Anyone have any thoughts on what this rash is? (pics incl)

Hey guys,
So the attached photos show a rash that has appeared on and around my right elbow today. Any clues as to what it might be would be greatly appreciated. In the first two pics it looks quite light. You can kind of see that it is a little red circle surrounded by a paleish circle then another red circle, when my arm was outstreatched it just all looked red.

The last two pics show what it looks like now. My arm is still bent, but this time it looks a lot redder, and it is joined by a couple more red patches.



Soybean xx

Does it hurt?

Gosh, no idea. Does it itch?

I was thinking it may be aratheum nodosym (not spelt right sorry). Ive had it a couple times. Generally on my calves. It starts with a red sore spot, then swells and turns purple. They get quite large. You may want to google this and compare symptoms. This is also related to immune disorders.

Ringworm possibly?

It looks rather like the Erythema Nodosum I had on my leg.

No itch, but it does feel slightly bruised. I've had strange dry patches of skin under my eyes that gets to the point of partially spliting open and raised red dry patches usually on my wrist but also in random other spots on my body over the last couple of months but this is completely new.

Natalie38, do you mean Erythema nodosum? I was kinda wondering if it might be something like that (I'm also getting joint problems which is why I wondered aboot that, but I won't go into that here as I've already gone into that in another thread).

Pasobuff, I just googled ringworm to check the symptoms and apart from the patches looking like rings I've not got any of the other symptoms.

Soybean xx

pasobuff said:

Ringworm possibly?

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The ring around it the whiter center made me think this one also. I have psoriasis, but the rash looks nothing like my psoriasis does when it starts.

I'm not sure either. But I can tell you that erythema nodusum is usually raised lumps, sore, and starts red but then turns purple like a bruise. Do you have it anywhere else? Check your forearms, palms, shins and feet.

What medication are you taking? If it coincides with something new could it be a side-effect?

I'm on Remicade, have been since May last year. Recently I have taken a few celecoxib due to arthritis in wrists, hands and feet. Both times I've taken them they didn't do much for the pain, but upset my stomach so I'm not taking them anymore.

My petechiae has reappeared all over my calves and feet. For a while now I've had some red cluster dot/spot type things just under my left knee, they feel bruised, are sometimes very red, and other times lighter, like a bruise that has almost gone. Also I've got a strip of red along the outer side of my left foot, I think that might be to do with the arthritis though. As I mentioned earlier I also have very dry patches of skin on my left wrist, that have been there for ages and every week or so will flare up and then just return to dry patches, sometimes going almost completely.

xx

Soybean, is the rash slightly raised and scaly?

I had something that looked similar but there was only one. It was itchy though and did hurt to scratch it like a bruise. We all (including GP) thought spider bite and left it at that. Went away after some cortisone cream for a few weeks.

Edit: it does have that "bullseye" type look which would suggest a bite.

David, It's difficult to tell properly because of where it is, but blindly running my finger over the one that first appeared, it does feel scaly/dry and possibly a teeny bit raised. Looking at it in the mirror it looks scaly, but because my arms slightly bent I can't tell if it's raised.

If so, that, along with your other symptoms would continue to correlate with the possibility of the DILE we discussed yesterday. Raised, scaly, polycyclic rash is an additional symptom.

Hi soybean...
your photos look exactly like my skin did as I started to break out in psoriasis. I had been om Remi for almost 3 yrs, then I became allergic to it. Go to ur dr.

Yes, looks a lot like when my psoriasis started too. The GP wasn't sure if it was discoid excema or psoriasis. It is very itchy, however, when it's flaring up.

I also thought ringworm when I first saw it, although I have little experience of skin problems. If it is ringworm, then applying Canesten cream three times a day will help, although I wouldn't like to suggest you do that without checking with a GP/pharmacist, in case it's not that and it aggravates things.

Thanks for your help everyone.

I spoke to my IBD nurse again on Friday. She wants me to come in on Monday where she will take some bloods and have a look at the rash and my joints.

Although with the joints she originally thought it might be a reaction to the Remicade, she now thinks that's probably not the case as she would have thought it would be getting better rather than worse the further away I got from my last infusion. She thinks maybe I might need an increase in Remicade and a short course of Prednisolone before my next infusion (in two weeks), but she wasn't definite on any of this so it could all change by the time I see her on Monday. She's also gonna try and get my GI to see me on the day of my next infusion. The rash is now just one big patch over my elbow. When I woke up this morning it was quite red, but I've been out in the sun for most of the day, and it's pretty light at the moment - yey sun!!! hehe!

xx

I went in to see my IBD nurse on Monday and she took bloods to test my inflammation markers and had a long chat with me. Typically my joints and the rash had got considerably better on the Sunday (although some of my finger joints had swollen again and she thought they kinda looked like gout) we both thought it was because of the glorious sunshine we had over the weekend. She's written all the info down and is going to discuss it in a MDT?? (I think they were the letters she said and I reckon they stand for multi diciplinary team) meeting next Wednesday. She didn't mention the prednisolone this time, but did say she doesn't think my GI will want to take me off the Remicade unless it's really necessary, so we're gonna see what happens after my next infusion (next Friday) before we make any decisions.

The rash is only slightly red still and the arthritis has got worse again, but this time has moved more to my knuckles and fingers aswell as my feet. I reckon it getting worse again deffo has something to do with less sun exposure this week, because over 2 weeks ago I asked my dr to test my vit d level on Davids suggestion (thanks David ) and have finally got the results today. I'm not sure if the receptionist said my levels were insufficient or deficient, but my dr has put me on fultium (a vit d capsule 20mcg http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con137942.pdf ) and has prescribed it for long term use. I asked for my vit d level and the lady read out '250h vit d3 10.3' and then read a note saying levels between 10 - 20 are deficient.

Thanks for your help guys xx

Hey guys!
It turns out the joint and skin problems I have been experiencing are caused by DIL from the Infliximab. I have updated my other thread explaining what's happened and have put a link in to my picasa account which has pictures of the joint and skin rashes and swellings etc. If anyone else is having joint and skin problems whilst on Infliximab, have a look at my post to see if it is similar to what I have been through. If so talk to your dr about the possibility of DIL.
link to my other post explaining what's been happening

I'm glad the doctors finally caught up and figured it out -- your case was pretty textbook.

Are they taking you off the Infliximab? What's the game plan?

Hey David,
No more Remicade for me! I've been put back on Mercaptopurine at 25mg. Fingers crossed this time it's kinder to my liver. I'll be on dual therapy for 6 weeks then it'll just be the Mercaptopurine. If I'm ok on it they will slowly increase me to 75mg. The GI said out of the 150 ish patients they've had on Remicade, Im the first one to have DIL, I'm guessing that is why they were so slow and had to be prompted to test for it! I was so happy coming out of the GI office on Tuesday just daydreaming about no more joint problems haha!

Thank you for all your help and advice - you're a superstar! :dog:

You're more forgiving than I am In my opinion, if you're going to prescribe a medication, you need to know the side effects and when textbook cases show up, you need to catch it. Weird manifestations? Sure, I can let that slide. But when you go down the list and check off the boxes and it all fits and the person ends up suffering for more than half a year because you do nothing... well... yeah.

You were on 6-MP previously and it negatively affected your liver? What happened specifically?

My WBC was low so they asked me to halve the dose for two weeks, but once I went back on the full dose I kept feeling sicky/being sick - small amounts, shaky, dizzy fainting etc so because I had drug induced hepatitis with the azathioprine they decided to air on the side of caution and take me off the 6-MP.

The GI is hoping that because this time (well in 6 weeks) I'll only be on the 6-MP I won't get the low WBC and sickness/fainting problems. I really really hope so too, so fingers crossed

That rash (blurry in the photos) does look a lot like the rash my daughter experienced before being taken off of Remicade. Hers was eventually covering nearly her entire body. She was admitted to Infectious Disease in the hospital. Hers was described to me as a serum reaction, though, and if I recall correctly, I think I was told DIL was ruled out. So, maybe it's different.

Glad they caught up with it, sorry I'm late to the thread.

Thanks muppet. You're not late don't worry. I've just updated this thread linking to my other thread explaining what has happened since the summer. After having the rash in the first post I've had lots of different rashes and swellings over my body - mainly around the joints. In my other thread I linked to my picasa account showing some of the other rashes and joint swellings. I hope your daughter recovered quickly from the rash - having it almost covering her entire body can't have been comfortable. xx

Our doctors had no idea what it was. She was quarantined in hospital. When the rash spread to her scalp, her hair started to fall out, and she developed blisters on the soles of her feet.

Eventually a pharmacy student on the ID team found a journal article describing her exact predicament as an effect of a bad Remicade reaction. This was in 2009 so maybe it wasn't textbook yet?

Wow! poor love that sounds awfully painful. Hooray for the pharmacy student though - must have been fate that he came across that article just at the right time. I hope they were able to minimise the pain with meds. Did the drs not even question it being the remicade? How is she doing now? Did they find another med to control her disease without causing such awful reactions?

Well, firstly, I'm sorry, I didn't mean to hijack your thread.

Sarah is doing great right now, on a 6MP/Allopurinol combo and a very low dose of Prednisone.

The doctors were very reluctant to admit that it was the Remicade. I suspected it right from the get go (but of course I'd say that, right? )

Ah not at all, I'm interested in what has happened to Sarah I'm so glad she is doing great right now, must have been a really scary time for you all :hug:

Haha! these drs do seem to have a hard time admitting when they're wrong, and I don't doubt for one minute that you suspected the remicade. You know your daughter much better than any dr and would have noticed the adverse reaction, taken in all the possibilities and narrowed it down to the most probable cause straight away.

Hi Soybean. I read a lot of your posts.
...you say "It turns out the joint and skin problems I have been experiencing are caused by DIL from the Infliximab."
What is DIL?
My daughter is experiencing similar bumps (EN) and bumps and swelling (vasculitis) all mainly on her feet and lower legs. She is on Humira and we are wondering if it could be the cause.
Thanks.

DIL = Drug Induced Lupus

Ok, thanks David. She did have a blood test for lupus and it was negative. Is that how they would determine if it is DIL?

If she has an ANA panel, yes, that's one of the tests that they'll run. You can read about DIL here.

Saw the pic and I just wanted to add that I've got that exact same rash. Mine is usually on my shins but I had these well before any Crohn's diagnosis or meds. In fact I had them a full year. Went to the doctor once they started getting too itchy. Gave me some cream. didn't really help. It would make it lessen quickly but never disappear. Then like 1-2 weeks after taking the cream it would come back. Now that I'm on Humira it's there but doesn't progress past the slightly visual state. No more red raised itch fest.

From time to time before humira I would get these on my
Eye lids too.

Brandonz, thanks for your response. Did you ever have extreme swelling with the rash? Seems the rash can be controlled but her feet continue to swell. The only thing that helps are steroids. We are now trying to see if humira may be the cause and it's been 6 days since her last dose and also no steroids. Feet still swelling and painful. Calling doc today.

David said:

DIL = Drug Induced Lupus

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Hi Soybean,
I'm inclined to agree with David. I got a similar rash to that in response to mosquito bites, last summer in Egypt. I am still in the process of being diagnosed with Lupus (though I have antidsDNA (95% specific for systemic lupus),& +ve ANA). An abnormal reaction to insect bites is on the St Thomas' Hospital Alternative list for Lupus (not yet made the ARC list). Mine looked just like that.

Sorry if this is late. just found the thread.
But don't worry: drug-induced lupus usually resolves itself after the offending drug is removed.

juljul xx

edit:
I took photos, here is the reaction to a mosquito bite on my lower leg.

Thanks all. Turns out she has HSP (Henloch-Schonlein purpura). Been quite a ride with doctor after doctor and many tests, but a ped nephrologist is who really nailed it. So far so good with new med, Celcept(sp?). Has been off Humira for 3 months with no sign of intestinal flare or involvement right now. Lupus is mentioned a good bit but all her markers are negative. I feel we reached a pinnacle with this latest. Fingers crossed for success and easier road.