've tried to get him to join this group I think it is beyond him. I hope the knee replacement improves things for you and that you manage to avoid covid on top of everything else. Wishing you well.

[Bfp1]

I had covid and recovered in some respects but some long covid still. With what we have who knows what is connected to which illness. I think I was bold about the steroids - no one really advised me re tapering so I was determined to get below 5 because of the side effects. So take good care and keep going. It is so nice to meet people on this forum who understand each other. It is such a beautiful thing to meet you. It’s like we are all connected. Good luck new friend xx