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Shirtless woman turned away from the viewer looking at a progressing timeline from a simple skin rash to a major skin infection

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Kimcoll1962
    1 month ago

    I am shocked! I’ve been dealing with these rashes for years! You won’t believe what I use to keep them at bay! Secret deodorant under my breasts, under my belly, in my leg creases, behind my ears! I had nooooo idea it was from PSA! I’m shocked! As long as I use the Secret I do not get any rashes. Keeping dry is the SECRET. Lol

  • Kelly Mack moderator author
    2 weeks ago

    Hi Kimcoll1962, Glad that helps! But you may want to see a dermatologist just in case and to have one handy in case you ever need one. Stay healthy! Best, Kelly (RheumatoidArthritis.net Team Member)

  • sbwilson64
    4 weeks ago

    I used deodorant for those areas too for a while. Unfortunately, my rashes started getting bigger and in more places. I stopped using the deodorant in those areas and the pain and breaking out had stopped. I cannot use deodorant on any place on my body anymore b you

  • Kathi Brill
    1 month ago

    Yikes I had the same problem the PA that saw me said I had a yeast infection from too much from cancer between my legs antibiotics, so a tummy flap because of countless surgeries is an ideal home for yeast to grow, under my breast arm pits and in my mouth. it was truly awful and painful. I ended up getting yeast meand I also had anti yeast powder. it took 2 weeks and it was gone. not something I want so I have cheap washclothes that I put under the tummy flap and boobs following a shower.
    ds for 7 days cream and a 3 day package of medication for yeast I rubbed in the cream

  • Kelly Mack moderator author
    2 weeks ago

    Sorry to hear about your skin infections Kathi! Sounds all too familiar! But glad that the treatment worked. One tip I got that works well is to fold up lactation pads and put them under my breasts before putting on my bra. Helps to keep my skin happier! Best, Kelly (RheumatoidArthritis.net Team Member)

  • Grand-moogi
    1 month ago

    I get that lichen planus but it is in the mouth, It is like a mouthful of ulcers. Auto immune thing exacerbated by Methotrexate. I am on Enbrel and I don’t think it impacts. I take lots of folate to counteract it which it almost does.

  • Kelly Mack moderator author
    2 weeks ago

    Hi Grand-moogi, Glad you have figured out the cause and a way to make it better. That is always good to hear! Best, Kelly (RheumatoidArthritis.net Team Member)

  • MrsT
    1 month ago

    I have issues with rashes and hives all these years but its never gotten that bad. I’m sorry you had to deal with that!

  • Kelly Mack moderator author
    2 weeks ago

    Thanks MrsT! Sorry to hear about your rashes and hives. Hope you are doing OK. Best, Kelly (RheumatoidArthritis.net Team Member)

  • sradoll
    1 month ago

    Kelly, this sounds horrible! I’m so glad you are on your way to finding out what this (latest) medical issue might be. Thank you for sharing your story.

  • Kelly Mack moderator author
    2 weeks ago

    Thanks sradoll! Really appreciate your support and am happy to report that I’m doing better. Best, Kelly (RheumatoidArthritis.net Team Member)

  • btcavanaugh1720
    1 month ago

    I have had an itchy painful face for 3+ months. I met with my GP (steroid cream), dermatologist twice (2 different antifungals) and my rheumatologist (a very expensive sunscreen). The antifungals helped 75% but the medicine hurt my skin so much that after a month’s use (pharmacist) I discontinued. It’s a relief to hear that others have had similar skin problems and I’m meeting with the dermatologist again in a week. I will discuss the various things y’all have learned and hope she comes up with a solution. Oh, and it’s been the hottest summer maybe ever here. Not good for itchy skin. Rheumatologist did not recommend omitting my Actemra infusion for a month although I have thought about it! Grateful to have this community of fellow warriors.

  • Kelly Mack moderator author
    2 weeks ago

    Hi btcavanaugh1720, Sorry to hear about your skin issues. It is really frustrating! Unfortunately I have also experienced that the antifungals can irritate my skin as much as the rash. Blah! Makes it hard to know what to do. I also found that I needed to try things and make repeated visits to figure out what worked for me. Hang in there! Best, Kelly (RheumatoidArthritis.net Team Member)

  • JoanneB
    1 month ago

    Hi Kelly. So interesting to read this. I have just experienced similar rash under my breasts. Went to rheumy who sent me to dermatologist. Did biopsy which came back ‘probable Licens planus”. That is an autoimmune rash. Its taken 3 months and several diff creams to finally go away. I’ve been off my Enbrel for 2 months and am hesitant to begin it again. But, I guess I need to try to see if it returns. Its very scary that so many people have these rash issues which can, like yours, become very serious. Glad you are doing better!

  • Kelly Mack moderator author
    2 weeks ago

    Thanks so much JoanneB! Yes, these rashes can be very scary and uncomfortable. Glad you got treated and your rashes cleared up. I can say now after a couple months that monitoring and treating rash signs promptly have kept things at bay. I was also afraid to restart by biologic, but it has been OK. Hope you are hanging in there! Best, Kelly (RheumatoidArthritis.net Team Member)

  • littlewing
    1 month ago

    Hi Kelly! I’ve been having an identical problem with my, what I call, “creases”. Mine are usually behind my ears, sides of my neck, under the breasts and tummy. But on a hot night I’ve even woken up with a rash on the crook of my elbow! I’ve used every antifungal cream they offered for up to two months before, at best they just keep it tamped down and I hate the gooey feeling. I had the idea this summer to ask my GP for me to try ketoconazole shampoo (prescription strength 2%) to try washing the crease areas with, in the same manner as one would use it on the scalp. It cleared the rashes quite quickly and easily, and no gooey cream 3 times a day. Just have use it twice a week. I still do get the satellite patches here and there, in places that are open to the air, but those aren’t as often or as annoying (and smelly) as the crease rashes. I’ve just had such success I wanted to share in case it might help someone else!

  • Richard Faust moderator
    1 month ago

    Thank you for writing littlewing. I happen to be Kelly’s husband. Ahh, ketoconazole, that sounds familiar, but never thought about the shampoo. Her biopsy did come back positive for inverse psoriasis (if is a rare form of psoriasis that affects only about 3 to 7% of those with psoriasis). Don’t know if you have spoken to a dermatologist about getting a definitive diagnosis for what you have. Wishing you the best. Richard (RheumatoidArthritis.net Team)

  • Daniel Malito moderator
    2 months ago

    @kelly God, I know that dance. Not the rash part, but the having so many doctors in and out of your hospital room you think you are hosting a one-person medical conference. It’s not as if they don’t make it totally obvious that they are on the “take a look at room 302 that’s something you won’t see everyday” magical mystery tour. I’ve even had medical students say to me things like “wow, I could write a paper on you. Err, I mean this.” Yeah, ya could. LOL Keep on keepin’ on, Kelly. DPM

  • Kelly Mack moderator author
    1 month ago

    Thanks Daniel! 🙂

  • Richard Faust moderator
    1 month ago

    Hey Daniel. My favorite was the medical student who showed up in full hazmat gear. I could certainly put up with the tour. The problem was the one person who could have done something on the actual diagnosis, the dermatologist, came in for about one minute and never looked close enough to see the inverse psoriasis – I literally missed his visit because I went downstairs to pick up an iced tea to bring back to the room. The biopsy her regular dermy did for it came back positive and the treatment seems to be holding it at bay.

  • Lawrence 'rick' Phillips moderator
    2 months ago

    I also hope it is manageable. I know my skin is so sensitive these days. for years I had a rash that would come up on my legs. It never went away and then out of the blue it went away. Now it is other patches on my skin that get red, inflamed and itchy then goes away.
    My dermatologist calls me his enigma patient. I just tell him I used to be a red head with a million freckles and a passion for the sun. Yeah, then he calls it something else.

    Or that something else he calls me. 🙂

    rick

  • Kelly Mack moderator author
    1 month ago

    Ha ha! Hang in there Rick! We sure get to be the strange patients, don’t we? At least we are always interesting! 🙂 -Kelly

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