Persistent painful blisters/spots

[Guest Posts]

I've been plagued with itchy painful skin since February. It's been happening every 2-3 weeks in a cycle of small red spots which then cluster, become one big firm blister in which you can see the individual ones and resemble tapioca. They eventually burst and ooze clear liquid before crusting. The cycle takes 3 weeks before starting in another place. I've had repeated aciclovir which is not working and no dermatologist has seen me.

I'm on sulfasalazine, methotrexate and Humira amongst other things and these episodes have started well after beginning these. I have Ankylosing Spondylitis, Peripheral Inflammatory Arthritis and PsA has been mentioned. Please help.

Best wishes

Emma

[Dr Anton Alexandroff]

Dear Emma,

So sorry to hear about your skin problem! Humira sometimes can cause unusual rashes and it also suppresses the immune system. Perhaps you could ask your dermatologist or GP if it maybe useful to arrange a swab for cold sores (HSV) infection and scraping for fungal infection. Prophylactic aciclovir may help with a recurrent HSV infection. Sometimes a skin biopsy may be necessary to establish a diagnosis.

I hope this is helpful.
With Best Wishes,

Dr Anton Alexandroff FRCP(UK) PhD CCT(Derm) FRSM FAAD
Consultant Dermatologist and Honorary Senior Lecturer
The British Skin Foundation Spokesperson
London, Cambridge, Leicester and Bedford

https://www.alexandroff.org.uk/

Instagram your_skin_dr
Twitter your_skin_dr

[Thivimaru]

Dear Emma,

I agree with my colleague Dr Alexandroff, the history you describe is unusual and not typical of psoriasis which does not usually cause water filled blisters.

The medications you are taking (Humira and Methotrexate) are a combination that many of my patients are on for their psoriasis and can reduce immune system function making your skin more vulnerable to infections. I agree that a skin swab and a biopsy would be helpful in making the correct diagnosis to guide treatment and I would suggest that you are referred to dermatology for review.

Many departments are now offering Teledermatology consultations so it would be helpful to take photos of the rash in different stages of evolution to help the diagnosis