Author Topic: Prednisone, acne, and tapering  (Read 4098 times)

Ark mom

  • Hero Member
  • *****
  • Posts: 675
Prednisone, acne, and tapering
« on: May 18, 2012, 04:30:06 PM »
Okay, so my face is really breaking out in acne.  I have been on prednisone, 10 mg daily, for over a month.  My doctor said he really wants me to slowly get off the drug, but he really didn't say what to do.  He have me two more months of it.  Is it the prednisone causing my acne, correct, and not Plaquenil? 

About three days ago, I took one 10 mg tablet, cut it in half, and then one of the halves into half.  So, I took, in effect, 7.5 mg, instead of 10 mg.  I have been on this dose for three days now.  The first two days were yuck.  My elbows really hurt, and I felt worse than usual.  Today, I am a little better.  My doctor is hard to get a hold of, and I suppose I can call my pharmacist. 

I realize that you guys should not be advising my drugs, but I was curious what a typical taper schedule looks like as a point of reference. 
41 yo with Sjogren's (sero-neg), FMS & sub-clinical Graves; Plaquenil, Evoxac, prednisone, Restasis, Cellcept, gabapentin, duloxetine

anita

  • Hero Member
  • *****
  • Posts: 1925
Re: Prednisone, acne, and tapering
« Reply #1 on: May 18, 2012, 04:43:22 PM »
Your doctor is the only one that should be advising your taper...not even the pharmacist.  Taper schedules can vary based upon other meds, your other conditions, etc.  You need to leave a message for the doctor and wait for his return call...even if it takes a few days.

50 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (PID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Nitro, Cardizem, Imdur, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Oxycontin, Zofran

Ark mom

  • Hero Member
  • *****
  • Posts: 675
Re: Prednisone, acne, and tapering
« Reply #2 on: May 18, 2012, 05:25:02 PM »
I totally get that, Anita, thank you.  As I mentioned before, I'm not soliciting advice on how to taper MY meds.  I did call and leave a message today.  I was just wondering was it is like for others so that I can ask the right questions and be proactive in my care since this is my first time.

Do you feel sicker as you begin tapering?  Is that normal?  How much do you usually subtract and how often?  How do you know when is the right time to begin your tapering?  Do you just keep going on the taper schedule if you start to feel worse?  Thank you in advance! 

I am surprised that my doctor didn't give me any instructions at all about what to do other than say he wants me to get off of it soon. 
41 yo with Sjogren's (sero-neg), FMS & sub-clinical Graves; Plaquenil, Evoxac, prednisone, Restasis, Cellcept, gabapentin, duloxetine

Sleepy In Seattle

  • Hero Member
  • *****
  • Posts: 1072
Re: Prednisone, acne, and tapering
« Reply #3 on: May 18, 2012, 05:58:31 PM »
Wow - I am also on my first experience with Prednisone - 60mg/day for a month, then they'll taper me off - but we're going to try a fast taper -
when the month of 60mg/day is over, I go to
- one week of 50mg/day
- one week of 40mg/day
- one week of 30mg/day
---etc, until I'm off it.

But if you're feeling crummy only backing off from 10mg to 7.5mg, I am a little scared how this is going to go!!! (I know everybody is different). Also, they are ramping me ONTO methotrexate, so it's not like I am going back to just Plaquenil.

I kinda love the prednisone. I feel great on it! Awesome energy level, very few aches or pains, and almost no side effects, except my brain wants to think about stuff every night at about 3-4am. But I meditate and can usually get back to sleep by 4:30 or so. It's not too bad. And I am sorta starting to look like a chipmunk, with puffy cheeks.

Maybe we can just both see what happens and compare notes!  :D

Best of luck to you with it - and DEFINITELY keep your doctor in the loop. You don't want to mess around with Prednisone.
Sjogren's, Lupus, Raynaud's, APS
Fatigue, Brain Fog, Autoimmune Hearing Loss, joint/muscle pain, dry mouth, clots in retina, etc :p
Supplements, Plaquenil 400mg/day, Aspirin 325mg/day (for APS), Methotrexate 10mg/2x per week, Prednisone 5mg/day

anita

  • Hero Member
  • *****
  • Posts: 1925
Re: Prednisone, acne, and tapering
« Reply #4 on: May 18, 2012, 08:46:36 PM »
Most people can tell the difference during the taper...a little worse with each decrease in dose.  But if it doesn't ease off after a day or two, you should ask your doctor.  The 'rebound effect' (withdrawal syndrome) make symptoms worse when you try to get off it.  This may mean that you need to go even slower then what you're doing. 

Hopefully your doctor will call you back.  Make sure to tell him how you felt with just the drop to 7.5mg.
50 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (PID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Nitro, Cardizem, Imdur, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Oxycontin, Zofran

Crymeariver

  • Guest
Re: Prednisone, acne, and tapering
« Reply #5 on: May 18, 2012, 10:05:52 PM »
My doctor typically has me taper to 7.5 then to 5 and then by 1 milligram and to adjust the dose every two weeks.  I typically go even slower. 

irish

  • Hero Member
  • *****
  • Posts: 10415
Re: Prednisone, acne, and tapering
« Reply #6 on: May 19, 2012, 12:07:34 AM »
When you have been on 10 mgm for one month the usual method of taper is to just taper 1 mgm at a time. You may have to stay at 9 mgm for 2 weeks or so and then taper down 1 more mgm. I am on a taper right now and I think I am on a 1 mgm every month taper.

The reason you had return of symptoms and felt so lousy is because you dropped your dose way too much. You need to see your doc or get a specific taper plan from him. Tapering off of a steroid can result in very serious issues. One of the serious issues can be an adrenal crisis of failure.

When we take prednisone for and period of time over 5 days (5 days is often used for a quick start/stop regime that doesn't usually need a taper) the adrenal glands get lazy and stop producing cortisone. When we stop taking the prednisone cold turkey or cut down too fast we are in a deficit of steroids. The adrenal glands need a taper of the prednisone so that they get stimulated to wake up and start producing cortisone again.

My MIL was on 25 mgm of prednisone for a long time. She quit cold turkey without telling any of us. I told her she was lucky she didn't die. I guess the doctor royally balled her out also.

People don't realize the significance of these tapers. I am astounded that your doctor didn't explain this to you. I would ask him how he expected you to do a taper when he never told you how. Maybe there was a communication gap. Good luck. Irish

Ark mom

  • Hero Member
  • *****
  • Posts: 675
Re: Prednisone, acne, and tapering
« Reply #7 on: May 19, 2012, 12:05:41 PM »
Well, thanks to everyone who has replied!  I went back to my full 10 mg dose today until he tells me exactly what to do.   I remember feeling significantly better when I first started taking prednisone, but now I feel like I am declining instead of continually improving. 

It is disappointing to learn that this disease is not easy to get under control.  Out of the past three months, I have only had about 6 good days total.  I might have a few hours here and there of feeling okay.  This is certainly not quality of life.  I don't understand why my doctor isn't working harder to make my life more livable.  Is it because I don't test positive for the disease? 
41 yo with Sjogren's (sero-neg), FMS & sub-clinical Graves; Plaquenil, Evoxac, prednisone, Restasis, Cellcept, gabapentin, duloxetine

Scottietottie

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 8712
Re: Prednisone, acne, and tapering
« Reply #8 on: May 19, 2012, 07:26:03 PM »
Hi  :)

I don't know much about prednisone but I know it gives my son acne. (He has Crohn's Disease and needs pred periodically)

Take care - Scottie  :)
http://sjogrensworld.org/   (our home page)
http://www.sjogrensworld.org/chats.htm   (find our chat times here!)


Never do tomorrow what you can put off till the day after tomorrow!

Nancy60

  • Hero Member
  • *****
  • Posts: 1032
Re: Prednisone, acne, and tapering
« Reply #9 on: May 19, 2012, 08:08:36 PM »
Sometimes I don't think doctors really "get" how this disease really effects our lives, we almost have to have a breakdown before they realize how bad things have gotten.  A very frank discussion with your doctor might be in order.  Don't be afraid to tell him exactly what sjogrens is doing to you in specifics and that you need help, the current treatment isn't working well enough for you.  You might want to ask them to schedule extra time as you have several things that you need to discuss, that way your doctor will know you need extra time.

Good luck and I hope you find some releif.

Nancy

lolo1979

  • Sr. Member
  • ****
  • Posts: 324
Re: Prednisone, acne, and tapering
« Reply #10 on: May 19, 2012, 10:54:24 PM »
Arkmom-
I can totally relate to the situation you're currently in. When I was first diagnosed, my first rheumy put me straight on 10mg of prednisone, with absolutely no tapering instructions, and not even instructions for when to come back for a follow up visit.

I was on it about a month, and knew from research that it wouldn't be good to continue indefinitely. So I did exactly what you tried - cutting up the 10mg pills and going down to 7.5.  I definitely felt rotten for the first 2-3 days following my drop, and then it leveled off a bit.  But I was too scared to drop any more without clear tapering instructions, so I called him and made him tell me what to do.  He finally called in the doses required for tapering and gave me instructions on how to do it. Mind you, I went a lot slower with my taper than he told me I needed to.

After that, I found a new rheumatologist who would look after me better, give me a more defined treatment protocol, and in general not just leave me hanging with no instructions on what to do going forward.  Keep us posted on what happens!

Ark mom

  • Hero Member
  • *****
  • Posts: 675
Re: Prednisone, acne, and tapering
« Reply #11 on: May 20, 2012, 10:47:08 PM »
Nancy, yes, I think you are right.  I think my rheumy is a good doctor.  Heck, he is treating me without any indication of disease other than the symptoms I describe, but he is very quiet and introverted.  He doesn't say much.  Maybe he think I have been on prednisone before and know what to do.

Lolo, thanks for your description of your experience.  I at least understand now why I felt sicker at first, now.  I am feeling that maybe I might want to seek a second opinion, perhaps finding a doctor who is more verbal and will discuss things with me more. 

Even though I went back up to my 10 mg, I feel worse today.  Dizziness is really kicking in as well as some nausea.  Hope the office calls me tomorrow!  Nighty night, y'all.
41 yo with Sjogren's (sero-neg), FMS & sub-clinical Graves; Plaquenil, Evoxac, prednisone, Restasis, Cellcept, gabapentin, duloxetine

irish

  • Hero Member
  • *****
  • Posts: 10415
Re: Prednisone, acne, and tapering
« Reply #12 on: May 20, 2012, 11:46:16 PM »
Doctors are really just getting to know Sjogrens and many of them don't understand it yet. I think there is a whole lot more to be known about sjogrens. It is only the tip of the iceberg. I read years ago that a few scientists felt that sjogrens was the primary autoimmune disease and that all of the other diseases are kissing cousins. This sure tends to feel right to me for some reason.

The 6 days of feeling good is probably about right. I don't think that I have had that many days in the 9 years that I have been home on disability. I remember last April having 4 hours one afternoon when I felt almost like myself. I had energy, my brain was working good and I was able to get some things done. Of course, I couldn't hardly move for the rest of the week.

People are right when they say that the doctors don't get this. We look good and we may be able to go shopping or do some other task, but people don't understand what doing those does to us. They don't get that we can't do 2 things at once anymore. We have such a limited window when we can accomplish anything and then we have to sit and rest.

I guess I would suggest to you that you write down every day the amount of time that you felt good. You could even do a diary of time and events/chores, etc. Might give the doctor a better picture of your daily life. We just have to learn to do the absolutely necessary and let the rest slide. My house looks like someone took an egg beater to each room. Every so often I will take a box and go through the rooms and pick up, dust, etc but it wears me down. Vacuuming is a bummer!!! Good luck. Irish