Rashes whilst reducing Prednisolone

[Menno1525]

At the time I was diagnosed with possible GCA (April 2023) I had a massive allergic reaction on my face, similar to ones I’ve had in the past when triggered by latex or other contact irritants. It resolved in a few days on the highest doses of steroids as did the psoriasis on my scalp and other skin irritations - sweat rashes etc. My skin had never been so good in decades! However as I reduced steroids the rashes on my body and the scalp psoriasis (though not the allergic reaction on my face) started to return and have got worse despite all my usual treatment with emollients etc. I’ve now been on 5mg for a couple of months and the last two weeks or so the rashes have really flared on my chest, abdomen, back, elbows etc. starting off like red pin pricks then spreading out into flaky itchy patches that merge with each other to create larger areas of redness. This last week I’ve been treating it with hydrocortisone cream which seems to be breaking it up a bit but I’m still very uncomfortable. Rheumatologist doesn’t seem interested and has just told me to go back to my GP ,which I will do on Monday, but I’m not sure if this a steroid induced rash, a rash produced as a result of steroid withdrawal, a symptom of whatever auto immune condition I have (tests for GCA were negative) or something like a delayed reaction to to the Shingles/Flu/Covid jabs I’ve had recently. Recent blood tests seem OK though inflammatory markers continue to be slightly raised, I’m otherwise feeling well, no headaches or aches and pains apart from a bit of inflammation in my Achilles tendon, and mentally sharper than I was on higher doses. I haven’t made any changes in my meds, diet, washing powders, bath stuff etc that might account for an outbreak so I’m at a bit of a loss.

Has anyone else had something like this on lower doses and how was it resolved? Rheumatologist wants me to continue reducing and I’m inclined to agree as I’d like to get off the steroids asap and give my liver a rest.

[PMRpro Ambassador]

It isn't uncommon for people with previous allergic problems to find they improve on higher doses of pred but reemerge at lower doses.

"I haven’t made any changes in my meds, diet, washing powders, bath stuff" - YOU mightn't have, but the manufacturers may have done! And even your pred tablets having a different filler because they are from a different manufacturer could be to blame.

I was watching a Bad Skin episode last night with a young woman with awful eczema all over that she'd had most of her life and was treating with the usual stuff the GPs hand out. Dr Emma dealt with it by giving totally different creams and emollients - saying a lot of the usual stuff actually CAUSES problems. Within a few months her skin was like a baby's! Now I know this is TV and they are looking for sensations but it isn't the first time that someone with severe eczema or psoriasis has been taken off the usual stuff and been sorted out good and proper! It is obvious that even if the alternative treatment used is more expensive - the patient no longer requires as many appointments and medications so money is saved there instead of effectively throwing it away. And the patient feels better - which surely is the point?

[Waves2]

I too developed a range of skin problems as I reduced just below 5mg. I think it was triggered by a combination of post shingrix vaccination, stress and the lower dose poking adrenals. Started as itchy rash on my back then spread to arms and legs. Diagnosed as chronic urticaria and treated with a daily antihistamine, emollient cream and corticosteroid cream it is finally going six months later. It also reawakened a psoriasis patch which has not troubled me for nearly 30 years. I am keeping my fingers crossed this was just a blip and I have continued a very slow reduction of pred .25mg at a time over several weeks.

[Menno1525]

Saw my GP yesterday. She thinks it's a probably Psoriasis and has prescribed a heavier duty cream of the Betnovate type, a huge tub of emollient and some more stuff for my scalp. Has also prescribed some coal tar lotion which I will try out very carefully as coal tar soap in the past used to bring me out in a rash! Not entirely clear on best way of using these together but she has referred me to the community dermatologist who may give some advice. Hopefully I'll get to see them before the rash clears up..... No clearer on the cause of it so I'm going to proceed to my next drop in Pred and see how it goes.

[Body_bonkers]

I’m developing new rashes on lower doses too but too early to tell if something new previously supressed by higher steroid dose or just reaction to tapering

[Menno1525 in reply to Body_bonkers]

Good that it's not just me! Gives me something to talk to the dermatologist about when I finally get to see them. Currently I'm taking antihistamines and am head to toe in emollients, steroid creams and a rather noxious coal tar preparation. Seems to settling a little but I'm definitely in longsleeves, high collars and leg coverings of some description so I don't look too leprous when out.