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Prednisolone - side effects - bruising/thin skin

Posted , 25 users are following.

Guest
Guest

Hello again -

I have been treated for PMA and Temporal arteritis since last January and am currently on 7 mg/day of prednisolone with a view to trying to reduce 1mg every 4 weeks as suggested by the rheumatologist. I am 71.

At present the worst side effect for me has been easy bruising and thinning of the skin. The slightest bump or friction on shins and arms produces dark purple bruises due to subcutaneous bleeding. Also - even a mild scrape (eg from a cardboard label on trousers which I was trying on in a shop) can cause the skin to break and bleed. My rheumatologist tells me that this will improve as I reduce the dose but this does not seem to be happening. What are other people's experiences of this? Do I have to get down to a much lower dose before I see an improvement or will this problem persist even when I (hopefully) manage to come off the steroids?

I would be grateful to know what other people think.

Purple cat.

3 likes, 68 replies

68 Replies

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  • terry60219
    terry60219 Guest

    Posted

    Thank you to all of the above contributors. It is comforting to know I am not the only person in the boat.

    After months of misdiagnosis it was confirmed I had GCA in July this year. 

    My CRP was 166 and I was getting white explosions in my right eye as well as all the other symptoms.I was told I would be blind.

    I was given 100 mg. in hospital and after three days released on 90 mg. which has been reduced down to currently 20 (Dec.)

    As well as the prednisone I was taking Bactrim,somac,fosamax and calcium to offset the side effects.

    regulare blood tests showed the CRP had dropped to less than zero until I go to down to 25 and it was  showing at 1.

    I have retained my sight. so far  . I can put up with the lack of sleep , chubby cheeks and aching legs but the continued shin skin tears/bleeds has Brenner driving me crazy . Even taking off adhesive bandaids brings skin off if not done carefully. 

    Seems from above its going to be a long haul but if it keeps my sight what the hell . . BTW I am 74.

    Terry

    • lodgerUK_NE
      lodgerUK_NE terry60219

      Posted

      Terry

      Your GP can prescribe Double Base Gel.  It was recommended to me by another GCA person and it tried it and it helped.   So when the GCA went into remission I still use it.  It can be bought over the counter as well.

      I also use arnica cream and tablets.   The tablets only when I had checked with the Pharmacist that they were OK with the current meds I was taking.   The cream, all the time for the unexplained bruises.  Still use both and the tablets, in particular helped get rid of bruising when I had an op.

      When you listed the 'just in cases'  I noticed Fosomax (bone protection). Have you had a Dexa Scan to see if you really need this.  You may well not need it at all.   I also was given Calcium as a just in case and then ran into problems with excess Calcium.  I suggest you ask for both be to be tested and see if you really do need to take them.

      Never heard of Bactrim and somac, what are they for please?

       

    • EileenH
      EileenH lodgerUK_NE

      Posted

      Bactrim is trimethoprim/sulfamethoxazole, also known as co-trimoxazole among other names, and is an antibiotic used to treat a variety of bacterial infections.

      Somac is pantoprazole - a PPI like omeprazole.

      I can see the logic of the Somac - but not the Bactrim. Why is that being used?

    • EileenH
      EileenH terry60219

      Posted

      I hope they are keeping a close eye on the CRP - if it had reappeared on the scale at 25mg it may be a sign you are at the limit of lowering your dose for the moment and not all inflammation is being combatted.
    • lodgerUK_NE
      lodgerUK_NE EileenH

      Posted

      Eileen

      Ta muchly.

      I do sort of worry about these 'just in cases' and they were both new ones on me.

      Speak soon, when I catch my breath.

    • sandy08116
      sandy08116 terry60219

      Posted

      I was misdiagnosed as well. GP thought it was TIA (sort of stroke). Thankfully another sent me for tests and GCA was quickly diagnosed and prednisone started immediately which saved my sight. I also had visual auras. 

      BTW - I am 75. Haha

    • terry60219
      terry60219 sandy08116

      Posted

      There must be something about being 74/5 and describing symptoms.

      I was given mri,s of cervical spine, brain a Doppler of carotid artery and even suggested I have mental counselling. It was only when I sat the doc down and told him to listen while I read out all my symptoms that he rushed me off for blood test. Just as well I am not a litigious sort of person.

      Such if life .

    • EileenH
      EileenH terry60219

      Posted

      Since a lot of doctors insist you can't have PMR/GCA under the age of 70 (yes you can. they are TOTALLY wrong) you would think they might bear it in mind wouldn't you?

  • terry60219
    terry60219 Guest

    Posted

    I was prescribed the Somac and Bactrim ds  (1/2 tab three times pw) when I was on 90 mg.a day and taken off at  35. I cannot remember why i was given the Bactrim. I did have an artery removed from the scalp for pathology and put back two days before.

    The fosomax was prescribed following a bone density test when was down to fifty mg.

    i was having blood tests fortnightly down to 35 mg. Now monthly.

    My next appointment is with rheumatology on Monday will ask about the gel .

     

  • terry60219
    terry60219 Guest

    Posted

    Please excuse my short hand replies. My iPad screen popped off and after putting back on the iPad had a mind of its own. My initial crp was 116 not 166..

    IT may be of interest that the research dept at the hospital I attend has taken blood before and after me taking the prednisone as part of their research to come up with an accurate  flag in the blood for the prescribing of the correct dosage of prednisone . From what i understood it is currently a bit trial and error .

     

  • terry60219
    terry60219 Guest

    Posted

    Sorry ,my iPad closed down. The flag or biomarker is called thrombospondin one
    • EileenH
      EileenH terry60219

      Posted

      I suppose it depends what you regard as trial and error in GCA/PMR. They give a dose that is going to be at least enough to reduce the inflammation for most people and then reduce to find the correct dose. It is called titration - it is not trial and error! It takes into account the difference in bioavailability between patients.

      I understand the work on thrombospondin1 to be more related to taking the trial and error out of assessing dosage in corticosteroid replacement therapy - which is a different aspect of use of corticosteroids. 

      It is very unusual for an antibiotic to be given for the TAB - and they don't replace the artery, they don't usually even anastomose it (join the ends together) as its role is taken over by adjacent arteries. I assume your TAB was positive for GCA?

  • terry60219
    terry60219 Guest

    Posted

    My goodness my terminology is not as it should have been.

    In regard to my artery in layman terms two days after admission I was wheeled into surgery and a opthalmology surgeon gave me a local on the  right side of my temple ,took out 5 cms of my artery, sent to pathology ,chatted about nothing until it was returned and replaced it ie. sewed it back in. Part of his idle chatter was to explain that it did not really matter if it could not be replaced. I understand that because of the high readings they wanted to know how bad the arteries had been affected.

    The hit and miss is my terminology not the hospitalsalthough I believe it is about right insofar as it seems the dosage is reduced until there is a reaction then mucked around with until the correct  level is reached..The eight page document sent to

    me quotes in part “there is no test that can help guide a doctor to fine tune the correct dose of glucocorticoid in people who have a variety of medical problems including people taking glucocorticoid medications . In this study we wish to measure thrombospondin...to see if the thrombospondin level is altered compared to healthy people..People taking gluc....medications like prednisone.... often get side effects. We want to see if we can find a marker to help guide doctors regarding the right dose to prescribe.we have also found that the white blood cells have a special pattern of steroid receptor which will help us understand how these medications work. The research has been initiated by the investigator ,Associate Professor Warwick Inder and funded by the Princess Alexandra Hospital Research Foundation and SERTA. “

    I am sorry being a not medical person I do not know what TAB is.

    The care given to me by the hospital has been fantastic .

     

    • EileenH
      EileenH terry60219

      Posted

      TAB is temporal artery biopsy. I have to say - that is a technique I have never come across. Obviously the Australian health system has lots of time!

      And how very interesting - I look forward to what they discover!

    • terry60219
      terry60219 EileenH

      Posted

      G’Day,

      I attended Rheumatology today and my crp is less than 2.

      TheBactrim was administered to me to guard against pneumonia and influenza as it was the height of the flu season ,I was on very high dosages and as you well know prednisone is a suppressent of the immune system.

      I also had to catch a few planes back in Sept.

      The TAB confirmed eGCA and that my arteries are somewhat fibrous.

      Ha,I don’t know about the health system having lots of time but it is one of the best and appearantly the PA Hospital is of the highest standard. Actually I am now wondering why I am In top private health cover 

      when the public system has been so great free .

      thanks

    • EileenH
      EileenH terry60219

      Posted

      Yes - I gather from a top PMR rheumy in the UK that giving Bactrim to patients with ANCA vasculitis has become standard - but she hadn't come across it for GCA where only pred is used as opposed to the other immunosuppressants used in ANCA vasculitis. The evidence I have seen over the last 8 years with pred for PMR and GCA is that it doesn't suppress the immune system half as much as it is said!

      In the UK if you were in a private healthcare system and dx'd with GCA, it's pretty likely the premium would either shoot up to unaffordable levels at the next renewal or they'd exclude the GCA and associated events from cover. And it is surprising what they can decide is associated with GCA!

    • terry60219
      terry60219 EileenH

      Posted

      Actually my doctor asked me why I had been prescribed the Bactrim at the time .

      whether it helped or not I don’t know but at least I was able to fly a number of times and not   end up with any nasties. I was paranoid about being in close proximity to children.

      my Goodness it would be pointless having private health if they did that .

      i have also had a davinci robotic prostatectomy .the cost was $36,000 aud

      of which I was out of pocket $11000.

       

    • EileenH
      EileenH terry60219

      Posted

      It is one of the problems of private insurance for pre-existing conditions and why single payer funded insurance is so important for many many peopl.

      My husband has recently had radiotherapy for prostate ca - didn't fancy surgery and its potential side effects. He had next to no side effects other than fatigue (welcome to my world!) and a bit of cystitis which resolved quickly once the r/t was finished. How was the robotic procedure? 

    • terry60219
      terry60219 EileenH

      Posted

      I’m glad I had it. I was given the choice of treat and watch or have it out.

      I elected for the extraction by robotic surgery as I did not want it hanging over my head.

      Went in Sat. Afternoon and home Monday morning . Playing  golf after 6 weeks.

      subsequent pathology of the prostate showed the Gleeson score to be higher than initial biopsy showed. Dodged a bullet 

      No side effects at all but I did follow to the letter what I was told for pre and post.

    • EileenH
      EileenH terry60219

      Posted

      Yes, he was offered "wait and see". I suspect that it is very common for the Gleason score to be higher than found at biopsy - and usually there is a limit for surgery to be approved. As a medical physicist/physiologist he had a load of colleagues to ask about it and none of them were scared of r/t (he'd had it before 23 years ago anyway) and one told me there is to be a paper published soon showing that, in general, surgery is not a good choice. And the cure rates are the same whatever approach you choose in early tumours.

    • terry60219
      terry60219

      Posted

      I had no symptoms whatsoever aside from high psa . My doctor got me into a trial of using an mri to detect cancer of prostate and biopsy using mri and low and behold the rest is history.
    • EileenH
      EileenH terry60219

      Posted

      His psa wasn't even particularly high, just raised but rose over a period of 3 months between the first and the urology appointment. He had the biopsy first and then the MRI - I told him about the studies that the MRI should be used before the biopsy but he isn't as proactive as me in asking about stuff. But as you say - hopefully this second brush with cancer is now history. 

    • terry60219
      terry60219 EileenH

      Posted

      There is no way i would have had other than davinci surgery. This was in 2013 and biannual blood tests have shown no reoccurrence.

      I have read all the pros and cons and the bottom line,for me anyway was that I don’t have think about anymore.

      The adage “die with it not from it “ does not take into account quality of life.A golfing friend of mine had radiotherapy for it 11 years ago and still suffers with terrible side effects and has the threat it may come back.

      No doubt procedures have improved.

      I found this out after my op.

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