So today I came across a pretty weird crazy case in the Rheumatology clinic. A 47 yo female had come in with complaints of a new “rash” that had formed on her arms. It all started 2 months ago when she was admitted to the hospital for something unrelated and was given several doses of prednisone. She was on the prednisone for 2 weeks and then was tapered off. Just when the prednisone finished the “rash” formed on her arms. 

Anywho, I took a look at this rash… which didn’t look like any rash I’d ever seen. It really looked more like this:

(This is not a picture of the patient… just something I found online… but it represents the physical finding pretty well, except the dark spots were a bit bigger and went from the top of her hand up to her elbow)

Now, to me, it just looked like a bunch of freckles on both her arms. I had never heard prednisone causing this kind of side effect. I was pretty confused (as was my attending so it wasn’t just me)

Of course we were missing a very important part of the history. This patient apparently had vitiligo a long time ago. Vitiligo is the same disease that Michael Jackson had. Yeah, the one that turned him white. It’s thought to be due to auto-antibodies that attack melanocytes, the cells that create skin pigmentation  stopping their function and effectively turning someone non-pigmented. 

So what had happened was the prednisone had actually supressed the auto-antibodies and allowed the melanocytes to regenerate/ regrow (not really sure which) and started producing melanin again causing these spots of pigmentation. CRAZY. What she thought was some crazy side effect of the drug was actually just her skin color returning to normal. 

In other news, I got another interview! This time its at Stamford, CT, about an hour northeast of NYC. Exciting times!