From Rash to Infection
Over the years I’ve contended with a recurring rash that appears periodically under my breast. It is one of those side effects of autoimmune disease and autoimmune suppressing medications. But my dermatologist has helped me manage it when it comes back with some antifungal cream followed by steroid cream.
Recently, my annoying habit of fighting rashes devolved into a full-blown health crisis. I had been treating my latest rash for a couple of weeks without much success and had decided to make a visit to the dermatologist when, over a weekend (why do health crises always start over a weekend?!), the rash spread quickly and aggressively to other areas of my skin. By Monday, my rashes were weeping from my ears, my breasts, and my belly. I was miserable.
Fear of the progressing rash
A visit to a physician’s assistant in urgent care resulted in a suggestion to see my dermatologist. He told me he was afraid to do anything because of my complex health history (I am scary!). But my rheumatologist returned my message the next morning and said: “Stop your biologic immediately and get to the emergency room.” His fear was an infection and how quickly it was spreading. My immune suppression could lead to an infection in my joint replacements (both hips and knees) or to a blood infection (sepsis). By that time I felt at risk — I felt terrible and nothing seemed to be stopping my symptoms from worsening.
I took the infection very seriously
I’m usually a person who takes drastic measures to avoid the hospital, but this time I packed a bag and rushed myself over there (with my husband). My rheumatologist called ahead and asked the emergency room doctors to admit me for treating the skin infection I had developed. They put me in a room and the next day, groups of doctors (it’s a teaching hospital) made visits to examine me and determine treatment. I saw teams from internal medicine (hospitalists), infectious disease, dermatology, and my own rheumatologist with a couple of his fellows.
The infection began to respond to treatment
After starting oral antifungal medications, it took less than a day for my infection to start improving. They also treated me with antifungal powder and an antibacterial fabric dressing to help keep the rashes dry.
I was thankful that my infection responded quickly and blood tests revealed nothing had spread further than the skin (as bad as that was itself!). Mysteriously, the cultures swabbed from the skin came up with nothing, but that may have been due to the antifungal cream I had been using before going to the hospital.
I was able to go home on the third day and continue treatment and follow up as an outpatient. I needed to stay away from people in case I was contagious, so I was able to work from home. But I also needed to be able to air my skin and treat it throughout the day.
After some time, it seemed like improvement slowed down
After a few days at home, I started getting nervous again because my improvement seemed to reach a standstill. I wasn’t so infectious, but I also wasn’t improving. They put me on five days of antibiotics just in case I had some bacteria to fight and also another week of antifungal. I was also finally able to see my dermatologist.
Seeking a different opinion for my rash experience
I recounted my health scare to my dermatologist and he immediately said that he thought I may have something completely different from what had previously been mentioned — inverse psoriasis. This was a surprise and had not come up before, even under all that scrutiny at the hospital! He said: “Let’s figure out what’s going on.” And I felt a huge sigh of relief.
Testing for other answers
The dermatologist took a couple of biopsies from the rash areas and sent them out for testing to determine if I had an infection, inverse psoriasis, some combination, or something else. I learned that inverse psoriasis is a skin inflammation that occurs in the folds of the skin (like under the breasts, armpits, and between the legs). Satellite spots can occur elsewhere, which explained these dots of dry rash in other areas of my skin. It can flare up after an infection (I had a slight ear infection before all of this happened), and it can get infectious when it is really bad (or incorrectly treated).
While the biopsy results would take 10-14 days to come back, the dermatologist said let’s get me started on some steroid creams in the meantime. Since the infection seems to have been treated, it was now good to treat the rashes.
I'm hoping whatever it is, it's manageable
I’m still waiting for the definitive answer, but it seems I have one by the fact that with just a few days of steroid cream treatment my rashes have almost disappeared. I’m so grateful to be feeling better, even though I’m frustrated to have another condition to monitor and worry over. I am hoping that with some vigilance, inverse psoriasis will be manageable for me.
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