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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 9185
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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Can an “overdose” on nicotine cause a skin rash or joint &

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Can an “overdose” on nicotine cause a skin rash or joint & tendon pain? If not, please help point me in the right direction; my dr’s are at a loss.
I quit smoking a while back but have not stopped the NTR. I probably consume upwards of 20mg of nicotine through gum and/or lozenges. I have been experiencing significant pain from what is being called plantar factitious and itchy rashes on the back of my calves top of my thighs and my shoulders which looks much like shingles. I also am experiencing whitlow-like break outs on beyond the third knuckle of my right ring finger and pinkie.
The rash flares up and then goes away in 1-2 week intervals. When it is particularly bad, the lobes and tops of my ears break out as well as other spots around my face. Sometimes, particularly on my ears, the rash oozes yellow liquid although I do not believe it’s a secondary infection; products like Neosporin do nothing.
While my diet did go in the tank over the holidays, I’ve been struggling with weight loss; I’ve been eating better and less and swimming a 500 per day (roughly; probably safer to say every other day), but my weight keeps going up. That said, there are areas of improvement in my diet; particularly in portion control…
Prednisone clears up all symptoms, immediately. However, as my wife says, I’m not that pleasant when on it.
I’ve been to two dermatologists who swear this is a contact sensitivity but the patch tests can’t find anything. I’ve been to an allergist who says this is not an allergic reaction. I’ve had several blood draws to test for things like herpes, Reiter’s syndrome, autoimmune issues, Celiac disease, allergic reactions, and lupus. All have been non-conclusive.
Overall, I am a healthy 40 year old white male of Germanic and Welch decent. I have fair blood pressure, sugars and triglycerides for someone my age. I am 5’10” and 205(ish) lbs.
Any help resolving this rash will be greatly appreciated.
Hi,

Would it be possible to take a photograph of this rash at your convenience?
Customer: replied 4 years ago.

Here's a link to a series of images:


https://docs.google.com/folder/d/0B05PuMh9ap1UNU0wTDB4TjNpMGs/edit


 


The images in the 700 series were taken in July '12 and show when the rash on my lips was quite significant. The images in the 4006-4015 range were taken today. My lips cleared up a while ago; these are just given as reference.


 


The rash, while itchy, isn't at bad at the moment as it has been. My fingers are moderately bad at the moment and the skin on the tip of my pinkie is a bit compromised; this will get worse in coming days.


 


Also, I've been nicotine free for over a week and the rash is not markedly improved.


 


Thanks.

Good Morning,Can't seem to view these images on my phone. Will get to a computer in 4-6 hours and take a look. Regards.

Thank you for the photographs. Your history and clinical picture are highly suggestive of Discoid Eczema. This is a type of Endogenous Eczema characterized by the coin/disc like patches, which may or may not become confluent and are itchy. It is often, but not always, seen in people who are prone to allergies or have other skin eczema.

Discoid Eczema is harmless per se but has considerable nuisance value because of recurrences. It has nothing to do with nicotine use. The condition ultimately burns out on its own but it is impossible to predict how long this will take. Management focuses on symptomatic relief and clearing up the patches and consists of:

1. Daily use a good moisturizer (Aveeno, Cetaphil or Jergens) - at least twice a day. Preferably three-four times a day. This is the most important measure to prevent the rash coming back again and again.

2. Flovent cream (Fluticasone propionate) twice a day till the rash disappear, then once at night for 14-28 days after that. This should be combined with Mupirocin cream in a 1:1 ratio prior to application. Once the rash has subsided I start patients on Tacrolimus 0.03% ointment or Pimecrolimus cream for a few months to prevent a recurrence.

3. Tab Atarax 25 mg two to three times a day depending on the severity of the itching

4. Soap free body wash (Nivea makes a good one) for bathing - avoid soaps as much as possible.

5. General Precautions - only use luke warm water for bathing, keep away from dust, cotton socks only, avoid any perfumed creams.

Since these are prescription drugs, I would recommend seeing your family physician or dermatologist and discussing my recommendations. Some patients need oral steroids for short bursts to get initial control after which the regimen above is continued. Oral steroids clear up the problem in a matter of days but obviously are not a long term solution, hence the need for a regimen like the one detailed above.

Till you discuss my suggestions with a dermatologist, do all the general measures I've mentioned and use a mixture of 1% Cortizone cream and Bacitracin ointment over the rash. Mix them in a 1:1 ratio. And take Claritin 10 mg twice a day in place of the Atarax.

About the joint and tendon pain - I don’t believe these are related to your skin condition - the most common skin condition that has joint and occasional tendon involvement is Psoriasis but your skin patches don't look like Psoriasis. Autoimmune conditions like Lupus can also cause skin and joint symptoms but you seem to have been worked up for these. The best person to see about your joint pain would be a Rheumatologist.

Please feel free to ask if you have any queries.

Please remember to only rate my answer when you are satisfied. If you do have any queries please respond via the REPLY button. I will be happy to continue further and do everything I can to provide you with the service you seek.

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