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Remicade eczema

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Posted 3/2/2013 3:30 PM (GMT 0)
My husband started remicade in April 2008 at the dosage of 5mg/kg every 8 weeks. In oct 2010, his dosage was increased to 10mg/kg every 8 weeks. For the past 6 months he's been dealing with skin issues.

He has had small problems with eczema on his hands and sebboreic dermatitis on his scalp before the remicade. However, they didn't really require any treatment. But in the last 6 months, he has had a patch on his scalp that responds to steroid cream, but comes back with a vengeance. Also, he has developed numerous spots on his back and belly. The dermatologist is treating this with tacrolimus cream. So, he is responding to steroids and tacrolimus cream, cessation of treatment brings it back.

His dermatologist thinks it is all eczema (not psoriasis), though I have my doubts. The question I wish we could really answer is whether this is because of remicade. Is the remicade managing a bad flare up of eczema, or is it causing these skin problems?

He is due for another infusion of remicade on March 15. My question is this - do we take remicade at the same dose and see if his eczema gets better or worse? Another option we've tossed around is lowering his remicade dose to like 7.5 mg/kg to see if it helps.

I think we're going to try this approach. Take the regular dose of remicade this time, and track symptoms. If it gets worse, lower the dosage of remicade the subsequent infusion. In the meantime, we can try to manage symptoms with creams. Is this a good approach? Or are you supposed to stop the remicade if this happens?

Also, are ther other effective remedies for eczema than steroids and tacrolimus? I don't want my hubby to use steroid creams all the time.

Also, if remicade is the culprit, is it time we moved on to another TNF agent like humira or cimzia? Opinions welcomed.

Thanks,
PV
Posted 3/2/2013 7:45 PM (GMT 0)
Hi has your husband had a blood test done lately. He needs to see
also if he has been anti body's to Remicade. I have done Humira
in the past. Its nice to do your own injections.
Posted 3/2/2013 8:14 PM (GMT 0)
No. His GI doesn't like the test because he says most people on remicade will have built some antibodies to it and that he can't base his decisions on that test.

My husband will be calling for an appt with him next week,and I'll make sure we ask that question. I'll let you know what he says. My husband is of the opinion that he's just had a stressful few months and also it s winter and so he's having trouble with eczema. So I don't know what to think or do. :-)

PV
Posted 3/3/2013 12:50 AM (GMT 0)
From the Remicade prescribing info:

"Psoriasis: Some people using REMICADE had new psoriasis or worsening of psoriasis they already had. Tell your doctor if you develop red scaly patches or raised bumps on the skin that are filled with pus. Your doctor may decide to stop your treatment with REMICADE."

 A Medscape article about the problem of skin issues and anti-TNF meds:

http://www.medscape.com/viewarticle/538180

If you can't access Medscape, here's another report about this initially:

http://www.foxnews.com/story/0,2933,152410,00.html

Posted 3/3/2013 2:40 AM (GMT 0)
I began to get eczema on my face after starting Remicade a few years ago. It's seemed to wax and wane, and right now it's doing pretty well. I've always wondered if the Remicade is what caused it, but can't prove it, obviously. Hope you and your husband find some answers soon!
Posted 3/3/2013 3:25 AM (GMT 0)
I know that remicade maybe the cause of the skin problems, but remicade has worked wonders for the crohns and I am very scared to take him off the remicade and have the crohns flare up again.

That's why I want to see if the skin issues can be managed by treating the eczema and maybe lowering the dosage of remicade a little. My husband's father died in January and we had a difficult trip to India in December, and he had a colonoscopy for surveillance in February. So there's been plenty of stress in the past few months, so my husband wants to try treating the eczema to see if it will just subside on its own.

I hate this part - not having any difinitive answers. It could be this, or it could be that, it maybe helping or it maybe hurting, it may work or it may not work . . . So frustrating, and so worry inducing. I guess I'll be trying to meditate a bit more to keep positive.

I'll keep you guys posted on how it goes. Thanks for letting me vent a little.
Posted 3/3/2013 3:31 AM (GMT 0)
I don't take Remicade; so, I can't help you there. But... I was practically born with eczema and I'm 20 now. (not old...but, experienced enough with eczema). I am generally using steroid creams for it - there are milder ones and, if your husband can tolerate them... I'd ask about them. I use the 'heavy-duty' ones for my hands.. especially now that I work in the hospital and have to wash my hands and use sanitizer every time I turn around. But, I've found that the Aveeno Eczema Therapy Lotion helps with the burn on my hands if they are severely cracked. Another thing I like to do is take Vitamin A&D Ointment (you can find it probably in the first aid section of drug stores/stores like wal-mart, depending on where you live; or in the baby section) and put it on a couple of times throughout the day. I don't use any lotions (other than occasionally the Aveeno lotion). I use the original Dove soap bars. It's the best when it comes to people with skin like mine (eczema prone and sensitive). Eliminate any scented sanitizers or hand-soaps. Those are major offenders for drying eczema on the hands, too. Back to the A&D ointment.... your husband can put it on his hands at night before bed. Also, it's great for moisturing all-over in general - that's basically all that I use nowadays for moisturizer (except for my face).
I get the spots on my arms, legs, sides, and occasionally on my back - sometimes even my face gets a bit of eczema but that usually clears up very quick on its own. The spots are difficult to get rid of, I find. My fingers are generally just always covered in it, but it's easy to coat them with some sort of cream. Again... A&D ointment is good to run onto the spots (or all over) a couple of times a day just to keep it moisturized and prevent any 'friction' with his clothing to further irritate the spots. Other than that... alternating the use of steroid creams will be your best bet. Triamcinolone is a good cream that comes in various dosages, I am sure you know, and they have fairly low ones - it always seemed to help me until just recently.

Best of luck,
Jade
Posted 3/3/2013 5:16 AM (GMT 0)
Jade:

Thanks for the info. He's been given ketaconazole shampoo for his scalp dermatitis. He's also been given desoximetasone cream and tacrolimus cream. The desoximetasone works like a charm, but you stop and the spots return with a vengeance. Maybe there is some rebound from the steroid cream and we need to taper?

Right now he's just trying the tacrolimus cream and avoiding the steroids. His hands aren't much affected. His back, back of the knee, scalp and trunk are affected more and so I've been rubbing tacrolimus cream on his spots nightly. There is improvement, but it isn't gone, and it'll probably return the moment we stop.

Ill go buy the aveeno eczema therapy in the am and have him moisturize with it and see if it helps him be itch free during the day.

Thanks,
PV
Posted 3/3/2013 3:44 PM (GMT 0)
I've had eczema since I was an infant. I'm also on Remicade. I don't find that the Remicade has any effect on my eczema out breaks. My dermatologist tends to be pretty conservative when treating me because of the Crohns and the medications I take to treat it. While I do get the occasional small patch of eczema on my trunk my major problem area is my face. My derm has prescribed Protopic. He has also given me a prescription moisturizer for when things are really bad but I can't remember the name of it now. I use Ceravae cleanser and moisturizer most of the time. I do remember reading an article in the NY Times a few years ago that discussed using bleach to treat eczema. From what I remember you put a small amount of bleach in a tub full of water and soaked for a short time. The article gave the exact ratio of bleach to water. Apparently for some people the eczema is caused by a bacteria and the bleach bath helps to keep the bacteria in check. It might be worth trying for someone like your husband whose issue is mainly on the body.
Posted 3/3/2013 5:25 PM (GMT 0)
Thanks! I'll look up the bleach article. Protopic is the same cream that my husband is using right now (tacrolimus). It responds to it, but comes back when he stops. Do we just have to continue using it indefinitely?

I thought we treat it and hopefully it goes away, but so far that hasn't happened. While he's had eczema on his hands and knees some in the past, this is the worst he's had. When you treat the eczema do you stop the meds once the spot recovers? Do you taper off? Or do you just do it everyday?

Thanks,
PV
Posted 3/4/2013 3:04 PM (GMT 0)
I forgot all about the bleach! I have tried that a few times. I interned with my old pediatrician for a few years and she noticed the eczema getting bad and she recommended trying bleach, like petitarte said.
The thing with eczema is that, at least for me, it will probably always be there to some degree - it's just a matter of maintaining it. It may not be like that for everyone...but, for me, it sure is.

Cerevae is a great cleanser, too. Or, even cetaphil. I hope you find something that works! It's frustrating! I have had issues with it on my scalp before, but it seemed to clear up on its own...for the time being. My scalp is definitely much more dry/itchy...but, no eczema break-outs per se.

Jade
Posted 3/5/2013 2:03 AM (GMT 0)
PV - when I'm in a flare up I use the medication daily but never for more than 2 weeks straight.
Posted 3/5/2013 2:16 AM (GMT 0)
I think we're going to try a bleach bath and moisturize with aveeno eczema. He's right now on week two of the tacrolimus cream. He's improving, but it isn't gone in some spots.

Do I try to taper off the cream slowly? The dermatologist didn't mention a taper. She said you should see improvement in 3 weeks and my husband didn't think to ask about tapering. From what ive read with steroids at least it is best to taper to prevent rebound.

Is acne and eczema related? My husband has also been struggling with acne (came up right along with the eczema problems). The dermatologist wants him to take doxycycline and use clindamycin cream and I'm too worried about his getting cdiff again that we decided not to try that yet. In the meantime he's just doing benzoyl peroxide stuff for the acne.

Thanks so much for taking the time to respond to my questions. It is wonderful to be able to get advice and ideas from others who've been through this. Thanks!!!

PV
Posted 3/6/2013 12:36 AM (GMT 0)
Hm. I've never heard of a taper for steroid creams... usually, they just say to use it twice or so a day for 2 weeks. Of course, I'm sure many use it for longer... but, I don't think a taper would make a difference. You don't want to use it too much - it thins out the skin over time. That's why they say to wash it off of any parts of skin that aren't affected by eczema.

Acne and eczema - I don't think so. But, if he's on steroids, that could be contributing to it. If he's had c-diff.. which I've had recently... I don't recommend th doxycycline. He could try Epiduo. The base of that prescription cream is benzoyl peroxide. That is fairly commonly used. Acne just takes time to get rid of. But, try OTC stuff first for sure. If the epiduo doesn't work...he could talk to his PCP about trying the generic for Retin-A. I use that and it works fairly well.

Is he itchy all over his trunk? Have y'all tried calamine lotion or oatmeal baths? That might help some with the itchiness and the dryness as well.
Posted 3/6/2013 12:55 AM (GMT 0)
My dermatologist won't give me any oral medications because of the Crohns and the Remicade. When I get an eczema flare on my face I tend to break out in little itchy pus filled pimples. I just use the Protopic and they clear up. I've never been told to do a taper with a steroid cream and I've been using them for over 25 years. I've just always been told not to use them for more than 2 weeks since they thin the skin.
Posted 3/6/2013 2:16 AM (GMT 0)
What do you do when the eczema comes back days after you've used steroid cream for 2 weeks? He was using a steroid cream on his scalp and days after he stopped the cream, the eczema was back and worse (bigger patch than before). I did some looking online and it seems some people have reported that they've seen this rebound effect from the steroid creams and suggested tapering instead of stopping cold turkey.

The protopic cream is clearing up his eczema - he's applying that once daily at nighttime. The dermatologist told him to apply this cream on the spots for 3-4 weeks and he should see improvement. She also said to spot treat as needed with it for short courses.

He isn't itchy anymore for the most part. I'd say his most problem area is the scalp - he has 2 sizeable patches on his scalp and treating it with head and shoulders, tar shampoos, ketaconazole etc isn't keeping the eczema at bay.

What we've seen is he uses the steroids and his skin clears up. Within days of stopping the steroid cream, the eczema is back and with a vengeance. I am hoping that the tacrolimus cream will clear him up and not have a resurgence after he stops the treatment.

Any ideas why the eczema comes back after treatment with steroid creams? I know it could be the remicade; we are going to keep an eye on things after his next remicade infusion on march 15 to see if he gets worse. If you can think of something other than the remicade like diet, please lemme know.

Thanks,
PV
Posted 3/6/2013 2:26 AM (GMT 0)
The only thing that helps my scalp is Olux foam. I've gone to several different derms over the years and none of them wanted me using the steroid creams for more than 2 weeks at a time. They are not good for your skin. They thin it so really not good for your face or scalp.

My eczema has been milder since I started Remicade. I used to get it really bad on my hands. They would be full of blisters and bleeding. It was also much worse on my trunk and upper thighs. Now I just get a small quarter sized patch on my waist and another on my back. My hands just get 1 or 2 blisters and don't bleed. Only my face and scalp still give me trouble and even that is milder than pre remicade.
Posted 3/6/2013 3:56 AM (GMT 0)
Can you use steroid creams for maintenance - ie. use it twice a week instead of daily to just keep the eczema manageable without thinning out skin? It looks like the olux foam is also a steroid.

Thanks again for all your help.

PV
Posted 3/6/2013 7:41 PM (GMT 0)
Both chrons and exzema are auto immune deseases. The Remicade shouldn't be affecting it except for the better if at all. However, as with most of these types of deseases what works for one may not work for others. I would ask the dermatologist for suggestions. Probably have to keep trying different things. With chrons you have to keep trying until finding what works for you.

Best of luck

Jayne
Posted 3/8/2013 5:11 PM (GMT 0)
Idk about the remicade but as far as eczema, my youngest son developed severe eczema at 4wks old and I will spare the long story but it was all related to food allergies for him and once he had an allergy test (IGE) at 2yrs old and we eliminated all of his food allergens the eczema left and never returned. I developed eczema on my left arm at 17yrs old and it would come and go and steroid cream kept it in check. occasionally it would pop up on my right arm or right foot. (I didn't have my first crohns flare until a month before I turned 30) At 25 I started developing flaking itchy scalp that by 35 was more like plaques or cradle cap, I could use coconut oil and scrape off all of the flakes like cradles cap but 2-3 days it would be back. I tried various shampoos and rinses but nothing worked or even helped much, except washing my hair less often instead of more. With my crohns I learned I couldn't eat or drink anything containing citric acid, later ,as I am aging and requiring some anti-aging creams lol, I realized some products would break me out bad after a day or two of use, after comparing products I realized the ones that bother me contain.... citric acid, So not only can I not eat it I can't even put it on my skin, So I started reading shampoo and conditioner bottles guess what they have in them/ yep citric acid, even the organic all natural ones. So, Idk what kind of work he does if he could try showering or bathing in just baking soda water for a week or two and see if that helps determine if it is a contact reaction from soaps. Also I don't use fabric softner I just add vinegar to the place for fabric softner in the washer. your clothes don't smell like vinegar they just smell like nothing when they come out of the dryer, and I don't use dryer sheets either as the vinegar is the fabric softner. And as far as my eczema on my arm, My dr's had never said it was from food or allergy, but when I had my IGG allergy test done at 34 and cut out wheat it went away, when I started eating some wheat again it came back, when I went into a visit to my homeopathic dr for a refill on my steroid cream she told me it was food. Sure enough, when ever I eat wheat it comes right back;( So it could be caused by multiple foods and / or environmental factors, I would start by trying to eliminate soaps and lotions for a bit and maybe if it's horribly dry try a mineral oil, Vaseline, coconut oil or something with only one ingredient and see if that helps at all then add back soaps one at a time and start comparing ingredients to what he reacts to? Food is harder without a test bc it is a delayed reaction and might take 5 days to react to an ingested food. And I know the IGG tests aren't reliable when taking cortico steroids and I would think since remicade suppresses the immune system then the test wouldn't be accurate then either, on the other hand if he is reacting to a food while on remicade then it isn't suppressing the reaction anyhow. But the test is expensive and difficult to find a Dr that will do it so I wouldn't do it unless I knew it would be accurate while taking the meds he is currently on.
Posted 3/8/2013 5:22 PM (GMT 0)
Forgot to comment on the acne part, but when I was about 25 I had my eyebrows and upper lip waxed, a couple days later my entire face was broke out in acne like pustules so badly that my lymphnodes under my jaw were swollen, dr said it was severe acne and gave my anti biotics. even though in my entire life I had never had more than 3 or 4 pimples at a time. The next time I had my eye brows waxed the same thing happened so it was obviously a reaction to the wax. And when I react to citric acid in face products it might be confused with acne as it forms a sort of little pustule but it isn't like big acne pimples but rather a lot of tiny little infected pores/ hair follicles but they aren't big and raised like pimples? and now that my scalp is in much better shape I can feel tiny pimple like bumps on my scalp if I use hair sprays before it gets dry and flakey.
Posted 4/9/2013 9:22 PM (GMT 0)
PV....did y'all ever find anything for his scalp? Sure enough...as soon as I "spoke," I started getting a bad flare up of eczema on my scalp and I can't get rid of it! It's definitely a struggle to blow-dry my hair in the mornings when I'm hurtin' all over!
Hope all is well your way,

Jade
Posted 4/9/2013 10:03 PM (GMT 0)
We have been doing tacrolimus cream (protopic) on his scalp every other day, and it is keeping the eczema at bay.

The protopic also helps his other eczema spots. He has one spot on the back of his leg that is very stubborn - it has needed steroid cream, and we've now gone from twice a day steroids to steroid every other day, and tacrolimus the rest of the time.

Tacrolimus seems to be a relatively safe choice. I read several long term use studies that have not shown any ill effects, so we are just going with that. If we can stop the steroid on the spot behind his leg and maintain with tacrolimus, I'd say we are doing well.

Also, the warmer weather I think is better. His scalp seems to have calmed down since the weather got a little warmer. Also, he alternates head n shoulders, neutrogena t-gel, and ketaconazole shampoo on his scalp.

I hope you find some relief.

PV
Posted 4/10/2013 12:48 AM (GMT 0)

PV,

Has he tried Spectro? They have a great product line for eczema. Definitely works for my Daughters periodic break outs.

Tom.

Posted 4/10/2013 2:11 AM (GMT 0)
Thanks Tom. I'll give it a try.
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