I'm a GCA patient, diagnosed in AUG 2022. I started on 60 MG pred and have weaned down to 10 MG at present. About 2 months ago I started getting an unusual rash on my hands and wrists -- back then it was only reddish. But it kept getting worse and worse, and now it's an actual bumpy rash -- small bumps, and it's spreading up my arms. I've noticed that my feet are starting to get red also. It's getting really BAD.
I've been to the dermatologist, and he took a biopsy, but no results yet. He suspects ringworm, but I cannot imagine that because that's VERY contagious and neither my wife, my daughter, or any of my grandkids have contracted it from me.
I've been applying cortisone creams, exzema creams, psoriasis creams, etc to no avail.
I'm wondering if I'm developing an allergy to prednisone?
And if so, THEN WHAT???
What do people with GCA do if they cannot take prednisone?
Thanks
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montebello
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In the USA you may well get Actemra - not so in the UK. But an allergy to pred is very unlikely - unless it is one of the ingredients in the brand you are on that are used as fillers to make the tablet.
If the dermy is right in suspecting ringworm then using cortisone creams is likely to make it worse.
Well, a diagnosis is a good start! Rather than throwing creams at it indiscriminately. Now it is on your feet - have you tried asking a podiatrist? SheffieldJane had what she though might be psoriasis - the podiatrist diagnosed athletes foot I think and when treated correctly it went away/
After taking a scraping she ( Podiatrist) was able to tell me there and then what it was. I had no idea Athletes foot could spread all over the foot. It did go away. I had had it for a couple of years.
Lamisil Once but yours is on your hands and feet. It is unlikely to be Athletes foot. Sorry if I have this wrong, I am in a cottage in the Peak District and my internet keeps dipping in and out. For diagnosed athletes foot it worked with one application. I could hardly believe it.
Just to say that in Jan 22 I got in the bath one evening and noticed what seemed like red patches appearing on my forearms. By the morning, my arms, shoulders, chest, back and legs were covered in an itchy, raised ("bumpy") rash.
I'd done nothing different, eaten nothing different and not changed my soap, washing powder or body lotion.
My GP increased my steroids back up to 30mgs (from 7.5mgs) as prescription strength antihistamines alone weren't improving things.
After ten days on 2 types of antihistamines and the 30mgs of pred, the rash began to subside. It took a good 6wks for it to completely settle down though and I only washed in Dermal500. I put absolutely nothing on my skin that wasn't gentle, unperfumed or hypoallergenic.
Rheumatologist advised that steroids can sometimes make you more sensitive to other autoimmune reactions triggered by a heightened sensitivity to something that probably wouldn't have caused a reaction prior to pred.
I'm still careful with my skin and really take care of it.
Kendrew, this is very interesting. As I said, I am awaiting a diagnosis by the dermatologist but in the meantime I'm going nuts from itching, especially at night, which is why I continue to try different ointments. What did you do for the itching while awaiting for the rash to subside?
says "Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loose skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using this medicine."
I bathed in aired water or showered in the same, and then moisturised with Aveeno, but I found taking Fexofenadine & Hydroxyzine (prescription antihistamines) very quickly helped ease the itching, (if not the raised, red hives) fairly quickly. I also wore light, loose clothing and definitely no tight or restrictive underwear, particularly where sweating more likely.
Often, just keeping skin well moisturised can help itching. I suffer from eczema and some times I use the E45 anti itch cream, the one that contains lauromacrogols, and it gives me some relief from the itching. You could try that to see if it helps the itching as it is unlikely to interact with any of the other meds that you are on, unless you are specifically allergic to any of the inactive ingredients in the cream. Also, a cold compress can often help. I've used a bag of frozen peas in the past when my eczema has been really itchy and I am trying not to scratch. What you describe does sound like a potential drug reaction, could it be any of the other meds that you are on.? Have a look at the in-pack leaflet and see if skin rash is mentioned as an adverse reaction. Though I think the advice already given is best, to wait and see what it is first.
lots of great advice. I just want to reinforce one message...get a diagnosis and don't just try different creams, some can make the condition much worse. Perhaps worth remembering that the pred we take makes us very susceptible to fungal infections (other people round you have immune systems to protect them...you don't)
I do hope you get this resolved quickly. Generally we should get a diagnosis for any skin thing that seems abnormal (better to zap early).
I would have thought an allergy to Pred would be worse at higher doses. People do seem to complain about allergy symptoms generally as they get to lower doses, possibly because Pred is no longer suppressing them. However, you’re still up at 10mg. As PMRPRo says, some people get a reaction to certain dyes and ingredients in specific brands of Pred, noticeable if the pharmacy swaps in a new equivalent to your usual one. However, it sounds a bit patchy.
Fungal infections like Ringworm love a suppressed immune system so putting on steroid creams will be counterproductive. Broken or inflamed skin can make it more prone to irritation so trying different remedies without a diagnosis might make things worse or confuse the issue should more tests be needed. However, when one has irritated skin, one will try anything to stop it!
In the meantime, keep your skin out of the sun and avoid washing socks etc at low temperatures. You could treat your shoes with an anti fungal powder from a pharmacy to try to avoid an infection cycle. I used to in the summer when I was on Pred. The trouble is these things are around us all the time and they just need a susceptible bod and conditions to set up home in. I hope you get a diagnosis soon!
I treated my husband's toenail fungus infection for a year, which helped only mildly and kept it from getting worse. But, here is the interesting thing: When he became more incapacitated, he no longer wore shoes!!! After a time, his toenails became normal looking. Takeaway: Don't wear shoes in the house. When you must wear shoes (as in going out), buy yourself new shoes because they won't have the fungus lurking in them. If this helps, you may need to get rid of all your old shoes. I hope this helps for you, as it did for my husband.
are you taking anything else, like Alendronic acid, Lanzaprozol or Adcol. I too was diagnosed last august, put on Prednisolone plus these other things & I developed the most horrendous skin rash that spread over entire body. The skin flaked off. Told it must have been caused by the medication so everythin bar Prednisolone was stopped
Cavalier, I was also put on Alendronic Acid about 2 months ago, but I stopped it after it affected my GI system. Aside from blood pressure meds, I'm on nothing else except prednisone at present. PMRpro suggested that the BP meds might be causing the rash, so depending on the results of the dermatology test I'll mention this to my GP. But the more I think of it, the more I suspect a fungal infection. It's appearing on my feet now as well.
Interesting to see that alendronic affected your GI system. Sorry to go off topic, I only took them for the first 3 weeks and each time spent the following day commuting between the bedroom and bathroom. After that, I decided enough was enough.
I also was on on pred for GCA and was tapering. I December last year I had to take a substantial increase in pred and, although I had no rash I itched from head to foot. They have never found a satisfactory diagnosis and any of the prescription creams or bath oils they gave me made it worse. I then started using Aveeno Bath Soak, Aveeno Shampoo and Aveeno Moisturising Cream, which definitely reduced the itching as long as I used it everyday . Now itching still there but less severe. The other thing they thought in my case was that I was anaemic which can cause itching so I have been on iron supplements. As I say, now bearable but not gone away.
Oh dear, believe it or not , getting sudden rashes from all sorts of numerous types of skin reactions can be quite common while on steroids .It happens because the Prednisone may be having two effects on you , first you can be more prone to pick up certain infections because the steroids can effect your immunity, second, the steroids can make your skin more fragile and prone to react.
The positive news is it is highly unlikely that you have developed an allergy to Prednisone, but you may be having an allergic reaction to something else you are coming into contact with , or having a hypersensitivity reaction to the skin infection you have.
As others have said , taking a daily antihistamine should reduce the inflammation and feeling of burning or itching because it reduces the hypersensitivity, and it would probably be worth taking this , even if you receive other treatments until the issue has healed ( as long as it doesn't counteract with your other medications).
As your skin problem could be anything , from a wide variety of fungal or bacterial infections ( not just ringworm ) , to contact dermatitis or and equally wide variety of eczemas you may find that trying out one cream after another without a specific diagnosis could be making your skin more inflamed. It could even be a reaction to a scratch or insect bite.
Until you know your biopsy results it may be better just to wash the areas with plain water, gently dab the skin dry , and allow the air to get to it, as the effect of the skin getting over warm under clothing or damp from perspiration makes most of these things worse and can cause the chance of the skin being broken.
Wear loose clothing made of light natural fibres and keep clothing off the areas if possible.
Keep your feet open to the air if you can too by wearing comfortable sandals , crocs , cotton slippers or sliders that don't rub the skin.
If your skin is itchy or burning a trick is to get some of those premade icepacks and hold them in a cotton cloth over the areas close to ,but not directly on ,the effected skin to cool it.
If you feel the need to itch again don't it on the area as it will spread but you can gently rub the skin a few inches away from the infected areas to distract the nerve reaction and reduce the itchy feeling.
Try not to touch the rest of your body with bare hands in case it is an infection which you can spread around .
Your Dermatologist is likely to give you the right sort of cream when they know what it is , something like hydrocortisone of a higher % if it is inflammatory or bacterial or fucidin if it is fungal. They may even suggest you increase your Pred a little for a while to help the treatment , but don't try that until it is recommended.
You may need antibiotics, antifungals , be prepared it can take some time for these things to clear up , especially when you are on steroids.
You can try to work out if there are any foods or beauty products that are triggering it , giving an extra rinse to your clothes to get rid of all soaps us also a good idea.
You can help speed up the healing process by increasing your water intake to help reduce the inflammation and remove the toxins , and taking a combined vitamin and mineral supplement after your fattiest meal of the day , if you don't take one already including Vitamins A,C,E,D and K also helps to improve the condition of your skin. Hope you get some answers soon , Bee
I suspect a fungal infection due to you being previously on such a high prednisone dose.
Miconazole nitrate cream 2% can be prescribed by the dermatologist. You can also get it OTC (Lotrimin) but only comes in 1% cream.
I'm very prone to athletes foot and prednisone makes it more prevalent for me. Interestingly, my athletes foot never seems to infect others although others can infect me. Prior to prednisone I had dealt with on two separate occasions full body fungal skin infections that were caused from the spread of my athletes feet, so I am no stranger to fungus.
Importantly, hygiene is key. Change bath towels, wash cloths, and hand towels everyday and use a separate hand towel from others when drying your hands (or you can use paper towels - whichever you prefer).
It can take a week or so to start getting fungus under control with medication but you have to stay on top of it and doing so , over time it does resolve.
My husband went through this for many months of misery and in the end it was Kidney function, from which he died. They were treating him for Discoid dermatitis with lots of dermovate, from which he first went blind. Get the full works of blood tests and make sure someone looks at them.
Hi, I debated about whether to share our horror story. It started with rash on back, then hands. Became very lumpy and ugly. Itching in places there was no rash. Went on for horrid months. After he died, it became apparent that the four consultants and the GP were not reading their reports. Kidney failure overcame him before it Ws diagnosed is my point. They were treating him for cardiac problems and the Cardio was saying it wasn’t that bad—30% loss at age 84. He was a tall athletic man. So, GP determined to keep him out of hospital and a nurse had him admitted, but it was too late. Legs like tree trunks. He fell in hospital and broke hip. This was during a summer lull in Covid, which he did not get. So hands like chicken skin and back rashy and all lumpy. My point is that your rash may not be externally caused. Take care and be sure you are being heard. I wrote a letter that got attention, but too late.
Not sure where to post this, but here's an update....
Biopsy came back positive for ringworm. DOC prescribed a 3 month course of antifungal pills to be taken once a week -- as well as some topical cream. My only lingering question is "why do my hands turn red?" Sometimes they are red, sometimes they are not. I don't think the DOC knows the answer. We'll see.
Thanks for looking into this. It could be Erythromelalgia but as I said there's absolutely no pain with my condition -- and I've had it now for several months. The red hands happened PRIOR to any itching or blotching that took me to the dermatologist (who eventually diagnosed me with ringworm). So maybe the red hands are part of ringworm?
As for erythema, that's also a possibility. But the redness occurs on the back of my hand, not the palm. I don't know if this rules anything out or not?
I'd go to my GP about this, but I doubt he'll know what it is and unfortunately he's not the kind of guy who pursues what he doesn't know. He'd only send me to the dermy.
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