Managing Steroid Dosage: Coping with Persistent Symptoms and Allergic Reactions

The steroid dosage has been reduced to 7.5 mg, and the symptoms are becoming more pronounced?

Last year, I developed a skin wound from scratching due to flea bites, which became infected with bacteria.
The wound started to hurt, but after taking antibiotics, the pain subsided.
However, my immune system began to attack my blood vessels, resulting in unbearable itching, especially when exposed to hot water or higher temperatures.
For the first three months after the infection, the allergic reaction was localized to the area of the bites.
I consulted a dermatologist and was prescribed corticosteroids, which significantly improved my condition.
However, once I stopped the medication, the allergic itching returned with a vengeance—redness and swelling persisted, and the symptoms recurred repeatedly.

When bitten by mosquitoes, my allergic reactions were more pronounced than before; large areas of redness developed with numerous small rashes that could not heal on their own.
I needed to take corticosteroids and apply topical steroids to gradually alleviate the allergy.
Previously, I could be bitten by mosquitoes without issue, and the itching would subside within minutes.
Subsequently, my dermatologist referred me to an immunologist, who discovered that the old lesions from insect bites were still inflamed and starting to affect the surrounding skin.
A biopsy from the China Medical University revealed inflammation in the blood vessels, but blood tests did not show any related ANCA vasculitis markers.

The immunologist has currently prescribed corticosteroids and immunosuppressants for me, but antihistamines have been completely ineffective.
My vasculitis can be controlled under a regimen of 10 mg of corticosteroids combined with 7.5 mg of methotrexate (MTX), but last week, the doctor said to reduce the corticosteroids to 7.5 mg while keeping the MTX dosage the same.
After lowering the corticosteroids, I began to experience pain in my thigh (sharp pain when standing, tightness) and warmth in my knee.
Additionally, I developed random allergic rashes all over my body that were extremely itchy, requiring the application of potent corticosteroid ointments to gradually ease the allergic reactions.
Doctor, I am at a loss as to what to do because it feels like my immune system's attack on my blood vessels cannot be controlled.
As soon as the corticosteroids are reduced, the vasculitis symptoms become very pronounced and increasingly severe.
How should I express my panic and the unpredictable variables I am facing to my primary physician? I have reached this point, yet the symptoms continue to recur! My skin itches, my thigh hurts, and the skin color on my thigh appears purplish, resembling bruising.

Mr. Zhu, 30~39 year old female. Ask Date: 2019/05/09

Dr. Zeng Guosen reply Internal Medicine

Hello, skin disorders can indeed be very bothersome.
If reducing the steroid dosage to 10 mg causes instability in your symptoms, there’s no need to panic.
This indicates that your skin condition is still unstable.
It may be advisable to adjust the methotrexate (MTX) dosage and wait until your condition stabilizes before tapering the steroid dosage.
If you have any doubts, uncertainties, or concerns about your condition, please feel free to communicate openly with your physician.
Wishing you a speedy recovery.
Thank you for your question.

Reply Date: 2019/05/09

More Info

Managing steroid dosage, especially in the context of persistent symptoms and allergic reactions, can be a complex and challenging process. Your situation, involving a history of allergic reactions and subsequent treatment with steroids and immunosuppressants, highlights the delicate balance that must be maintained in managing autoimmune responses and inflammation.

Firstly, it’s important to understand the role of corticosteroids in treating conditions like yours. Corticosteroids, such as the ones you are taking, are powerful anti-inflammatory medications that can significantly reduce symptoms associated with allergic reactions and autoimmune diseases. However, they also come with a risk of side effects and complications, particularly when used long-term or when dosages are adjusted. The symptoms you are experiencing, such as pain in your thighs, skin rashes, and the resurgence of itching and inflammation, may indicate that your body is reacting to the decrease in steroid dosage. This is not uncommon, as the immune system can become accustomed to the presence of steroids, and reducing their dosage can lead to a rebound effect where symptoms re-emerge or worsen.

The fact that your symptoms improve with higher doses of steroids suggests that your immune system is indeed reactive, and it may be necessary to find a balance that allows you to manage your symptoms without relying solely on steroids. This is where communication with your healthcare provider becomes crucial. You should express your concerns about the pain, the skin reactions, and the unpredictability of your symptoms. It’s essential to convey how these issues are affecting your quality of life.
Here are some points to consider when discussing your situation with your doctor:
1. Symptom Tracking: Keep a detailed log of your symptoms, including when they occur, their severity, and any triggers you notice (such as temperature changes or specific activities). This information can help your doctor understand the pattern of your reactions and adjust your treatment plan accordingly.

2. Discussing Dosage Adjustments: Be open about your concerns regarding the reduction of steroids. Ask if there are alternative strategies to manage your symptoms while tapering off steroids, such as adjusting the tapering schedule or exploring other medications that might help control inflammation without the side effects of steroids.

3. Exploring Additional Treatments: Since antihistamines have not been effective for you, inquire about other options. There are various immunosuppressants and biologic therapies that might be more effective in managing your condition without the side effects associated with long-term steroid use.

4. Pain Management: Discuss the pain in your thighs and knees with your doctor. It may be related to inflammation or other underlying issues that need to be addressed. Pain management strategies, including physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), or other pain relief methods, could be beneficial.

5. Emotional Support: It’s understandable to feel anxious and overwhelmed by your symptoms and treatment. Don’t hesitate to ask your doctor for referrals to mental health professionals or support groups that can help you cope with the emotional aspects of managing a chronic condition.

6. Follow-Up Appointments: Ensure that you have regular follow-up appointments to monitor your condition closely. This will allow for timely adjustments to your treatment plan based on your symptoms and any side effects you may experience.

In summary, managing your condition requires a collaborative approach with your healthcare provider. Open communication about your symptoms, concerns, and treatment preferences is key to finding an effective management strategy. Remember, it’s important to advocate for your health and seek the support you need to navigate this challenging situation.

Similar Q&A

Managing Steroid Use for Chronic Urticaria: A Patient's Guide

Hello, Doctor. Recently, my urticaria has flared up again. The doctor prescribed multiple antihistamines, but they haven't been effective. After that, I received an injection of 40 mg of methylprednisolone and was prescribed two tablets of Dexamethasone to take twice a day. ...

Dr. Wu Yuxin reply Dermatology
The method of medication and dosage varies depending on body weight and symptoms; you should consult your physician.

Managing Steroid Dosage: Concerns Over Accidental Overdose and Dependence

Hello Dr. Ke: I have been continuously taking steroids due to kidney issues, but I have developed a dependency on them, which has led to fluctuating dosages. Currently, I am taking eight 5mg tablets every two days. However, I accidentally took an extra eight tablets this morning,...

Dr. Ke Taiyuan reply Internal Medicine
When tapering off high doses of steroids after long-term use, it is indeed important to reduce the dosage gradually. However, your current situation involves accidentally taking a little more on one or two occasions, rather than consistently over several weeks. There is no need t...

Can Steroids Cause Permanent Immune Imbalance and Pituitary Damage?

Hello, due to the doctor's suspicion of asthma exacerbation, I was prescribed a potent corticosteroid, Methylprednisolone, to be taken 4 times a day at 16 mg. However, due to time constraints, I often take it only during dinner and late-night snacks, which has caused issues ...

Dr. Gao Jiankai reply Internal Medicine
Dear Yan Yan, Thank you for your message. The side effects of steroids primarily affect normal hormone function and immune response. The hormones influenced by steroids are typically secreted more in the morning and less in the evening, so it is best to take steroids in alignmen...

Understanding Drug Allergies: Managing Symptoms After Steroid Treatment

Hello Doctor: I have a drug allergy to Lamictal (an anticonvulsant medication) and was hospitalized for six days receiving high-dose steroid treatment. After discharge, I switched to oral steroids, but I felt very uncomfortable after taking the medication (dizziness and nausea), ...

Dr. Zeng Guosen reply Internal Medicine
Hello: Steroids can have gastrointestinal side effects, which may worsen gastric ulcers or cause gastrointestinal discomfort. If symptoms persist, please consult a gastroenterologist. Sincerely, Dr. Tseng Kuo-Sen, Department of Internal Medicine, Taoyuan Hospital, Ministry of Hea...