Skin Care In Rheumatoid Arthritis

Dr.Dhanashri Bide

Skin manifestations in patients suffering from rheumatoid arthritis are fairly common and are seen in almost 40% of the patients .Some manifestations are specific for the disease and some are the consequences of the treatment given for RA.The severity varies from patient to patient and if proper care is not taken it affects the day to day routine in many ways.

Various skin conditions observed in the patients are as follows:

1.Rheumatoid Nodules:

These are hard lumps observed around bony areas like elbows , ankles or fingers.The size can vary from a pea size to size of a ping pong ball.Usually the medicines given for arthritis take care of these nodules.In few patients surgery may be required.

2.Corns and callosities:

The joint deformities affect normal movements and lead to excessive trauma and friction.This makes the patients prone to develop corns and callosities which can be very painful.

There are few simple tips to take care of them.

A.Soak the area with the corn or callus (let’s use your foot as an example) in warm water until the skin softens – usually 5 to 10 minutes.

B.Wet a pumice stone or emery board.While the skin on your foot is still soft, gently move the pumice stone or emery board across the corn or callus to remove dead tissue. 

C.Apply a moisturizing cream or lotion to the corn or callus and surrounding dead skin every day. Look for products that contain urea, salicylic acid, or ammonium lactate. These ingredients will soften the skin over time.

D.Surround your corn or callus with donut-style adhesive pads or make your own donut pad .Padding helps protect the corn or callus from irritation and relieves pain and pressure.

E.Wear properly sized and shaped footwear. Wear shoes with increased width and height in the toe area. Consider buying footwear at the end of the day when your feet are slightly swollen.

F.Keep your toenails trimmed. Long toenails can make your toes push against the top of your shoe causing friction and increased pressure. Cut toenails straight across. Do not round the corners.

G.If your corns or calluses are painful, apply a cold pack to reduce the pain and swelling for no more than 10 to 20 minutes at a time.

H.You may visit your doctor in case of difficulty.They will do paring with 11 no.surgical  blade and help to remove the excess hard skin.

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3.Raynaud’s Phenomenon

In few patients tips of the fingers and toes turn blue in winter season or while working in cold water.

Tips to avoid:

A.Wear warm gloves ,socks and hat or monkey cap to keep the body warm

B.Running warm water over hands and feet or soaking in a bowl of warm water can be helpful.

C.To prevent drying and cracking of skin by moisturising after every wash.

D.Avoid smoking and caffeine

E.Wear comfortable wide shoes and warm socks

4.Skin Changes:

Skin can become thin, transparent ,dry,fragile and bruise easily.It is essential to wear protective gear (e.g.Hand Gloves) while working so as to avoid trauma.

Tips to avoid dryness:

A.Take bath with Luke warm water

B.Quick bathing so as to retain natural oil in the skin

C.Use fragrance free soaps and laundry detergents

D.Avoidscrubs,besanata and utane

E.Pat dry the skin and within 5 minutes apply moisturiseror oil.They give best results when applied immediately after bath and lock the water in the skin.

F.Wear comfortable cotton clothes and avoid wool.

5.Photosensitivity:

In few patients this side effect is seen because of the medicines used for treating rheumatoid arthritis.Best way to avoid is to protect.One should avoid going out before sunset if possible.You can plan your work accordingly.If at all it is essential to go out then protective clothing in the form of hat,umbrella ,scarf .sun coat and gloves should be worn.Alternative option is to use a sunscreen all the time.It should have sun protection factor of minimum 30 and needs to be reapplied every 2-3 hours.It should be gently spread over the skin and should not be rubbed in.The quantity to be used is also important and your doctor can guide you regarding proper use of sunscreeningagents.Care should be taken while working in the kitchen and in front of computer devices as the heat and infrared radiation can also have damaging effect on the skin. 

6.Yearly skin check up: If you are taking biologics for your disease there is increased chance of developing skin cancers.If you notice any bump or swelling on the skin you must visit a dermatologist.Yearly check up with dermatologist can help in early detection of  skin cancers and prompt treatment can be  given.

Thus a patient suffering from RA should try to understand other implications beyond the joint disease.Skin manifestations are fairly common and can cause significant morbidity.Simple home care can help in relieving symptoms of many conditions like corns ,callosities,skin dryness and photosensitivity.All patients should understand and implement these measures in their daily care routine so as to avoid complications.This can improve the quality of life and will help in regaining the confidence.