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What Causes Rashes On The Torso While Treating Psoriatic Arthritis?
Question: Hello, I am currently being treated for severe Psoriatic Arthritis, neuropathy (caused by chemo in 2008), and muscle spasms. I take Sulfasalazine for the arthritis, Tizanidine for the muscle spasms, and Horizant ER for the neuropathy. I have also been undergoing pain blocker shots in my spine to relieve pain from Complex Regional Pain Syndrome from a foot surgery in October 2016.
On January 31 I discovered a large bruise on my hip, but was not too concerned because my veins run close to the surface and a slight bump can cause bruising. I showed it to my pain management doctor during my appointment and she agreed that it looked like it was a vein that had been hit and just suggested that I investigate treatment for my veins if they bother me.
By the next week I noticed two small bruises on my abdomen and could feel a tiny bump under each one. Again, I was not too concerned. However, it seemed like every day there was a new bruise.
On February 11 I went to the ER because I had caught the bug going around. I was given Arithromycin and Prednisone which I seemed to tolerate pretty well.
The bruises(?) continued to spread to cover a good portion of my abdomen, stomach, sides. I went to see my GP on Friday who looked at these marks, asked me if they itch (which they do not) and told me to go see a dermatologist. Of course, being the weekend there were no openings.
This morning I actually watched and felt an area on my upper arm (about the size of a half dollar) form the bump under the skin and turn a light shade of red. The area also is giving off some heat. Then I felt the same sensation on my upper thigh. The bruises(?) on my torso are also feeling more sensitive and warm now. I'm not sure if this is a delayed allergic reaction or something else is going on.
It seems that the spots are darker and more sensitive right after I get out of bed in the morning, and fade only slightly later in the day. There are no marks on the skin other than the discoloration so I feel that it is not a bite of any kind.
I appreciate any help you can provide
On January 31 I discovered a large bruise on my hip, but was not too concerned because my veins run close to the surface and a slight bump can cause bruising. I showed it to my pain management doctor during my appointment and she agreed that it looked like it was a vein that had been hit and just suggested that I investigate treatment for my veins if they bother me.
By the next week I noticed two small bruises on my abdomen and could feel a tiny bump under each one. Again, I was not too concerned. However, it seemed like every day there was a new bruise.
On February 11 I went to the ER because I had caught the bug going around. I was given Arithromycin and Prednisone which I seemed to tolerate pretty well.
The bruises(?) continued to spread to cover a good portion of my abdomen, stomach, sides. I went to see my GP on Friday who looked at these marks, asked me if they itch (which they do not) and told me to go see a dermatologist. Of course, being the weekend there were no openings.
This morning I actually watched and felt an area on my upper arm (about the size of a half dollar) form the bump under the skin and turn a light shade of red. The area also is giving off some heat. Then I felt the same sensation on my upper thigh. The bruises(?) on my torso are also feeling more sensitive and warm now. I'm not sure if this is a delayed allergic reaction or something else is going on.
It seems that the spots are darker and more sensitive right after I get out of bed in the morning, and fade only slightly later in the day. There are no marks on the skin other than the discoloration so I feel that it is not a bite of any kind.
I appreciate any help you can provide
Brief Answer:
Immune markers and inflammatory markers need to be tested for.
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have gone carefully through your query and have checked the attached image. Complex Regional Pain Syndrome is a poorly understood entity. However, it is highly likely that a malfunctioning immune system has a major role to play. The marks on your abdomen are likely to be due to inflammatory cause as it has local rise of temperature associated. Possibly that too is due to a malfunctioning immune system. I would insist you to get your ANA (anti nuclear antibody) and CRP (C Reactive Protein) levels checked. Possibly both would be raised. If so, visit a rheumatologist and seek further evaluation and treatment.
The rashes could be erythema nodosum or erythema multiforme. The treatment of the former depends upon the underlying cause. Is suspect autoimmune cause here. As such treatment with disease modifying anti rheumatoid agents (DMARDs) like sulfasalazine are the most effective treatments that we can offer (you are already on it). Depending upon the severity, corticosteroids might be required.
Erythema multiforme is frequently self-limiting and requires no treatment. The appropriateness of corticosteroid therapy can be uncertain.
The rheumatologist can evaluate and comment further.
Feel free to write back.
Regards
Immune markers and inflammatory markers need to be tested for.
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have gone carefully through your query and have checked the attached image. Complex Regional Pain Syndrome is a poorly understood entity. However, it is highly likely that a malfunctioning immune system has a major role to play. The marks on your abdomen are likely to be due to inflammatory cause as it has local rise of temperature associated. Possibly that too is due to a malfunctioning immune system. I would insist you to get your ANA (anti nuclear antibody) and CRP (C Reactive Protein) levels checked. Possibly both would be raised. If so, visit a rheumatologist and seek further evaluation and treatment.
The rashes could be erythema nodosum or erythema multiforme. The treatment of the former depends upon the underlying cause. Is suspect autoimmune cause here. As such treatment with disease modifying anti rheumatoid agents (DMARDs) like sulfasalazine are the most effective treatments that we can offer (you are already on it). Depending upon the severity, corticosteroids might be required.
Erythema multiforme is frequently self-limiting and requires no treatment. The appropriateness of corticosteroid therapy can be uncertain.
The rheumatologist can evaluate and comment further.
Feel free to write back.
Regards
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Prasad
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