Back rash

This was posted on 1/6/06 by Pauline:

ed,

It was not discovered what made the raging rash on Greg’s back, but I believe it was from severe sweating against the wheelchair back which is Naugahyde. We were in Florida at the time of the rash showing up.

Doctor prescribed the benedryl-like drug to allow Greg to sleep at night. The doctor had me wash and rinse his back, mix half & half white vinegar and warm water and rinse again, pat dry thoroughly and apply a very thin layer of Triamcinolone Acetonide Ointment USP, 0.1% as prescribed. I think that the doctor prescribed the vinegar/water solution to dissolve any possibility of soap or other residue and cause a drying effect on the nearly blistered skin.

We were lucky Greg only had it on his back. In the past, this same ointment has been prescribed for me by a dermatologist for itchy, scaly patches on my lower leg and it cleared it up completely. That doctor told me if I could see the ointment on my skin I had used too much, so it is a very thin layer that is used.

Pauline

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I received the following via email today (4/13/08):

I would like to copy an email I sent to Pauline in Maine in case you can answer my question.

Here goes:
Hello Pauline in Maine,
I was wondering if you ever discovered the cause of the back rash. My husband has complained of this off and on since his hip replacement surgery a few years ago. At first I thought it was chemicals used to launder the sheets in the hospital coupled with the heat he generated by laying on them for so long. It’s been a few years now, since his surgeries, and he still complains. I’ve tried changing laundry soaps, given him benedryl, nothing seems to make it go away. Also, his symptoms seemed to appear soon after the surgery as well. I must add that prior to his surgeries (double hip replacement), he was also diagnosed with high blood pressure and started taking toprol. Several months later vytorin, plavix, cozaar and norvask were added.
Do you think there is any connection to this? Do you have any suggestions on how this can be treated?

Thank you.

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I’m posting this here because others have had experiences with rashes and can be helpful.

Many with PD and PD-related disorders get seborrheic dermatitis (a form of eczema). A dermatologist should be able to look at the rash and tell what sort of rash it is.

If it’s seborrheic dermatitis, dermatologists often prescribe hydrocortisone (some strengths are available OTC), Elidel, and Protopic. A relatively new product is Xolegel.

For my father, for seborrheic dermatitis on his arms and chest, we used Elidel, and it worked very well.

“Clinical outcomes” paper – PSP and MSA

This is a very interesting article written by some of Europe’s top PSP researchers (and presumably top MSA researchers too).  The first author is O’Sullivan.  This is also a very important paper because it includes analysis of brains donated to the University College of London brain bank.

110 pathologically-confirmed PSP cases and 83 pathologically-confirmed MSA cases were examined for early clinical features and survival.  PSP cases were divided according to the D. Williams criteria of Richardson’s syndrome (RS) and PSP-parkinsonism.  MSA cases were divided according to the presence of early autonomic failure.

The PSP findings confirms what D. Williams has told us before:

“In PSP an RS phenotype, male gender, older age of onset and a short interval from disease onset to reaching the first clinical milestone were all independent predictors of shorter disease duration to death. Patients with RS also reached clinical milestones after a shorter interval from disease onset, compared to patients with PSP-P.”

The MSA findings are new to me (though maybe not to many of you):

“In MSA early autonomic failure, female gender, older age of onset, a short interval from disease onset to reaching the first clinical milestone and not being admitted to residential care were independent factors predicting shorter disease duration until death. The time to the first clinical milestone is a useful prognostic predictor for survival.”

Interesting (and scary?) that “not being admitted to residential care” predicts *shorter* disease duration in MSA.

I’ve copied below the abstract.

Update:  the full paper is now available at no charge.  See our post here with links.

Robin

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Brain. 2008 Apr 2 [Epub ahead of print]

Clinical outcomes of progressive supranuclear palsy and multiple system atrophy.

O’Sullivan SS, Massey LA, Williams DR, Silveira-Moriyama L, Kempster PA, Holton JL, Revesz T, Lees AJ.

Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, Queen Square Brain Bank for Neurological Disorders and Institute of Neurology, Sara Koe PSP Research Centre, Institute of Neurology, University College London, London, UK, Faculty of Medicine (Neuroscience), Monash University (Alfred Hospital Campus) and Department of Neurosciences, Monash Medical Centre, Melbourne, Australia.

Prognostic predictors have not been defined for progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). Subtypes of both disorders have been proposed on the basis of early clinical features. We performed a retrospective chart review to investigate the natural history of pathologically confirmed cases of PSP and MSA.

Survival data and several clinically relevant milestones, namely: frequent falling, cognitive disability, unintelligible speech, severe dysphagia, dependence on wheelchair for mobility, the use of urinary catheters and placement in residential care were determined.

On the basis of early symptoms, we subdivided cases with PSP into ‘Richardson’s syndrome’ (RS) and ‘PSP-parkinsonism’ (PSP-P).

Cases of MSA were subdivided according to the presence or absence of early autonomic failure.

Sixty-nine (62.7%) of the 110 PSP cases were classified as RS and 29 (26.4%) as PSP-P.

Of the 83 cases of MSA, 42 (53.2%) had autonomic failure within 2 years of disease onset.

Patients with PSP had an older age of onset (P < 0.001), but similar disease duration to those with MSA. Patients with PSP reached their first clinical milestone earlier than patients with MSA (P < 0.001). Regular falls (P < 0.001), unintelligible speech (P = 0.04) and cognitive impairment (P = 0.03) also occurred earlier in PSP than in MSA.

In PSP an RS phenotype, male gender, older age of onset and a short interval from disease onset to reaching the first clinical milestone were all independent predictors of shorter disease duration to death. Patients with RS also reached clinical milestones after a shorter interval from disease onset, compared to patients with PSP-P.

In MSA early autonomic failure, female gender, older age of onset, a short interval from disease onset to reaching the first clinical milestone and not being admitted to residential care were independent factors predicting shorter disease duration until death. The time to the first clinical milestone is a useful prognostic predictor for survival.

We confirm that RS had a less favourable course than PSP-P, and that early autonomic failure in MSA is associated with shorter survival.

PMID: 18385183