skin tears

[GinnyMa]

I have vasculitis, MPA, microscopic Polyangiitis, and have been on prednisone for 3 years. Currently I am on 2.5 mg. Recently I developed several skin tears on my legs. Saw my rheumatologist yesterday and he told me to stop the prednisone. Suggestions please…can I just stop the 2.5 or should I taper??

[PMRpro]

No, you must NOT stop the pred cold turkey - you MUST taper and slowly. Unless your adrenal function has returned you could become very unwell with an adrenal crisis and end up with a big bill for intensive care!

Studies have shown that even 2 to 3mg pred is plenty to suppress natural production of cortisol so the taper must be slow - over months, not weeks - and it is advisable to have a synacthen test to be sure your adrenal function is working.

Even stopping the pred rarely leads to a great improvement in skin quality that has deteriorated due to pred use, especially in older patients. If I were you. I'd be in no great hurry to take the gentleman's advice!

[Asbeck in reply to PMRpro]

NRR (No Response Required) Thank you. I've been wondering about this. I am between 1.75 mg. and 1.25 mg. (one day of 1.75 mg. and 3 days of 1.25 mg.) It seems so small a dose. This is the first drop where I have not yet felt terrible for a good 6 days out of 10 during my taper. I use the DSNS method (or whatever it's called). It's your recommendation. So I will shoulder on slogging tapers of .5 mg. If anyone other than PMPro reads this--I am doing well at this dose. My body and face seem to be slowly losing some of the symptoms of Prednisone use. There is hope after 11 years!!!!! And I believe that my GCA is in remission. My PMR is very manageable. Maybe some of my slight pelvic girdle pain is actually just old age. I think that I am rather well. I had lost hope that this would happen. Thanks again for the advice.

[PMRpro in reply to Asbeck]

That's not a small dose in the world of PMR! Even 1/2mg can be loads to keep it under wraps! Trouble is, rheumies don't have to experience it and work on theory. All the best.

[DorsetLady]

No you cannot just stop… as PMRpro has explained.

Re skin tears, most on the PMRGCA form where it’s often discussed have taken to making sure legs - and arms, another favourite place - are covered by lightweight trousers/shirts. Or if outside in garden then more robust coverings… and make sure skin is well moisturised at all times, using a non perfumed medical emollient [plenty online] rather than one from fancy perfumed range…

[SusanEleven]

Hi Ginny,

I've been on a maintenance dose of 2mg for my GPA. My rheumatologist said that I can wean off now via a taper. He estimated about two months to get off completely. I told him I'd take it more slowly. And he has asked me to ask my endocrinologist for a synacthen test since I've been on prednisone for 7 years without a break. (That was not his doing ... he inherited that from my misdiagnosing previous rheumy who started me on pred and left me on it.) I'm using the Dorset Lady method to taper. Slow and steady. My doc said "You'll feel it." But to try not to confuse that with any reoccurring disease symptoms.

I use Cerave moisturizing cream. My skin hasn't torn but it's fragile and bruises so easily. Ah steroids ....

And Monday is my next Truxima infusion. It has done its job so far for the GPA. Hooray!

[oldtimer2]

I use Limbkeepers (lightweight ones as the thick ones are too warm) - sleeves mainly as I can keep my legs protected with trousers. They have helped a little as well as keeping the skin well creamed with oatmeal cream.

In regard to the steroids, the advice you were given sounds a bit gung-ho! Yes they contribute to skin thinning but so do many other things especially age....and there's nothing you can do about that!