skin infection | Arthritis Information

 

I am an adult (46 and counting) who had JRA as a child (dx age 7). It went into remission at age 19 and just came back last year.  My biggest problem is my eyes, I have had 3 bouts of iritis in the last 10 months despite the MTX.  I also have dry eye (sjorgen negative) and take restasis which has been a big help, although the first month was hell.  The only joint that really bothers me every day is my left foot/ankle.

I am on 15mg MTX weekly, 400 mg plaquenil daily, 1 mg folic acid daily and naproxen as needed.  The latter just messes up my stomach so I avoid it unless the foot is bad.  They have been talking about putting me on remicade but today decided to add the plaquinel. I have had a skin infection since January that they don't seem to agree upon - what is it, is it viral, bacterial, ?????  My eye doc wanted the remicade but my rheumy veto'd it until they figure out the skin infection.  Its mostly on my arms and hands although occasionally it is also on my forehead.  Has anyone had this type of reaction to MTX?

Could it be something else? It only seems to itch when a new patch first appears. Its red but quickly fades to something that looks a bit like a liver or age spot.  Some are tiny, 1/8 of an inch but others are dime sized. Its not attractive.  The first dermatologist said it was an HPV infection "flat warts". Today they were asking me questions about psorasis.  Could this be part of the RA itself?

All help greatly appreciated.  It seems like asking the rheumatologist to talk to the opthmalogist to talk to the dermatologist to talk to my primary isn't realistic - so I am trying to connect my own dots.

Thanks

Have you ever found a picture online that looks like yours? Maybe if we had some visual, we could start popping out some more ideas.....

I'm thinking......I'll get back to ya...

I looked in the on line atlas in January - my rheumatologist said he thought it was fungal and he cut my MTX in half - but I couldn't find anything fungal.  The dermatologist told me it was flat warts and that looks reasonable - see picture below.  The problem is that neither my rheumatologist, the rheumy he brought in to consult or the doc that heads the uveitis clinic believe it.  I don't even know how I feel about starting the remicade but I really need my life to settle down.  I read and write for a living so these bouts are really messing things up.  Here is a picture - there is a ton of then on my forearms, speckles on my hands and forehead.  I hear that plaquinel is a real hit or miss drug, mostly a miss but for some patients, it does work. I like the eye doc best and think I lean toward the remicade because I am more inclined to trust him yet he defers to the rheumy.

 

That is so bizarre.  I really am not sure what to tell you. Skin things can be SO tricky though, maybe it would be worth it to have a second derm. take a look at it?

The one on the lower left that is a little smoother and more red is like something that I have all over my legs and some on my arms.  My skin Dr wasn't really concerned and prescribed a cream that I have yet to get filled (tired of Rx's).  Mine never get flat and as large as yours.  The flat larger ones look like psoriasis to me.

 

Hi Mollysgone. What about cysts? Could it be that? Check out this website

http://www.assh.org/Content/NavigationMenu/PatientsPublic/Ha ndConditions/GanglionCysts/Ganglion_Cysts.htm

If it is something like that it is definately caused by RA. I would ask one of the doctors to do a biopsy; maybe that would clear up all the confusion.

Hope I helped! Kitty
A biopsy would be a good idea. Your Rheumy should be able to do it in your office. If it is a fungal infection though, your Rheumy has good reason to be concerned. Fungal infections can turn septic especially with drugs like MTX and Remicade. However, they can give you a creme to treat those and just keep you off the meds until it clears. Enbrel, I know, can cause these skin infections. And going on and off the meds seems to weaken their effectivity. So, that's the reason behind your Rheumy's caution. Your opthmalogist might not be as aware of these possible problems. He's just wanting to get your eyes under control.

First, make sure that they are treating the skin infection. I have these continuously and they are the devil to get rid of. I have to treat them with creme four times a day.

There are also other problems as those mentioned above and vasculitis. So getting to what is the cause of the problem is really important.

I hope you find your answers soon.
Hi Mollysgone,
                Perhaps you can contact me via my email address. I am currenty drinking an all natural product which is a COX-2 inhibitor as well as inhibiting Prostaglandin at PGE2 & have had tremendous results. MTX is a drug used in chemotherapy as you might know it can destroy the liver within 6 months & people using MTX should have consistant blood tests to monitor liver function. I now have total mobility back throughout my body using this all natural product that has a broard spectrum of usages. Hear from you soon.
Yours in health,
Durocell.

Thanks everyone

The rheumatologist thought it was fungal - I had a slew of them on my arms in January but the dermatologist said no.  The derm gave me a creme as well, effudex, but I decided that I am already dumping chemo in my eyes (restatisis) and in my mouth (MTX) so I said No.  The effudex is designed basically to burn the rash off your skin - great idea eh.  They are sending me to "their dermatologist" at the end of the month for a biopsy so I will see what she says.  Thanks for the heads up on remicade, Deanna.  I suspect that this is why they wanted to hold off despite the concern from the uveitis guy.

The picture above isn't me - just something I saw on line that is similar.  My rash - they are almost like little leisions - start out red and then turn brown.  They can get very scaly - I sometimes need to put baby oil on them.  The psorasis pictures I see on line don't really look like what I have but maybe the on line pictures are only really severe cases. I go to a teaching hospital in Boston and they have had a few docs in to look at this - yesterday was the first time I began to wonder if they were thinking this might be the disease itself.

Ugh, I confess that I am having hard time getting used to living with this disease again.  It was so much a part of my life as a child that it took years for me to believe that it would never come back - which is what everyone told me.  I never dreamed that when it came back it would be so different.  I was ANA and RF postive as a child with signficant disease in both knees and elbows although the worst was on the right side.  They didn't even look for eye disease then so who knows.  My eye doc said I had scarring from previous episodes - maybe I did.  Now, its more on my left side and really the smaller joints (hands and feet) - I am now RF negative although still ANA postive (speckled).

Has anyone else out there had a long standing remission come to a sudden and abrupt halt????????

Katie, alias arriscolwell, has had the same thing happen to her. She was JRA and is now showing all the signs of RA after several years of remission. I believe that has happened to several former JRA'ers. You might start another post asking that question. I think you'll find quite a few on here with the same experience. Interesting you should bring this up I am also 46 and just went to my
derm for a skin lesion that keeps appearing on my leg. I am not on MTX
since Dec. but I had a bout of pleurisy and notice that every time I get
that this appears. Thought maybe lupus so into the derm I go. He said no
I got this last year same place same thing. and he calls it a Fixed Drug
Eruption. Basicially a reaction to one of my drugs for the pleurisy. he
thought maybe the viocidine but that can't be because I got the rash
before I went to the PCP about the pleurisy but what I was doing was
taking a LOT of motron which is one of the drugs that can cause this
syndrome. here is one that I copied for you but there are several drugs
that can cause this and they say most physicans don't pick up on it. Good
luck Terry. Bring it up to your doc. You may have to do a trial and error
with your meds to see what it is if it is a fixed drug eruption.
If you look it up you will see photos of what it can look like. mine is on
my like and it burns and stings and when it goes away it leaves a dark
bruise like appearence.




Fixed drug eruption

Fixed drug eruptions (FDEs) characteristically recur in the same site or
sites each time a particular drug is taken; with each exposure however,
the number of involved sites may increase.

Fixed drug eruption is a type of allergic reaction to a medicine. Usually
just one drug is involved, although independent lesions (patches) from
more than one drug have been described. Cross-sensitivity to related
drugs may occur and there are occasional reports of recurrences at the
same site induced by drugs that appear to be chemically unrelated.
Sometimes the inducing drug may be re-administered without causing
reappearance of the patch(es) and there may be a refractory period during
which no reaction can occur after the occurrence of FDE.

How does FDE occur?

Clearly some sort of allergy is involved but exactly how an FDE arises and
in particular why just certain areas of skin are affected, has not been
worked out.

What does it look like?

Fresh lesions are well defined, round or oval patches of redness and
swelling of the skin, sometimes surmounted by a blister. This then fades
to a purplish or brown colour.

Fixed drug eruption
          
          
The lesions usually develop within 30 minutes to 8 hours of taking the
drug. They are sometimes solitary at first, but with repeated attacks new
lesions may appear and existing ones may increase in size. Lesions are
more common on the limbs than the trunk; the hands and feet, genitalia
(glans penis) and perianal areas are favourite sites. Lesions may occur
around the mouth or the eyes. The genitals or inside the mouth may be
involved in association with skin lesions or on their own.

As healing occurs, crusting and scaling are followed by a persistent dusky
brown colour at the site. This may fade, but often persists between
attacks. Pigmentation tends to be more extensive and pronounced in
people with brown skins. Pigmentation from FDE fades when the
causative drug is avoided. Non-pigmenting fixed eruptions have been
reported with pseudoephedrine and piroxicam.

Local or general symptoms accompanying an FDE are mild or absent.

Drugs involved

The number of drugs capable of causing fixed eruptions is large. Most are
due to the following:

Paracetamol /phenacetin and other pain killers (Panadol and many other
makes)
Tetracycline antibiotics; doxycycline (Doxine, Doxy, Doryx), minocycline
(Minotabs, Minomycin), Panmycin
Sulphonamide antibiotics including cotrimoxasole (Bactrim, Septrin, Apo-
Sulfatrim, Trimel, Trisul), sulfasalazine (Colizine, Salazopyrin)
Acetylsalicylic acid/aspirin (Disprin and many other makes)
Anti-inflammatories including ibuprofen (Anafen, Brufen, Motrin,
Nurofen, Panafen)
Sedatives including barbiturates, benzodiazepines and chlordiazepoxide
(Novapam)
Hyoscine butylbromide (Buscopan, Scopoderm)
Dapsone
Phenolphthalein (an old-fashioned laxative for constipation)

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