Could My Symptoms Indicate a Vascular Issue After Using Betamethasone?

Is this a venous embolism?

Hello Dr.
Wu: Before applying the medication, I had no abnormalities, but a month and a half ago, after applying Betamethasone ointment on the left foot's fourth toe, about an hour later, I experienced weakness in that toe, inability to bend it, and slight swelling.
Subsequently, I felt a heaviness behind my knee and above my thigh, leading me to suspect a neurological issue.
I consulted a neurologist and took several anticonvulsants, anti-inflammatory medications, and B vitamins, but there was no significant improvement.
I also underwent electromyography and nerve conduction studies, which showed no significant differences.
Later, I tested the ointment again on the back of my left hand, and about 30 minutes later, I experienced the same heaviness in my left wrist, the inner side of my left forearm, and the inner side of my left upper arm.
Since applying the ointment, my left hand and left foot have felt very heavy, as if something is stuck or pressing down, with this sensation persisting for 24 hours.
The only visible difference is that there are some dark red streaks (not raised) on the inner side of my wrist and the inner side of my ankle.
Pressing on these areas results in a more pronounced feeling of heaviness and pressure.
What could be the cause of this? Could the ointment be causing vascular issues, or is this a symptom of some sort of vascular obstruction? Will this symptom resolve on its own (as it has persisted for 1.5 months), or should I see a vascular specialist?

Liang, 20~29 year old female. Ask Date: 2021/07/15

Dr. Wu Xueming reply Cardiology

Based on your description, it does not align with the presentation of venous embolism; however, if the symptoms persist, it is still recommended to visit a hospital outpatient clinic for further evaluation.

Reply Date: 2021/07/15

More Info

Based on your symptoms and the timeline of events following the application of betamethasone ointment, it is important to consider several factors that could be contributing to your condition. Betamethasone is a potent corticosteroid that is used to reduce inflammation and suppress the immune response. While it is generally safe when used as directed, there are potential side effects and reactions that can occur, particularly with prolonged use or in sensitive individuals.

Your symptoms of weakness, inability to bend the toe, mild swelling, and the heavy sensation in your knee and thigh could indicate several underlying issues. The fact that these symptoms appeared shortly after applying the ointment raises the possibility of a localized reaction to the medication. Corticosteroids can sometimes cause skin thinning or atrophy, which might lead to altered sensation or weakness in the affected area. However, the systemic effects you describe, such as heaviness in both the left arm and leg, suggest that there may be more at play.

The appearance of dark blood streaks in the wrist and ankle areas, along with the increased sensation of pressure when pressed, could indicate a vascular issue. This could be due to a number of reasons, including venous insufficiency, thrombosis, or even a localized inflammatory response affecting blood flow. Given that you have experienced these symptoms for over a month without significant improvement, it would be prudent to seek further evaluation.

While your neurologist has ruled out significant neurological issues through tests such as electromyography (EMG) and nerve conduction studies, the persistence of your symptoms warrants a thorough vascular assessment. A vascular specialist can perform Doppler ultrasound studies to evaluate blood flow in your limbs and check for any abnormalities such as clots or venous insufficiency.
In terms of whether the symptoms will improve on their own, it is difficult to predict. Some localized reactions may resolve with time, especially if they are due to a mild inflammatory response. However, if there is an underlying vascular issue, it may require intervention to prevent further complications.

In summary, while it is unlikely that betamethasone itself is directly causing a vascular blockage, your symptoms suggest that there may be an underlying vascular issue that needs to be addressed. I recommend that you consult with a vascular specialist for a comprehensive evaluation. They can provide you with the necessary tests and treatments to help alleviate your symptoms and address any potential vascular concerns. Additionally, keep your primary care physician informed about your ongoing symptoms and any changes you experience.

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