Q: For a couple of years now I have suffered from what looks like very dry skin all over my body. Now, however, the skin is beet red, dry, flaking, itchy beyond imagination and looks as if I have been burned in a fire – head to toe. I’ve been treated by a dermatologist with cortisone creams that have been ineffective. I went back to my dermatologist and he put me on an antibiotic for a month. That was a waste of time and money. I went back again last week and he wants to prescribe Soriatane 25 mg for a month. That sounded good until I found out my local pharmacy wanted to charge me a whopping $1,000 for a 30 day supply of the medication. I can’t use a topical ointment – I’d have to buy it by the gallon bucket to cover everything.
I’m a senior citizen living on Social Security and I just can’t afford anything that costs so much and may not even work. The skin all over my body is beet red and flaking off like you wouldn’t believe. If I rub my arms or stomach, the floor beneath me looks as if I have been standing in the middle of a snow storm from the dead skin that flakes off. I don’t just want to get a prescription but really want to know what this terrible rash is and get rid of it once and for all. I’ve never had anything as serious and frightening as this one. I really need help – and a correct diagnosis my dermatologist in a pretty large facility can’t provide. A friend told me I might have scalded skin syndrome. Is that possible and can you offer any insight?
A: I can only assume your dermatologist considered allergies, psoriasis, icthiosis, drug reactions and the more general possibilities for the rash, so I’d investigate an undiagnosed autoimmune disorder in which a person’s immune system mistakenly attacks and destroys its own healthy body tissue. There are more than 80 known autoimmune disorders and finding the cause of any disorder may be difficult to zero in on but can hopefully be determined through testing.
While I don’t believe it to be your problem, I will briefly discuss scalded skin syndrome, a condition that results from a staphylococcus aureus infection that most often appears in newborns and young children; however, individuals of any age may be affected, particularly those adults who suffer from renal failure or immune deficiency disorders. The symptoms can resemble those of other skin conditions but having a skin biopsy and bacterial culture for identification should assist.
Staph infections are caused by different strains of the same bacteria. Interestingly, as many as 40% of healthy adults may have staph on their skin or in their body, yet not have any symptoms at all. Carriers may not exhibit symptoms, yet they can pass the bacteria on to others. Some strains, such as the one that causes scalded skin syndrome, produce toxins and cause the symptoms to occur when the bacteria release two different exotoxins — epidermolytic toxins A and B. These exotoxins cause blisters to form and skin to slough off, producing an appearance of severely burned skin. The blisters are generally fluid-filled, large and may rupture, leaving the skin moist and painful. The skin will ultimately peel off in large sheets, not in snowflake form. Because skin helps protect us from infection, scalded skin syndrome may put a patient at risk of developing sepsis, a very serious bacterial infection of the bloodstream. If a patient carries the diagnosis, treatment will begin with intravenous fluids to help to combat fluid loss and prevent dehydration. Staph is typically immune to penicillin, so other antibiotics will be included in the IV treatment. While the condition may require hospitalization for a few days, proper treatment should allow the condition to clear within a week, yet in the case of scalded skin syndrome, the condition is extremely severe and would not likely follow the same recuperation period of some other conditions and would last much longer because of its severity.
The medication you have been prescribed treats psoriasis, a chronic, autoimmune disease that affects the skin. It occurs when the immune system incorrectly sends faulty messages to speed up the growth cycle of skin cells. There are five types of psoriasis, the most common type being plaque psoriasis that appears as a raised, silvery white buildup of dead skin cells. The lesions are commonly found on the elbows, knees, scalp and lower back. Treatment will likely begin with steroids to slow skin cell growth, while reducing inflammation; exposing the lesions to ultraviolet light; and systemic prescription medication taken either orally, through injection or infusion.
I could continue but my ultimate response will remain the same. You need a skin biopsy to hopefully put a name to the condition you have. If you are dissatisfied with your current dermatologist, request a referral from your primary care physician to another top-notch specialist in the field. You need to get to the bottom of this problem quickly, so don’t hesitate. And, were I you, I’d probably hold off on the expensive medication until you can put a name to the disorder.
