Skin in the Game

I have a new dermatologist. It wasn’t really a choice. My previous dermatologist of many years passed away and the practice was sold. My records weren’t even in the system when I called to make my annual skin-check appointment. It was time for a change.

My PCP recommended a practice that has several physicians and is conveniently located to my gaggle of other doctors. Looking at their website, I was a bit hesitant because the doctors all looked young, blond and thin. This, I thought, is a group devoted to trophy wives and Botox. The Dallas area is consistently rated one of the most vain cities in the U.S. beating out cities such as Las Vegas and Miami. (I know, right? You should live here.) Looking a bit closer, however, I noticed that one of the doctors specialized in people with rheumatoid arthritis and other inflammatory conditions. It took me more than two months to get the first new-patient appointment, but I had my initial appointment last week with very positive results.

We don’t often think about it, but skin is the body’s largest organ. Besides a primary function as acting as a barrier (not to mention keeping our insides from falling out), it plays an important role in regulation (specifically body temperature via sweat and hair, and changes in peripheral circulation and fluid balance) and sensation (via an extensive and complex network of nerves). It’s not surprising, therefore, that a systemic disease like RA would affect our skin. Before being diagnosed and starting treatment for RA, I used to get these weird rashes every few months. Neither my dermatologist nor my allergist could figure them out, but prednisone would always clear them up. Now that I’m taking RA drugs, the rashes have disappeared.

Some examples of skin issues associated with RA are:

• Rheumatoid vasculitis that affect the vessels that carry blood to the skin, nerves and internal organs.
• Livedo Reticularis is a net-like “rash” that appears under the skin, usually more common on the legs, but can appear throughout the body. While historically not connected to RA, more and more physicians are using this condition as an indicator of RA and may list it as a co-morbidity.
• Direct skin conditions such as Psoriatic Arthritis that have similar symptoms and treatments as RA.

In addition, the treatments for RA may make your skin more vulnerable.  Many NSAIDs and some DMARDs may directly cause skin rashes or sun sensitivity.  Steroids and aspirin can cause easy bruising because they thin the skin or interfere with blood clotting. And long-term use of anti-TNF agents, some of the most widely used RA drugs, may increase the risk of skin cancers (as well as lymphoma). My new dermatologist tells me that while it was originally thought this risk diminishes or is eliminated when the drug is discontinued, there is a growing concern that this risk extends well beyond the use of the drug and may be a permanent issue.

So what to do?

Like anything else related to this disease, be smart. Know the risks and take as many precautions as you can. Be aware of changes in your skin; use sunscreen; talk to your rheumatologist about any concerns.  And importantly, go to a dermatologist for an all-over skin check at least once a year.

My good news? My check up (including a couple of biopsies) came back with a clean bill of health. (It’s nice getting good news from a doctor for a change!)