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Weird Skin Issues on Steroids? (Actinic Purpura)

Weird Skin Issues on Steroids? (Actinic Purpura)

Protecting Your Skin from Steroid Damage

Steroids like prednisone can cause weird skin issues over time. In this article, find out how using prednisone can cause thin and easily bruised skin, skin tears, and other damaging side effects. Next discover ways in which these skin issues may be managed and prevented, such as wearing protective clothing, using topical creams, and supplementing with collagen.

Watch now!

Transcription autogenerated from the video above so some errors are possible.

Prednisone can make you feel so strange, like a ghost on Halloween. A ghost has no skin and prednisone and other steroids mess with skin. I’m going to tell you the story of my aunt and her skin today because it shows so many things that are so sad about prednisone. They’re just heartbreaking.

Spoiler alert at the end, she was misdiagnosed. But in the process of her misdiagnosis, she was given prednisone, methylprednisolone (Medrol dosepak), and Breo Ellipta, the inhaled corticosteroid. She actually took it for a whole year, even though she didn’t actually have any breathing problems. They told her she had breathing problems and she doesn’t actually have that.

The Consequence of Steroid Exposure

What is the consequence of that much exposure to steroids, especially when you don’t need them? Right after stopping the Breo Ellipta, this started happening to her; her skin just tears and it’s really terrible. She got lesions and they’re called purpura lesions. There are several times types of purpura.

There are actinic purpura, purpura lesions from steroids.

(And my diagnosis is actually idiopathic thrombocytopenia purpura, ITP. I had this bullseye on my arm that color purpura.)

immune thrombocytopenia purpura ITP
A purple-colored painless lesion on my arm called purpura, the “P” in ITP, indicating internal bleeding.

Purpura is a medical term for a purple colored lesion on your arm where there’s something weird going on with the bleeding, but the skin isn’t doing the proper thing in keeping the blood below the skin.

There are red blood cells infiltrating into the dermis layer and leaving a lesion and she got lesions all over her forearm and wrist. She says only on the top of her forearms and that even just a tiny bump will tear the skin like a paper. This is underneath the band-aid and it’s takes forever to heal. The ones on her hand, heal in about a week, but the ones on her forearm take about three weeks to a month to heal.
Actinic Purpura steroid induced, weirdness on skin, what is going on?

Why is this happening?

She said steroids can cause the skin of the forearms to bruise and tear easily. If taken when older, it’s called actinic purpura and has no cure. She has to wear long sleeves for the rest of her life and bruising and tearing can happen even through the sleeves.

And then, she said the ones on her hands go away in a week, and on the forearm to take a month. But what’s interesting is on the underside of her arms, she doesn’t get any of that. The underside or other parts of the body, just the forearms that were exposed to ultraviolet UV rays when younger, her dermatologist told her it was caused by the Breo. She said she had no bruising at all until she stopped taking the Breo inhaler.

She said;

I’m not a sun worshipper, but I have never spent my life covering my arms with sunscreen since I’ve always had more olive skin.

She’s so mad at her misdiagnosis. She had severe pain in her back and they thought maybe it was some breathing issue or they couldn’t figure it out.

Finally, after over a year, tons of doctors, test after test, after test, one of them finally said, let’s do a swallow test on you. Let’s just see what happens when you swallow. And this is what happened.

She had this hernia that her stomach was being constricted. And her esophagus was being constricted. That’s the reason why she has an incredible pain in the area, she was told it was all in her head. She was told she was making it up and maybe just go get onto the anti-depressants or something. She’d had to use pain medication just to get through the day.

Well, when they finally went and fixed this, she didn’t need any more pain medication and it wasn’t in her head.

How many of you felt that way?

She’s not the only person who feels this way. So if this is happening to you, you can know you’re not the only one. I’ve had several people reach out to me recently and they said;

I had TKI or ruptured blood vessels on my forearm. And it goes away in a few weeks.

My hair is also falling out and is now very thin as well. My skin is so thin that all I have to do is rub something or scratch an itch. I get red spots or the blood pools under the skin. My arms usually look like I’ve been in a fight, your choices, which is the worst one.

The capillary superficial reality is something you don’t mention but it’s one side effect like moon face that is visible to others. My understanding is that it doesn’t go away after cessation.

My skin comes off with band-aids. I can actually pull my skin off with my fingers. The sores are easy to get infected and difficult to heal even though I am not a diabetic.

My skin is now so thin. I am covered in stretch marks.

My skin is like paper.

Thinning skin on her lower legs, cuts and bruises, et cetera.

It makes me bruise easily.

Another Prednisone Warrior asked about a flat purple mark on her arm and this is what I said in a video for her:

I have noticed a small flat purple mark on my arm. I have been taken prednisone since March 2022 could this be a side effect?

So this is not uncommon and I was surprised at how many people mentioned it. I personally had a really hard time telling whether it was the prednisone or my disease causing me to have weird skin issues because my disease actually does cause the purpura and weird bruising. And so I had it too, but I couldn’t tell you if it was the prednisone or my disease. It scared me every time I would get a weird bruise or little red dots called petechiae. I didn’t know if my disease was coming back and I’d have to go and get another blood test and do a whole another rollercoaster for a steroid medication.

This always terrified me when it happened to me because I have a bleeding disorder, an autoimmune condition. But for most people, it’s not anything worse than itself. It’s painful, not pretty, and uncomfortable. But it didn’t mean anything else, it meant that I was bleeding inside.

Whereas for the people who it’s just on your arms, hands, maybe your face or neck area, places that have had a lot of UV light, some exposure throughout your life, then it’s not. It doesn’t have any long-term consequences for you. And so for you, at least it’s just cosmetic and painful. You don’t need to go get a blood test necessarily like I did.

How does this even happen?

How does prednisone do this? Prednisone causes not only osteoporosis, where your bones are thin and calcium, collagen, magnesium, and vitamin D are being leached from the bone and it has more holes. It’s not as strong as it was, the lattice structure, holding your bones up. Instead it has more holes or pores; that’s what -porosis means.

What’s interesting is collagen is the latticework structure in your bones and it’s also the last restructure on your skin. What they found is that when prednisone is caught collagen that is causing things to fall apart.

This directly straight from a scientific article published in PubMed about Actinic Purpura;

Dermatoporosis: skin fragility and skin atrophy.
Skin atrophy in dermatoporosis is due to an alteration of collagen. These collagen changes may correspond to changes in bone density similar to that seen in osteoporosis. It postulates that bone collagen also changes along with skin collagen, which leads to alteration in bone density. The pronounced skin atrophy caused by the photo-aging and ultraviolet radiation exposure makes the dermal vascular network very sensitive to the slightest trauma or any shearing force.

So let me translate that into English instead of medicalese. This is caused because normally there’s a really strong structure holding your bones and your skin together. Collagen is the main thing doing this. Prednisone is breaking down the collagen connection.

Somehow, we’re not sure how, whether it’s depleting your protein in your body, whether it is depleting the actual collagen, or there’s some connector in the collagen area. There’s not great research showing precisely why it’s happening. But prednisone does steal from your skin, bones, kidneys, liver, or everything, and makes you waste away.

Why does this happen?

Prednisone is doing this for a reason. It’s because it’s using all of those ingredients, those important things in your body, and using them to save your life. To turn off the inflammation, to stop the pain, to whatever it’s doing for you. It’s doing so by stealing from other systems.

What can you do about it?

One of those systems, unfortunately, is the skin. So now that you know what other people describe it as, now that you know how potentially it’s happening… What can you possibly do about it? Again, there’s not a lot of great research here. So I’ll tell you what my aunt said she’s doing. So my aunt said she uses DerMend along with Arnica.

She says it doesn’t necessarily do much to help, but it helps with bruises apparently. So maybe that helps and maybe it doesn’t. And then Arnica is another cream that she uses that might be helping potentially.

Other things that have been theorized to help include tretinoin or retinoic acid creams. So it’s a prescription strength cream based on vitamin A and it’s been shown that it potentially can help build back up the collagen.

Maybe there’s just not great research for protecting against those skin tears. My aunt wears protective sleeves and you can find them online. She says she has to wear them all the time. Doesn’t matter whether it’s hot outside, if she doesn’t wear them, she can get skin tears so you can get protective sleeves and she wears them underneath her other clothing.

Then since this is based on collagen, theoretically to me, it would make sense to supplement with collagen. Collagen is the main ingredient in bone broth. So if you were to eat lots of good chicken noodle soup made from actually like stewing that bone from a good pasture, raised chicken or from a great cow that’s grass-fed, getting good high quality collagen from a really good bone broth. That makes sense to me if collagen isn’t working well, let’s give some good collagens, right? You can check out this link to the collagen and bone broths I recommend.

Read more about Collagen: Weird Skin Issues on Steroids? (Actinic Purpura)

The best treatment is always prevention. So for everyone out there who hasn’t had this happen yet, this is why we wear sunscreen. This is why we wear long sleeves. So that consequences like this can’t happen later in life.

Who might experience this?

This can happen in just older people too. But for older people who are also prescribed steroids, that’s when it happens even more.

They say 12% of people over the age of 50 have it, 30% of people over the age of 65, get some sort of purpura lesions on their skin. So this happens way too often and it’s sad. For some people, it’s just a part of aging. But for those who are taking steroids, it isn’t just aging because essentially prednisone is aging you faster, right?

So if you have something that you found helpful for skin tearing, for steroid-induced purpura, or for other weird, thin skin issues from prednisone or other steroids, please comment below what you find helpful to help all of those suffering like me and my aunts. So I am Dr. Megan, your Prednisone Pharmacist, and I am here to not just help you survive prednisone, but find ways to thrive while on prednisone.

Dr. Megan Milne, PharmD, BCACP

Dr. Megan Milne, PharmD, BCACP, is an award-winning clinical pharmacist board certified in the types of conditions people take prednisone for. Dr. Megan had to take prednisone herself for an autoimmune condition so understands what it feels like to suffer prednisone side effects and made it her mission to counteract them as the Prednisone Pharmacist.

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