When does a rash warrant a trip to the doctor?

June 24, 2017 8:21 PM

Yesterday, I finished a three week course of prednisone, prescribed by my neurologist to rule out rebound headaches. About a week ago, I developed a rash on my chest that I thought was heat rash, because that happens to me and I was outside on a hot day. But it's gotten worse.

The rash has spread extensively and now covers from my breasts to jawline, on both sides of my body. It is itchy and painful and I feel like I'm on fire. During my time on prednisone, I developed a painful tingling on the left side of my body, so if the rash was just on the left side, I'd suspect shingles. The rash is a combination of red bumps and pink welts. I've had shingles before, and still have the topical corticosteroid from that, and using that today provided a small bit of relief. I have never had a problem with prednisone before, but I've only ever been on it for a week at a time. YANMD, but do I keep using that or pay the ridiculous copay for urgent care tomorrow?

posted by Ruki to Health & Fitness (7 answers total)

Best answer: I would go to urgent care.
posted by Hermione Granger at 8:40 PM on June 24, 2017 [2 favorites]

Best answer: If prednisone didn't help the rash, it's unlikely that topical hydrocortisone will do anything because it's much less strong, and it wasn't designed to be used on large areas of the body.

Yes, please go to the doctor about this! Pretty much any rash can warrant a trip to the (primary care) doctor, but an extensive and bothersome rash that is spreading is probably worth an urgent care visit.
posted by treehorn+bunny at 8:41 PM on June 24, 2017 [6 favorites]

Best answer: I would go to urgent care because it could be completely unrelated, or you could have developed a sensitivity to prednisone, possibly exacerbated by the more lengthy exposure. Or it could be shingles again! You don't know, and it should be treated appropriately.

Shingles absolutely can present on both sides of the body at the same time--it happened to my mom. They do typically manifest in strips of welts and bumps, hence the name I guess, but they can manifest more randomly too. And if it is shingles, you're contagious for anyone who isn't immune or immunized against the virus. Which is a lot more people nowadays but still not everyone, and it's best to know so you can minimize exposure to immunocompromised people.
posted by padraigin at 8:47 PM on June 24, 2017

Response by poster: Ah, well, crap. It totally feels like shingles, but I didn't know it could present bilaterally. I've cancelled my plans for tomorrow to go to Urgent Care.
posted by Ruki at 9:16 PM on June 24, 2017

If you have shingles it is best to start taking the anti viral meds right away so depending on how long you've had the rash I think you should consider going to the ER tonight. Speaking as someone who nearly had shingles in my eye, which could have blinded me, it's no joke. Alternatively if you have a supply of anti viral meds, start taking them now.
posted by mai at 10:44 PM on June 24, 2017 [3 favorites]

Yes, urgent care now. Lengthy steroids can bring on shingles.
posted by citygirl at 2:02 PM on June 25, 2017

Response by poster: So I had my followup with my neurologist and she said it definitely wasn't caused by the prednisone and that it looked like... chickenpox. I spent over an hour at my GP's office today where she said it looked like... chickenpox. They brought in a pediatrician. But they're confused because chickenpox isn't generally localized. They're treating me for chickenpox/shingles and debrided a sample to be be tested, plus ordered bloodwork for chickenpox, shingles, and measles titers. Even though I had it over thirty years ago, plus have had shingles, it looks like chickenpox, round two.
posted by Ruki at 10:26 AM on July 7, 2017 [1 favorite]