Reaction to nicotine patches - reaction not followed up

[SHINEYSABRINA]

Hi,in May 2006 I had a reaction to Nicotine Patches. Severe rash, arm body and legs. The skin was breaking. Severe leg swelling with burning erythema occurred and I was off the patches at this stage. I also had night sweats. I attended A&E and commenced a reducing does of steroids. I was also taking Zirtek (Cetirizine). I became disorientated about a week later with intermittent extreme fatigue. My friend arranged for me to go to the GP the next day, I was not capable. It looked like I had taken illegal drugs.He was a  locum and just told me to stop the steroids. I did but did not improve. I was off work for 3 months with extreme fatigue. My speech was slurred. I spend the day on the sofa and would only manage limited activity, like washing the dishes twice a week. I reduced my hours to 4 days a week when I returned to work after 3 months and needed to catch up on sleep at the week-ends. My GP agrees that yes I must have had some ongoing reaction however insists on it being depression (which I have a history of). I understand that tiredeness is a symptom of depression but I strongly feel that it is not the case. I was not 'down' at any stage. I commenced accupuncture in July of last year which helped but I am still not funtioning fully, as I did prior to this episode. I can become very suddenly tired and if I am planning a night out, I have to make sure that I take it easy before that and get extra sleep. I felt it may be fibromyalgia. I do get joint pain but it is very mild. Small amounts of exercise can leace me sore but nothing that would effect my day to day living. My skin has had major cahnges also. I now have very sensitive skin and have a continuous rash on my abdomen. I have tried Hydrocortisone 1% but that doesn't work. I had 'bloods' done, which were normal. Also my hormone levels were done and were fine. can you advise on what you think it might be.

[Kevin Pho, MD]

I am not aware of an allergic reaction to nicotine patches lasting this long.  The steroids and the Zyrtec would be appropriate initial therapy.  

Regarding the chronic conditions, you can consider an ANA level and rheumatoid factor to look for possible rheumatologic diseases like lupus or rheumatoid arthritis.  

Slurred speech warrants a neurology referral to ensure there aren't any TIAs or mini-strokes.  An brain MRI as well as carotid ultrasound can be done as initial evaluation.  

Further evaluation of the fatigue can be done with blood tests looking at the thyroid level, B-12 level, blood count and metabolic panel.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[SHINEYSABRINA]

Thank you for your reply. I am ot sure if you can reply to me again but I feel that the slurred speech was more to do witht the level of exhaustion that I was feeling and that my body did not have the energy to move its muscles!!! Do you think it would still be necessary to get it looked into?

Thanks