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The interferon can cause skin problems as well as the ribavirin. One example of a skin condition caused or made worse by interferon is psoriasis. You will probably want to tell the dermatologist you're treating for Hep C even though (some cynicism follows :) they might not know what you're talking about anyway :) I understand your concern that your family knows this person. I'd consider FlGuy's advice and consider seeing another doctor.
Meanwhile, if you don't mind spending a few hours looking at a lot of pictures, you might check out: http://www.dermnetnz.org/
Plug into the search engine different skin conditions such as: "rash", "psoriasis", "ezcema (eczema)", "Seborrheic dermatitis" and see how they match up with what you have. Just be aware that oftentimes skin conditions mimic each other and even professionals sometimes have to biopsy the skin before making a definitive diagnosis. Also, this is a New Zealand site, and we may treat some of the same conditions differently here.
Has your study nurse and/or doctor seen the rash lately, in it's current form? If not, you might want to make a special appointment and show it to them. Faster even, if you have a digital camera, you might want to email them a picture and get their input.
Good luck!
-- Jim
http://www.cnn.com/2006/TECH/space/10/11/jupiter.spots.ap/index.html
That is it, this is what I have. :) thanks.
NOT big red bumps like you mention.
If you go to a derm - and it is related to any of the treatment most likely they won't know anything about whether it could be riba rash or not. I mean most don't have any hep experience compared to a hep doc.
You need to see the doctor at your trial for SURE. #1. he would know what this is #2. it needs to be put into the trial study information.
when i had the "ribarash" it was small tiny little chickenpox like bumps and they itched like CRAZY. Do you have any itching cause you don't mention it?
I don't believe that the others who are on vertex who have had the bad rash problem had any itching either.
170,000,000 people have it ???????????
4.000,000 in the usa as of today?????
try not to invent a stigma for yourself and us all.
i shared it with my accountant and she told a friend who had it and i got them to this site and they are grateful for this site and it's info. would not happen if i was anonamous...if we all remain silent there will be no one to confort the next hepper...
horray for vx950. some of the rash is from autoimmune failures.
bobby, the hep c guy...
Well, that stigma has already been invented way before me, But I do understand what you are saying. I am going to tell my derm the truth today, and I will post back as to what rx I was givin. Thanks Pam
I think that is what the other Vertex'ers said that it was like having a sunburn............it got VERY bad for them I believe.
The classic "ribarash" is NOT like a sunburn - it's little tiny bumps that itch. This sounds like the same thing as the other people have had on the VX...see if you can find that thread and compare.
But this is something YOU ABSOLUTELY POSITIVELY HAVE TO SHARE WITH YOUR TRIAL PEOPLE AND NOT JUST THE NURSE.
Gosh why don't I remember who was just saying this there are two people I really like that have posted about it and bam it's out of my head.
It's a very long story at this point for what happened to me, but here's precisely what I would do if I were you right NOW: (1)STOP the VX and start getting it out of your system, (2) go to the derm and explain everything about your condition and have them coordinate with your study doc on what the plan of action is, (3) get them to start you on a prednisone taper starting at 40mg first day, then 30mg for 4 days, then 20mg for 4 days and THEN (and this part is very important) go to 15mg for one day and VERY carefully monitor how you feel on that day. Be very vigilant on that day and VERY closely monitor how you feel. If you feel the rash coming back in any way, immediately add another 5 mg of pred back in to put you back up to 20mg. Then continue for several more days at 20mg and attempt to decrease to 15mg again. If after decreasing to 15mg and you feel fine, then great. Stay on 15mg for 3 days and then go down to 10mg for 3 days and then go down to 5mg for 3 days. By that time the VX should be pretty much out of your system, and you should no longer need the prednisone to suppress the allergic reaction.
The reason the 20mg-10mg threshold is so important as described above, is that when I transitioned from 20mg to 10mg in my initial taper, that's where my rash came back with a vengeance (I was still taking the VX at the time too). At 20mg I was feeling fine, the rash was well on its way down and I was doing great. Then just as I went to 10mg, all hell broke loose again. And I didn't react quickly enough and increase my pred dosage back up in time. Once the rash had set in again badly, no matter how much prednisone I added after that (even as high as 80mg!), it no longer had any effect on the rash. The rash continued to exacerbate unabated into the most hellish experience of my life. The rash just took off out of control after that, so it is absolutely critical that you monitor that threshhold when you get to it. And this same thing happened to PDS too, the exact same threshold appeared to be triggered in her once she went from 20mg to 10mg. Fortunately, she rapidly went back up to 20mg and managed to catch it in time, and has now discontinued the VX (i.e. the offending agent). So hopefully by riding out 20mg for several days while the VX dissipates will allow you to step down to 10mg without incident when it happens.
Now, if your rash takes off and cannot be abated or controlled by the prednisone as described above, try an 125mg IV of Solu-Medrol. Solu-Medrol is an IV steroid similar to prednisone (i.e. it's in the same class of drugs). It's similar, but it isn't the same thing, so don't let some jive talking doctor try and tell you it is the same thing and won't work any better than prednisone. After my rash took off and was no longer responsive to prednisone, I languished for more than a week with the rash waiting for it to go away. It didn't go away, it only got worse. I struggled with my doctor to find a solution, but was basically told that you just have to ride it out and there was nothing to be done. I said I wanted to go to the ER I was getting so bad, but I was generally foo-fooed away from doing that, because as it was explained to me all they will probably do is give me solu-medrol which isn't effectively any different than what I was already taking. (Solu-medrol is what someone would commonly receive if they walked into the ER with a severe allergic reaction incidentally). So I was talked out of going to the ER and getting solu-medrol for many days. Finally, I came to the point where I was such a debilitated, welted over, leprosy looking nightmare. I could barely walk and was babbling incoherently. I was really on my last leg and finally had my gf take me to the ER (this past friday night). They administered the solu-medrol - and within 1 hour I could feel the reaction inside me start to subside. It was a MAGIC BULLET, it saved my life!! It turned off the reaction FINALLY!! All that BU11$H1T they told me to keep me from getting the solu-medrol was just that. I've never been so frickin frustrated and angry in my life!!! Today I sit here with fading welts and flakey skin, absolutely drained and exhausted from the whole ordeal, but thank god it has finally passed (for now anyway).
Anyway, sorry to vent. But believe me, learn from my experience. Stopping the VX now and getting on the prednisone plan as described above will probably fix you right up pam. Just be careful around the 20-10mg taper transition point as described, and hopefully you'll be AOK and have a nice soft landing. Best of luck...
Pln: just a point of reference. I think you started a week or two before PDS and MRE.
You and PDS sure as hell didn't deserve this whatsoever.
Boy, I'm just crossing my fingers that the rash is just a reaction of the VX working, sort of a last gasp of the virus leaving this world. I can only imagine how uncomfortable you must be, pln, and I'm not minimizing your sx, I'd rather you got treated and we knew ALL we can about VX. You are being brave about telling your derma, you are so close to end of trial, I'm sure it won't affect the duration of tx. Just know I am thinking very very good thoughts for you and praying that sometime next year, I am the one getting the scary rash!!! Good luck and I hope you feel better very soon.
Willow
Hey Pam, you are done with the VX end of this week, right? If so, why not complete the dosing? Without refuting anything anyone says above, its far from conclusive that the VX is the source of the rash. Just look at the number of SOC tx'ers here who have major itch/rash issues with no VX whatsoever.
Keep the faith! Just a few more days to go!
Your experience is pretty convincing evidence that the VX causes this skin reaction or rash or whatever it is, I hope they can remedy it somehow. All of you guys' descriptions are very similar. Thanks a lot for sharing it with me/us.
Im no expert on statistics, but it seems that 3 random people from various parts of the US on the VX trial posted here and they all had the rash would indicate a rather high percentage. Statistically that says something to me.
Have they given you your VL and other stats? Aside from this nightmare, how are you doing with the IFN/Riba?
hang in there.
I'm in VA as well!
FL,
The 12 week Arm is unblinded around week 10. This Arm ceases all dosing [VX, Peg, Riba] at the end of week 12. All other Arms remain blinded until around week 20, as I understand it.
The temptation to get a PCR off the reservation is becoming considerable!
Like Kal said - it sounds B.A.D. and I had an extreme case of the ribarash and it was nowhere NEAR what they are experiencing.
I also have a 'sunburned chest' that started in the beginning, (about 4-5 weeks ago) with some minor bumps and a little itching. It's still red and ugly - but doesn't itch much. I was getting concerned after reading pln's post..but I think that's really what it is...i.e. sun exposure coupled with the photo-sensitivity from the meds. It's as though my sunscreen didn't work...Who knows? If it was really sunburn, it should be gone by now. The PA from my study asked me specifically on my last visit if I had any rash...so I showed her my 'sunburned chest' and she said it did not look like the normal rash from riba that they're used to seeing. However, they weren't sure what it was. Also, I'm not on any bitter tasting pills...so I guess its still a mystery. I'm crossing my fingers that it doesn't turn into something worse.
http://www.dermnetnz.org/scaly/guttate-psoriasis.html
Also look at the herald patch compared to a seb derm patch which often is also mid-chest
http://www.dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html
Sometimes I thought these derms were winging it with the dx and actually had conflicting diagnosis' at one point. Here's another condition called "poikiloderma civatte" -- it can also occur on chest and I was also diagnosed with that although another doc thought it was rosacea or seb derm.
http://www.dermnetnz.org/colour/poikiloderma-civatte.html
Smartest thing one derm said to me when I questioned why I was getting so many diagnosis' is when he said the skin doesn't have a name for what it goes through, doctors are the ones that make up the names. The one thing I'm sure of is that inteferon brought out the worst in my skin -- and in many others.
Be well,
Jim
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Mre,
Sorry you're having some skin problems. I certainly can relate and went through skin hell for close to 54 weeks. I'm a little unclear on if you finished your 12 weeks of what you presume to be Vertex, as my understanding is that the trial is still blinded and no one knows if they're taking Vertex or not. What did the trial doctor or nurse say? I would assume they have more data than on one or two patients.
PLN:
I would not follow ANYONE'S advice on starting or stopping drugs -- especially the primary drug in a trial -- before first discussing with both trial nurse and trial doctor. Mre's experience, may be similar to yours, or may be different -- certainly no one can diagnosis a skin rash over the internet. If you have the least thought that the rash could interfere with treatment, I'd see the trial doctor very soon.
PDS: Is hubby done yet?
This is not to say that VX-950 isn't causing the rash discussed, but it doesn't make sense to jump to conclusions -- or to alter treatment protocols -- based on one or two reports. What does make sense is to show what is going on to the trial doctor and take it from there.
-- Jim
-- Jim
There's more to it than this and I'm not going into it all here. But at this point the VX in some shape or form is causing rashes in an apparently significant portion of patients while being dosed with peg and riba for the duration were/are on it. That doesn't mean it isn't going to work, because it most certainly does kill the virus and kills it with a vengeance. And it doesn't mean that it's failed its test by any means. It simply means that there is some form of potential roadblock with the VX that is going to have to be reckoned with in some way. Before this experience, I had never heard a single bad thing about VX. That's why I signed up, it showed great promise with nary an apparent downside. It may very well be they already know what the causative factor is for the rash and are already developing a workable plan to deal with it (shortened dose period, no riba, controlled pred taper at end of dosage etc etc). But I'm pretty comfortable going out on a limb right now in saying (1) the rash I had is NOT typical riba/SOC rash, it's a different animal altogether, I know that now, and (2) the VX in some way, shape, or form was responsible for the rash when dosed with the riba and peg (meaning that it's possible it wouldnt have happened without one or the other two drugs).
Again, I really don't want to be discouraging to anyone here who suspects they may be on placebo. But the curious irony here is that all things considered, I would probably have been better off if I were in the placebo group. My increased odds of achieving SVR because I was getting the VX are probably all but wiped out by now because of the riba and VX dose reductions I experienced along with having to take prednisone (an immunosuppressant). All I can hope now is that my anti-viral bridge hasnt been broken in all the chaos.
Regardless, best of luck to everyone in the study. Keep fighting!
Lastly, of course pam should tell her doctor and get his concurrence. But the thing is is that the rash is deceptive, it creeps up slowly and then all of sudden blows up in an uncontrollable manner. Then at that point the immune response is like a huge lumbering juggernaut that takes days or even weeks to respond or change directions to certain corrective inputs. The sooner you get on top of it, the better off you'll be...BELIEVE ME. And I can assure you the number A1 priority is to REMOVE the offending agent. Just my laymen's internet expert opinion, as asburd as that sounds. But at this point after seeing how my doctors fumbled around for so long and after all I've learned in the last few weeks, I'm convinced I'm the resident expert on the subject at this point. So yeah, I'm gonna go out on a limb and assert that you should stop the VX! And no I'm not a doctor, but I'm STILL going to recommend it! Purple welts on my A$$ I still say so and say without the slightest reservation!
First, of all, docs are real good at "shaking their heads" when it comes to side effects. I can't tell you how many times I've heard from a well-known doc in his field "Never heard of that", "Never heard of this" -- I think it's a course given in med school called "Never heard of 101" :)
Turns out, what I had was guttate psoriasis layered probably with contact dertmatitis, seb derm and who knows what else -- so yes, it was caused by the treatment drugs BUT BUT the strategy used was NOT to stop the drugs but to treat the skin problems. The risk versus reward thing -- just like we don't stop the drugs when we get anemic, we treat the anemia with Procrit, etc, etc. And, many others have had severe skin problems on riba and peg and in most cases the drugs are not stopped, rather the probem is treated. Of course in some cases the drugs are stopped as this is a case-by-case thing.
In your case, you apparently finished the 12 weeks of what you presume to be VX-950, so I'm guessing that regardless of what your doctors are saying now, they didn't feel it serious enough to stop your treatment during the 12 weeks on VX-950.
PLN has his own doctors and all I'm advising is that he has them evaluate exactly what's going on with him before making any decisions. While what you have may sound exactly like what PLN has, it indeed may be different in form and/or severity.
I do understand that another person here has reported similar skin problems. Did you ask your trial doctor how many of his VX-950 patients have a similar rash? It may turn out that you're part of an unlucky minority, just like I was part of an unlucky minority with my severe skin problems. Still, I gutted out treatment because the reward (both in my opinion and my doctors) was worth the risk.
Don't want to be insensitive -- and it's certainly impossible to compare one person's pain to another -- but I've been there, done that, paid my dues -- and suffered for 54-weeks so I'm gonna say it. Suffering 12 weeks with skin problems is *probably* nothing compared to what many of us go through who have treated for 48, 54, 72 weeks or even longer.
Sorry to be blunt but don't want to scare anyone off a VX-950 trial unless, of course, it's warranted by what their doctor says.
-- Jim
http://www.dermnetnz.org/viral/pityriasis-rosea.html
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You'll read that pityriasis rosacea resolves itself in a few weeks. Just keep in mind that all bets are off on things resolving themselves quickly when you're on interferon. My guttate psoriasis persisted for a year in spite of UVB Narrow Band light treatments which seemed to repress it some but at the same time aggravated my rosacea.
Again, not saying this wasn't caused by VX-950, but take a good look at those pictures. That's how 70% of my body looked and I was not on VX-950. Just Peg and riba.
Feel better soon,
-- Jim
T