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Living with Psoriatic Arthritis (PsA)

Skin lesions


#1

Hello all, your collective wisdom required please.

I was sent to the dermatologist with small solar keratoses (erythemosquamous lesions) on my nose and chest. This was a flying visit, barely had I sat down when the derm attacked me with the cryo spray. Then I was bustled out, I just about managed to squeak ‘I’m on Humira …’ before the door was closed behind me. Efficient? Very. Adequate consultation? Probably not. I will have a follow-up appointment in 6 weeks time.

I haven’t consulted Dr Google till today. He tells me that these things can turn cancerous and that the risk is greater when on immunosuppressive treatment.

I did have a rheumy appointment on 5th December but cancelled it 'cos my son is having gene testing (and I may be required to, too) on 4th December to help identify which type of Ehlers Danlos Syndrome we have and I thought it best to take the results, if there are any, to my next rheumy visit. Now thinking I should contact the rheumatology department, perhaps, for their view on the skin issues.

As you can tell, I am having so much fun. Actually I really am! The PsA is being good as gold. Nature abhors a vacuum however. All and any responses or thoughts welcome.


#2

Hi Sybil,

Yeah, I’d probably get get another Rheum appointment not long after the skin follow up (with more details hopefully), that’s worth doing, for peace of mind at least.

The Rhuematologist will probably just say to go for skin checks more frequently, though they may also recommend / refer a derm with more experience in this, so that could be helpful.


#3

Hi Jen,

okay, good thinking. Next rheumy appointment should follow hot on the heels of dermatology follow-up, so that will work.


#4

Hi Sybil, I just had some frozen off two months ago and then had a 6 week followup. She is a great dermatologist and definitely in the know re biologics. She tells me to come whenever I am concerned… better to check it out she reckons then let it wait. Do what gets you feeling more comfortable.


#5

The same thingies?

I will definitely check out any other ‘thingies’ though they were soooo small … I could have more and not know it. Husband admits to being pathologically unobservant and thinks I should get a private derm appointment to check out all the places I cannot see.

I want a doctor to tell me whether Humira / Mtx increase the risk of cancerization. Just want to know or at least to get their views to weigh up.


#6

yeap same thingies. I don’t know the answer to your question but I do know my doc told me best to get them early and keep a close eye because I am on humira. I understood this to be in response to slightly increased risk. Living in OZ I was always going to be at risk.


#7

I know my doctor said there is a higher risk of skin cancer with biologics, though I’m not sure if it’s a theoretical risk (ie should happen), or an actual risk (ie does happen).

Cause we all know theoretically that damping part of our immune system should make us more susceptible to infections, but in practice, this doesn’t seem to be the case for many of us with things like the common cold (which I get less of).


#8

Thanks MacMac. Helps me to get an angle on things.

I might as well live in OZ from the sunshine point of view … ended up in one wee corner of the UK where summer definitely means summer! I clearly need to adjust!

All the best, hope the horrible thingies stay gone.


#9

Me neither as regards infections Jen. I’m not going to catastrophize, I’m just going to carry on digging around & thinking. GP gave me an urgent referral to dermatology and I need to know what’s what.


#10

Oh my word Sybil. I’m at a loss for words. Please know I’m thinking of you and your son. :purple_heart::purple_heart::purple_heart:


#11

Hey thanks kris!

Don’t worry, nothing too bad is happening at all. The EDS thing is just weird, I attended an appointment with my son and his rheumy ‘diagnosed’ me too! It can’t be an official dx 'cos I’m not her patient. Think it is safe to say that however EDS affects me, I’ve got it covered as I must have had it all my life. And my son who is more obviously affected is relieved to have something that explains his ongoing issues and which can be managed. We need testing as there are some rare and very nasty types but most people have the hypermobility type which isn’t such a disaster for many.

Skin things … they do give me the heebie-jeebies I admit. But there’s a good chance they will disappear now that they’ve been zapped. I’m just making sure I keep my thinking cap on and consider any risks at least.

I reckon a lot of us encounter ‘one-thing-after-another’ syndrome as the years go by. Bummer eh? But so far, so good or at least not too bad.


#12

It is amazing to me how many syndromes and diseases there are that I’ve never heard of. And yes, I know you and your son are grateful to at least have a name to what he’s been going through. It’s positively maddening to not know what is happening to your body and why it’s happening. Thankful it’s a milder form Sybil, and that you’ve had no symptoms. Geez Louise, it’s hard not to think “what next”?


#13

I hate when doctors do that, especially for dermatology. When I had melanoma, she missed it, it was as plain as the nose on my face…
AK’s just have to be managed like trimming a hedge, I have so many, I do a chemo cream every 4 months on my nose. I did have one on my now change to squamus cell carcanoma, about 8 years ago. But most of them just get either frozen off or hit with the cream. I go to the dermatologist every 3 months and get a full body skin check. I have low normal IgA and IgG, plus remicade infusions with MTX injections, it does increase the chances, probably from 2% up to 10%…
Hope that helps, good luck with it!


#14

Thanks Jon! Was hoping you’d reply as I know you have rather a lot of experience in this area. I find the above very reassuring.

If I get scared something happens to my brain & I go into ignore mode, it’s almost beyond my control. Needed to hear those breezy words! I’ll just make getting checked a routine thing from now on … nothing to worry about (“I’m like a hedge, I’m like a hedge”).


#15

As a side not fellow hedge, my Dermetologist will not remove the non precancerous “body barnicles”, these are a gentetic condion that leave raised brown spots on the skin, my old Derm used to freeze them with nitorgen, they come back after a year or two. I was threatening my doc, that I was going to get nitrogin from our gas supplier, (about $15 a pint) to freeze them myself, this persuaded her to freeze them.(as she felt threatened, I would take her work away)… I heard that dry ice works the same, though not as cold, so I am going to get a small block and selectivly break off small pieces and apply it with tweezers to my spots to remove, you just hold it on the spot for 10 seconds to freeze it. I am a industroius kind of guy, will use the rest to make ice cream! Not recommended for the general public as it is a little risky… They also have over the counter products for wart removing that use triclorethelene solvent for freezing spots.


#16

Are we talking seborrheic warts? I notice that one NHS site states ‘The term ‘senile wart’ has now been dropped as it offended many patients.’ I’ve got plenty of them too. I was told I could get them removed privately though not on the NHS who of course find it cheaper to remove offensive words than offensive barnacles. I don’t really mind them. I think slathering them with moisturiser may make them fall off eventually(?) But the ice cream route sounds more ‘fun’. Good luck with that!

Seems that knowing which blemishes to look out for is important. The barnacles look worse than the AKs yet are benign and I’ve always liked moles yet they do need a bit of vigilance. Senility is hard work.


#17

They look like this:


#18

Do they feel a bit crusty? That’s the main delightful feature of seborrheic warts I believe.


#19

Yes, that is what they are, the doccalled them seboratic keratosis…


#20

Indeed the same thing (I googled).

I know they’re not sinister, as you say. I’ve been blasé about sun exposure though. Last summer, my very brave neighbour died of skin cancer. Still I told myself that I was ‘safe’ as my skin’s not the fairest. I now know that even people of colour can get skin cancer so my slightly yellowy skin tone doesn’t make much difference if any. I’ve been an idiot. It’s so common … I’m thinking that any increase in risk factors, however slight, requires increased caution. Good thing is that prompt action works. Still not entirely sure about the dry ice! Let us know …