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Author Topic: Skin Issues after starting treatment  (Read 3232 times)

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Offline Zohar

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Skin Issues after starting treatment
« on: May 23, 2010, 06:48:10 AM »
I've been on Nevirapine (viramune)/Truvada for nearly two months and I'm having some skin problems. I've developed an itchy rash on my  biceps, back of my neck, and odd hive-type lumps on my trunk. I've been using an antihistimine to take down the itch but it doesnt work very well and I'm scratching myself to death some of the time. I'm wondering if this could be urticaria as it seems to match the symptoms I've read online, but I never suffered from it before........?

I've also noticed that my skin all over and on my face  has become VERY dry  - almost like parchment - and no matter how much moisturiser I use, it doesn't really make a difference. It's as if I suddenly have lots of noticeable wrinkles when I move my face. On my forehead, the top layer of skin is cracking and, eventually flakes off. but it's not sore, or itchy.

And lastly the skin on my face just seems sort of 'blotchy' now - sort of random lighter and dark areas, a bit like how you can look up if you've been up drinking all night.

I'm becoming really self conscious because people have always commented on how nice my skin is, and now it's looking like hell. Other than seeing my doc, any suggestions on how to deal with any of  this?
''Poor is the man whose pleasures depend on the permission of another.''

Offline Ann

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Re: Skin Issues after starting treatment
« Reply #1 on: May 23, 2010, 11:31:08 AM »
Rash is the most common side-effect of Viramune and that is the likely cause. The rash can come on at any time during the first few months. It should go away within a week or so.

The dry skin you're experiencing could have been a precursor to the rash and hopefully will also resolve in time. I have very sensitive skin - always have - and it being unusually dry is often what alerts me to an up-coming problem, like a rash.

At the end of the day, any time something like this comes up the best course of action is to get in touch with your doctor. You won't necessarily have to go in for an appointment as this type of thing can often be dealt with over the phone and prescriptions phoned in to your pharmacy.

A good rule of thumb is: When in doubt, call the doctor. Better safe than sorry, eh?

You might want to read through the drug information pages that deal with the meds you're taking.

Good luck and keep us posted.

Ann


edited to fix dodgy linkage
« Last Edit: May 23, 2010, 11:35:07 AM by Ann »
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline peteb

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Re: Skin Issues after starting treatment
« Reply #2 on: May 23, 2010, 11:35:52 AM »
I had really dry skin esp. on my face I use Hydrocortisone cream 1 % it really made it much better it also helps with the itch
Pete

Offline Zohar

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Re: Skin Issues after starting treatment
« Reply #3 on: May 23, 2010, 01:01:18 PM »
I had really dry skin esp. on my face I use Hydrocortisone cream 1 % it really made it much better it also helps with the itch
Pete

Do you use the Hydrocortisone cream all over your face like a moisturiser, or just on the speciific areas?
I'd heard that you need to be careful with these creams as they can thin your skin...
''Poor is the man whose pleasures depend on the permission of another.''

Offline Billy B

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Re: Skin Issues after starting treatment
« Reply #4 on: May 23, 2010, 01:44:13 PM »
Hello Zohar - When I started my meds (Isentress & Truvada) the skin on my nose and cheeks got a little dry and flaky. I used Cortizone 10 Intensive Healing Lotion for Eczema and Dry Skin. It is in a red tube and worked miracles. It only takes a very thin layer of it to work. Also, I use CeraVe hydrating cleaner for my face and body. It is cheap, soapless and works. My Dermo recommended the mentioned products and he was correct in my case.
Peace,
Billy
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline mecch

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Re: Skin Issues after starting treatment
« Reply #5 on: May 23, 2010, 01:49:46 PM »
Dry skin from the scalp, then the face, then the torso, can happen in early months of HAART due to IRIS - Immune Reconstitution Inflammation Syndrome.  
It might be independent of a rash that could be caused by an allergy to your HAART medicine.
In both cases, the ID doctor and maybe a dermatologist should be able to sort out possible causes and be helpful with possible treatments.  

My scalp and face peeled pretty badly but the bonus was soft skin when it was over - oh yeah, and OF COURSE - a reconstituted immune system.  

On the other hand, rashes plaque me off and on since I started HAART but the doctor and dermatologist seem to come up with ways to diminish these and make it all bearable.  

Good luck.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Zohar

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Re: Skin Issues after starting treatment
« Reply #6 on: May 23, 2010, 02:00:56 PM »
Thanks for these replies, guys. I was being unrealistic perhaps when I expected to feel great a couple of months into the treatment, when the truth is, I actually feel lousy and look even worse. I've just noticed that the skin on my ears is now very dry and a bit itchy and really flaking off. I look like a freak. :-(

Are skin issues that are triggered by IRIS something you have to live with iforever/indefinitely, or do they calm down in time?
''Poor is the man whose pleasures depend on the permission of another.''

Offline peteb

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Re: Skin Issues after starting treatment
« Reply #7 on: May 23, 2010, 02:31:04 PM »
I use a thin coat all over my face
my arms ,back, neck, this really helped me

Offline Ann

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Re: Skin Issues after starting treatment
« Reply #8 on: May 23, 2010, 02:44:13 PM »
Zohar, again, people who start treatment with numbers as low as yours often feel worse before they feel better. But they do indeed, for the majority, feel better in time.

ALL this stuff should - and likely will - calm down in time. Try to be patient. I know that's easier said than done, but you're on the right track.
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Zohar

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Re: Skin Issues after starting treatment
« Reply #9 on: May 23, 2010, 03:38:14 PM »
I've just been reading up on hydrocortisone cream and apparently it should only be used as a last resort, as it will thin the skin and cause permanent damage.
''Poor is the man whose pleasures depend on the permission of another.''

Offline northernguy

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Re: Skin Issues after starting treatment
« Reply #10 on: May 23, 2010, 05:52:32 PM »
I've just been reading up on hydrocortisone cream and apparently it should only be used as a last resort, as it will thin the skin and cause permanent damage.

You're right one does need to be careful with cortisone on the face, make sure to consult with your doctor thoroughly if you use it.  Among issues to watch for are skin-thinning as you mentioned, steroid-induced rosacea and using it too close to the eyes.

Your skin issues sound a lot like mine, but mine were present even before meds.   Did you have any skin troubles at any point after seroconverting?
Apr 28/06 cd4 600 vl 10,600 cd% 25
Nov 8/09 cd4 510 vl 49,5000 cd% 16
Jan 16/10 cd4 660 vl 54,309 cd% 16
Feb 17/10 Started Atripla
Mar 7/10 cd4 710 vl 1,076 cd% 21
Apr 18/10 cd4 920 vl 268 cd% 28
Jun 19/10 cd4 450 vl 60 cd% 25
Aug 15/10 cd4 680 vl 205 cd% 27
Apr 3/11 cd4 780 vl <40 cd% 30
Jul 17/11 cd4 960 vl <40 cd%33
April 15/12 cd4 1,010 vl <40 cd% 39
April 20/12 Switched to Viramune + Truvada
Aug 2/12 cd4 1040, vl <40, cd% 38
Oct 19 cd4 1,110 vl <40 cd% 41

Offline Zohar

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Re: Skin Issues after starting treatment
« Reply #11 on: May 23, 2010, 06:41:52 PM »
_Did you have any skin troubles at any point after seroconverting?_

No, none at all. Always had really great skin.
''Poor is the man whose pleasures depend on the permission of another.''

Offline mecch

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Re: Skin Issues after starting treatment
« Reply #12 on: May 23, 2010, 09:03:19 PM »
I would ask your doctor if the flaking skin is due to IRIS.
Mine went away after a month or two.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Tempeboy

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Re: Skin Issues after starting treatment
« Reply #13 on: May 23, 2010, 11:53:25 PM »
Hey Zohar,

All of the meds you mention can cause skin side effects - especially if you are prone to skin issues.

The most likely culprite in your combination is Nevirapine, you could talk to your doc about switching.

In the interim you could try a moisturiser with an anti-inflammatory - pine tar is great - especially in a bath oil - and there are lots of others.  There are soaps and supplements you can try as well.  Tumeric, ginger and green tea can be helpful.  You could also ask about oral antihistamines.

Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

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Offline Zohar

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Re: Skin Issues after starting treatment
« Reply #14 on: May 24, 2010, 02:38:30 AM »
I don't think the doc would want me to switch after only two months. But even if he was OK with that, the question would be 'What next?' . I've been on Sustiva and that didn't work out for me and I'd really like to avoid PIs if at all possible.

I already use an oral antihistimine, but the relief is very short-lived - a couple of hour at the most.

Yesterday, I drank vitamin C in the form of those fizzy tablets, throughout the day, and it seems to have helped the rash - it's not looking quite as inflamed now, and only a few more spots/bumps have appeared.


''Poor is the man whose pleasures depend on the permission of another.''

Offline Zohar

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Re: Skin Issues after starting treatment
« Reply #15 on: May 26, 2010, 12:22:39 PM »
Just back from an appointment with the doc. He's diagnosed the 'rash' as atopic eczema, which he thinks is a result of the drugs activating my immune system, rather being a side effect, although I did get confused when he said the most likely drug to be causing the eczema is Nevirapine. Does he mean that different drugs activate the immnue system in a different way?

He's told me to increase the antihistimine dose to take down the itching and basically to wait and see if things get better on their own and review the situtation in a month. He didn't go into any detail as he was in a rush, but he mentioned that switching combos would mean going on to a protease inhibitor which I really wanted to avoid. :-\
''Poor is the man whose pleasures depend on the permission of another.''

Offline rmgjunk

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Re: Skin Issues after starting treatment
« Reply #16 on: May 28, 2010, 10:53:52 AM »
Hi, Zohar,

We're having the same issue at the same time.  I also started on efavirenz, but gave up after six months and switched to nevirapine.

After one month on nevirapine (2wks lead in, 2wks full dose) I developed that very same rash all over my body.  The only places spared were my palms, soles, face and scalp.  Man, I had never itched so bad!

My doctor suspended nevirapine for one week and started me on an antihistamine plus an urea moisturizer.  I'm still taking the antihistamine (half dose) but I'm back on nevirapine, one week on the full dose already (we did a one wk lead in period), and so far so good.  We will switch to a lighter antihistamine first, and then take it off and wait to see if it happens again and how bad.

It's important to check your liver function and monitor for other symptoms.  If you develop a fever, you should call your doctor immediately.

I would also avoid PIs for now, but if I can't tolerate nevirapine I'll probably switch to boosted atazanavir (reiataz I think).

[]s
Roger
14-Sep-2009 Tested positive
Last labs: VL <47, CD4 441/29%
Current meds: AZT, 3TC, Nevirapine

Offline Zohar

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Re: Skin Issues after starting treatment
« Reply #17 on: May 28, 2010, 01:30:39 PM »
It's interesting that your doctor suspended the nevirapine. I assume he kept you on Truvada for that time...?

I'm a bit surprised that after Sustiva and nevirapine the only other option is a PI. I was under the impression there were more drugs to choose from.
''Poor is the man whose pleasures depend on the permission of another.''

Offline Assurbanipal

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Re: Skin Issues after starting treatment
« Reply #18 on: May 28, 2010, 03:01:32 PM »
I'm a bit surprised that after Sustiva and nevirapine the only other option is a PI. I was under the impression there were more drugs to choose from.

Other drugs might include Intelence (same class as Sustiva and nevirapine) or Isentress (integrase inhibitor). 

There's a listing of drugs here http://www.aidsmeds.com/list.shtml
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline rmgjunk

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Re: Skin Issues after starting treatment
« Reply #19 on: May 28, 2010, 03:22:23 PM »
It's interesting that your doctor suspended the nevirapine. I assume he kept you on Truvada for that time...?

Actually, I'm on combivir (zidovudine + lamivudine), not truvada. Yes, I kept taking it alone for one week.  I was also concerned, but he told me it was OK, given the circumstances and shortness of the interruption.  I guess resistance to NRTIs doesn't develop so fast.  But I'm still a bit anxious about my next VL  :(

[]s
Roger
14-Sep-2009 Tested positive
Last labs: VL <47, CD4 441/29%
Current meds: AZT, 3TC, Nevirapine

Offline Zohar

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Re: Skin Issues after starting treatment
« Reply #20 on: May 28, 2010, 06:36:27 PM »
Other drugs might include Intelence (same class as Sustiva and nevirapine) or Isentress (integrase inhibitor).  

There's a listing of drugs here http://www.aidsmeds.com/list.shtml

I don't think I'd be able to get my doctor to prescribe Isentress or Intellence as they are not recommended as front line treatments in the UK.
« Last Edit: May 28, 2010, 06:42:19 PM by Zohar »
''Poor is the man whose pleasures depend on the permission of another.''

Offline Assurbanipal

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Re: Skin Issues after starting treatment
« Reply #21 on: May 28, 2010, 08:48:02 PM »
I thought Newt posted something the other day about Isentress in the UK ...

Here it is http://forums.poz.com/index.php?topic=32667.msg401772#msg401772

Sounds like it might be worthwhile to ask if you think it would help.
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

 


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