week 9 rash

[4c2h]

My rash began on my forearms as tiny bumps during week 7 of triple therapy with Incivek.  Spread to my thighs, now covers most of my torso. The bumps have turned to welts with areas of leathery texture. Severe itching, especially at night.  I'm not sure if I can make it thru week 12.  Topicals only provide short-term relief.  Last week the nurse said this was typical, Any suggestions for relief?
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[marivirginia]

My nurse ignored my spreading rash..completely disregarded..at week 10. 5 I insisted I see my doctor....when the nurse saw how the rash had progressed, she said out loud..I never saw any rash on you...to which I replied....yes it was there and I showed you..so the doc immediately took me off the incivek..went to a dermatologist and then came the withdrawl..it was difficult, but the dermatologist really helped me through it. today at 17 weeks, the rash is gone..I do not take meds for the rash and I am Undetected....hang in there, but do insist they look at the rash..good luck!
Mary

[marivirginia]

My nurse ignored my spreading rash..completely disregarded..at week 10. 5 I insisted I see my doctor....when the nurse saw how the rash had progressed, she said out loud..I never saw any rash on you...to which I replied....yes it was there and I showed you..so the doc immediately took me off the incivek..went to a dermatologist and then came the withdrawl..it was difficult, but the dermatologist really helped me through it. today at 17 weeks, the rash is gone..I do not take meds for the rash and I am Undetected....hang in there, but do insist they look at the rash..good luck!
Mary

[pooh55811]

PS: I just want to add that I do NOT think any over the counter meds will do anything for your rash. The over the counter meds are like taking candy when you have a bad rash. They don't phase it. They just are not strong enough. Your rash sounds pretty bad. You need to get it under control yesterday. In my opinion, if the nurse or doc suggest Benadryl or Zyrtec or Claritine (over the counte medsr), tell them you need Hydroxyzine.

If you do not get that rash properly treated and under control you potentially risk having to stop treatment. That has happened to a handful  people on the forum when their treating teams ignored their rashes.

[pooh55811]

In my opinion, the nurse should not have ignored your rash last week. Ignoring Hep C drug rashes is a big mistake because they tend to snowball, just like your rash did.

I got a bad rash starting about week 10. The over the counter meds were useless. The case manager did nothing. I finally demanded treatment, and finally got it, but by then the rash was everywhere and all various types of plaques, bumps, hives, etc. I eventually saw a dermatologist who put me on Hydroxyzine 50 mg. every 6 hours (oral), Fluocinonide ointment, and clobetesol soln.  These three drugs finally got the rash under control, although it took awhile to do so. The topical ointment helped decrease itching and clear the rash (in the are I put it on) but it took about 3 weeks at least to clear it. But then it just moved over, next door, where there was no ointment. That is why the Hydroxyzine is needed. It controls the itching and it also works systemically to counteract the drug reaction you are having. Until I was on Hydroxyzine, the rash was out of control, and I felt like total crap because that drug reaction is not just a rash, it is systemic. Once I got on the correct dose of Hydroxyzine, the rash was held at bay and I felt so much better, my whole body felt better.

By the way, I got the rash in early December and I still have it (lurking under the skin). It is just not a problem as long as I take the Hydroxyzine every 6 hours and use the topicals if needed. The other time it's a problem is if I get even the least bit warm. Then it blooms and itches. So I keep the house at 66 degrees and rarely go outdoors.

It helps to stick your feet out at night, have a fan by the bed or overhead, have very light covers, sleep in the nude, wear lightweight cotton during the day, (I lived in my lightweight nightgown during the day from Dec. through mid March), no tags in the neck, no lace or picky stuff, no heavy clothes with seams  (like Denim), take the oatmeal baths. A few ice packs in the refrigerator (not frozen just cold) help too because if you get an itchy spot you can cool it down so as to avoid scratching it. Once you start scratching, pretty soon you itch everywhere.

But, the main thing to get the rash under control is prescription medications (Hydroxyzine oral and a high enough dose to work) and steroid cream or ointment or solution.

From experience and from being on the forum it seems most treating docs (and the nurses and case managers)  are clueless about the rash and how to deal with it. You may have to be very assertive to get the prescriptions. Also, if you can get in to see a dermatologist on an urgent basis, that doc should order the right meds in the right doses.

I would urge you to act on this tomorrow morning and get the prescriptions tomorrow. You need to get that rash under control so that you can continue treatment.

I just reread your post. You may need to go to the emergency room and get something today. It sounds like it is getting worse.

Here is a link to rash photos (mild, medium, severe):

http://www.incivek.com/hcp/assess-and-manage-rash

http://hepatitiscnewdrugs.blogspot.com/2010/10/skin-rash-during-chronic-hepatitis-c.html

If you can get the rash and itching under control, you will be able to tolerate treatment.

My rash was not from Incivek. It was from Riba or Interferon or both. I am in week 42 of treatment. I never reduced any meds, but I probably would have had toreduce them if I had not gotten the Hydroxyzine and steroid prescriptions.

[Idyllic]

Yay for making it to week 7.

When the Incivek rash progresses to a certain point does not resolve on its own.  imo you should be a little more aggressive and start trying to contain it.

Oral Antihistamine:
I would ask the nurse for a prescription for Hydroxizine (Atarax) or you could use OTC Benedryl. During the day maybe you could use a non-drowsiness antihistamine.

Topical Corticosteroids:
A lot of people on here seem to find relief with Fluocinolone acetonide. It depends on the severity of your rash I suppose.

The Rash is number 4 and 5 in the bulleted list under the section entitled "Warnings and Precautions"
http://www.incivek.com/hcp/vertex-gps-guidance-patient-support

Plus there is a number for a help line. You ought to call and see what they say.

Here is some Steroid info from the DermNet NZ site
http://dermnetnz.org/doctors/dermatitis/corticosteroids.html

The Incivek link says, "Treatment of rash with systemic corticosteroids such as prednisone and methylprednisolone is not recommended."  

Class 1: very potent (up to 600 times as potent as hydrocortisone)

    Clobetasol propionate
    Betamethasone dipropionate in propylene glycol base

Class 2: potent (I50-100 times as potent as hydrocortisone)
  Betamethasone valerate
  Betamethasone dipropionate
  Diflucortolone valerate
  Fluticasone valerate
  Hydrocortisone 17-butyrate
  Mometasone furoate
  Methylprednisolone aceponate

Class 3: moderate (2-25 times as potent as hydrocortisone)
  Clobetasone butyrate
  Fluocinolone acetonide
  Triamcinolone acetonide

Class 4: mild
  Hydrocortisone 0.5-2.5% (acetate or alcohol)

Corticosteroids are absorbed at different rates depending on the thickness of the stratum corneum. A mild topical steroid that works on the face may achieve little on the palm. But a potent steroid may quickly cause side effects on the face.

For example:

    Forearm absorbs 1%
    Armpit absorbs 4%
    Face absorbs 7%
    Eyelids and genitals absorb 30%
    Palm absorbs 0.1%
    Sole absorbs 0.05%

Absorption is greater in an ointment base, in the presence of a keratolytic agent such as salicylic acid and under occlusion.

♫ Do not let this snowball!!
Hope you feel better!!

  

[coeric]

i was constantly reminded by the clinicians to pay close attention to my mouth. they said they wanted to see me immediately if any of the mucus membranes became inflamed. also none of the over-the-counter stuff had any effect on the rashes. at 42 weeks i still  occasionally use the chlobetasol, a powerful steroid cream, to keep the rash under control.  the dermatologist said the if i don't the rash could spread. if i had it to do all over again i might use the vic instead of the incivek.

[Dawn703]

I got the rash twice. The first time I used lotions such as gold bond, but mainly eucerin calming cream. Second time nothing touched it except fluocininide (a prescription). I got a little bit of relief the first time I used it then over a few days it got better and better.  

[curly501]

I've been told getting in the sun while on tx,is one of the reasons for rashes.

[hrsepwrguy]

Great to hear from you, glad to hear that you are still tx, wishing you all the best.

Keith

@4c2h sorry for the hijack

[coeric]

Sorry to hear about the rash.  i am on week 42 of triple with incivek.  my rash started the first week of treatment and was put on hydroxyzine to control itching .  By week 9 the rash had spread to most of my body, from the bottom of my feet to the top of my head.  went to my dermatologist who put me on chlobetasol cream.  At week 10, Dr. E discontinued the incivek lowered the peg to 90mcg.  i was asked several times at that visit by 3 docs (2 hepatologists and 1 pharmacologist) if i wished to continue therapy. i am experiencing cirrhosis and believed that this was my last chance. i asked Dr. E how my rash compared with the other patients and in the clinical trials that he had treated.  his answer - "one of the 3 worst,"  he uses photos of my rash to train other docs how to deal with it. there was some concern that some of the rash might be vasculitis, because the eosinophils were increasing.  Three biopsies showed that the rash was superficial. At one point he struck me really hard three times on a rib with a ball point pen.  he said if spot turned a whitish color it meant i might have a very serious condition known as SJS. fortunately it did not.    At week 11 i was spiking a fever and felt terrible. Dr. E reduced the ribavirin to 600 and the peg to 45mcg and started me on 80mg prednisone.  he tried to tapper the prednisone down but at week 14 the rash kicked up again big time. Dr. E reduced the ribavirin to 400. and increased the prednisone. i stayed on the prednisone until week 16. i spent at least an hour each day during that time in a cool oatmeal bath. i used 3 to 4 packages of avena oatmeal in each bath. after the rash subsided the clinicians slowly raised my dose of peg to 135 and ribavirin to 700.  i also developed stasis dermatitis from the edema i have in my lower legs.  the docs prescribed antibiotics and steroid creams to help manage the stasis dermatitis. i also apply manuka honey on the dermatitis. the honey also helped with the annoying cracks on the corners of my mouth. i still use the chobetasol to control the small areas of rash i still have.  
i was extremely fortunate to have an experienced hepatologist that has treated thousands.

blessing
eric

[ceanothus]

Many people on this forum have experienced moderate to severe problems with rash. It seems that only the mildest of rashes respond well to OTC meds. The rest require a prescription steroid cream applied 2x daily at a minimum, and the more severe rashes have required steroid injections and/or oral steroids in addition. A few people have had to stop treatment because the rash became life-threatening. These drugs can cause a rash so severe that it affects internal organs as well, and this is very dangerous. Before treatment began I was told that anything beyond a very minor rash should be taken to a dermatologist for consultation, without delay. Do be sure to see one ASAP. Best wishes!