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Athlete's foot and Imuran (weak immune system)

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Posted 9/18/2019 2:38 AM (GMT -7)
This might be a bit off topic as it is not directly related to UC...

Its seems I've picked up foot fungus. It's on the skin on my left foot, it covers about 1/4 of the skin on my foot. I am treating it for 3 months now. It pulled back a bit on one part of my foot, but it spread to other places.

I've used vinegar and baking soda (for 2-3 weeks), used Canesten cream (for 5 weeks), tea tree and coconut oil (for about 10 days).

Eventually, I went to a dermatologist. I've told her that I have UC and a weak immune system (low white cell blood count) due to Imuran and that it's probably why it's not going away and even spreading. But its now obvious to me that she didn't listen to me and instead told me that it's Eczema and prescribed me a Topical corticosteroid cream (for 5 days). She also sent me to the lab to do tests. And told me to come back next week for an appointment.

The topical corticosteroid cream did decrease inflammation and remove the itch (at least some relief). A week later, tests came back positive on "rare fungal spores".

Next weeks appointment, she told me it's a combo of Eczema and fungus. So she prolonged the topical cortico cream (5 days more). And prescribed me Canesten cream for 5 days. So I protested. I told her that I already tried that for 5 freakin' weeks. She told me that I am "being negative". Which pissed me off.

Next day, I cancelled the next weeks appointment. She didn't take my situation seriously (with the weak immune system and the UC...). There's no way I am paying for these appointments.

At the pharmacy they recommended me "Whitfield's ointment". So I am currently trying with this.

Anyone ever had issues like this ? How did you solve it ?

Post Edited (emilp89) : 9/18/2019 4:50:12 AM (GMT-6)

Posted 9/18/2019 8:09 AM (GMT -7)
It would have been nice if the dermatologist had taken the possibility of thiopurine factor more seriously. I am a firm believer in partnerships between practitioners and informed patients. It is worth noting that our litigious society means that most practitioners must observe things for themselves, including response to the treatments she prescribed. This is frustrating, and I have felt this frustration myself. But a practitioner who just took the patient's hypothesis, or even their report of using a particular agent, and went right to something more exotic is leaving themselves open to malpractice damages if there is any problem.

That said, you may be overly focused on the thiopurine. Has you low white cell count been confirmed? Patients on thiopurines are at greater risk of low white counts, but it is not a certainty. Also there is some increased risk of fungal infection, but it is described as slight and less than the fungal risk associated with corticosteroids or anti tnf drugs. The locations have also been fungus in Gastrointestinal tract, Respiratory tract, Bloodstream, or Wounds. There is not much data on foot fungus.

Your hypothesis may be correct. It may also be irksome to have to pay for a series of visits while a practitioner confirms what you already observed or suspect. It should be especially frustrating if you do not feel the respect or the partnership. ... But what do you want the dermatologist to do?

Do you want her to send a note to the your GI insisting you get a different med? Do you want her to prescribe a systemic anti-fungal like Lamasil, which may harm your liver? Maybe she could refer you to a surgeon for a foot amputation. There are no magic bullets for a lot of fungal infestations. Often available treatments don't work, and take a lot of time to work even when UC and thiopurines are not in the picture.

Your critique of this dermatologist may be valid, but it would be good to ask, "what it would look like" if she was taking your situation seriously? Except for leaving you with a feeling of being unheard, the initial steps she took were reasonable. The key question would have been "what escalation in treatment is possible?" if her ointments did not help. It seems a shame this conversation did not happen.

good luck
Posted 9/18/2019 9:06 AM (GMT -7)
I’ve been fighting a nasty case of nail fungus on one thumb and 2 toenails. My dermatologist didn’t want to prescribe me the oral med because of my UC. Tried to get me a antifungal topical prescription but insurance wouldn’t cover it. So she said to use over the counter topicals It’s better — but she said it could take up to a year. 😟 and you have to be vigilant with treatment.

Granted nail fungus isn’t the same as athletes foot — basically same thing but it’s mostly unsightly and doesn’t itch or hurt. Mine is better but still there

Other things my dermatologist said to try was soaking in vinegar solution (vinegar/water 50/50). Friends have told me to try tea tree oil. Just saw a tea tree/ epsom salt soak on Amazon I’m going to try.

UC — the disease that never stops giving (problems!)
Posted 9/18/2019 9:58 AM (GMT -7)
I had a fungal infection( not athlete foot) my scalp and another part of my body.
dermatologist prescribed to me a topical and 2 orals, Diflucan and Flagyl, and he asked me to use Nizoral Shampoo for both my scalp and my body regularly.

Try washing your feet with Nizoral Shampoo! Leave it for about 5 minutes then rinse it.
Posted 9/19/2019 1:52 AM (GMT -7)

DBwithUC said...
That said, you may be overly focused on the thiopurine. Has you low white cell count been confirmed? Patients on thiopurines are at greater risk of low white counts, but it is not a certainty. Also there is some increased risk of fungal infection, but it is described as slight and less than the fungal risk associated with corticosteroids or anti tnf drugs. The locations have also been fungus in Gastrointestinal tract, Respiratory tract, Bloodstream, or Wounds. There is not much data on foot fungus.

Your hypothesis may be correct. It may also be irksome to have to pay for a series of visits while a practitioner confirms what you already observed or suspect. It should be especially frustrating if you do not feel the respect or the partnership. ... But what do you want the dermatologist to do?

Do you want her to send a note to the your GI insisting you get a different med? Do you want her to prescribe a systemic anti-fungal like Lamasil, which may harm your liver? Maybe she could refer you to a surgeon for a foot amputation. There are no magic bullets for a lot of fungal infestations. Often available treatments don't work, and take a lot of time to work even when UC and thiopurines are not in the picture.

Your critique of this dermatologist may be valid, but it would be good to ask, "what it would look like" if she was taking your situation seriously? Except for leaving you with a feeling of being unheard, the initial steps she took were reasonable. The key question would have been "what escalation in treatment is possible?" if her ointments did not help. It seems a shame this conversation did not happen.

good luck

I've done 10s of blood tests (all after I started taking Azathioprine). They show wbc being on the lower boundary. Most of the time it being just bellow the lower boundary.

I wanted her to take it seriously and prescribe me some topical solution that's stronger than Canesten. I've used like 6 tubes of it with minimal effect. Or prescribe me pills (though at that time I was not aware that they can damage the liver).
Posted 9/19/2019 2:02 AM (GMT -7)

FlowersGal said...
I’ve been fighting a nasty case of nail fungus on one thumb and 2 toenails. My dermatologist didn’t want to prescribe me the oral med because of my UC. Tried to get me a antifungal topical prescription but insurance wouldn’t cover it. So she said to use over the counter topicals It’s better — but she said it could take up to a year. 😟 and you have to be vigilant with treatment.

Granted nail fungus isn’t the same as athletes foot — basically same thing but it’s mostly unsightly and doesn’t itch or hurt. Mine is better but still there

Other things my dermatologist said to try was soaking in vinegar solution (vinegar/water 50/50). Friends have told me to try tea tree oil. Just saw a tea tree/ epsom salt soak on Amazon I’m going to try.

UC — the disease that never stops giving (problems!)

I've already tried with vinegar. It did help with the itch. But it was the dermatologist that told me that fungus likes the acidic environment and that baking soda is better.

Yea, UC is crap. Even when you are healthy. Last year, my mom picked up a stomach flu and transferred it to me. She had it for a day or two. I had it for 10 days. :/
Posted 9/19/2019 2:10 AM (GMT -7)

The_Swan said...
I had a fungal infection( not athlete foot) my scalp and another part of my body.
dermatologist prescribed to me a topical and 2 orals, Diflucan and Flagyl, and he asked me to use Nizoral Shampoo for both my scalp and my body regularly.

Try washing your feet with Nizoral Shampoo! Leave it for about 5 minutes then rinse it.

I did try a shampoo that contains Ketoconazole. Which is like Nizoral, but different brand name I guess.
Posted 9/19/2019 9:47 AM (GMT -7)
I cannot comment on athlete's-foot specifically, but I can say that you should expect a lot more difficulty in conquering those things while under immuno-suppression. Not entirely analogous, but the wife and I were sitting outside in summer and she looked at the bottoms of my feet and said "oh my god did you realize your feet are covered in plantar warts?" Me: "no, I never look at the bottom of my feet." She, being the analytical scientist, started counting and tallied up over 40 of them. Saw a dermatoligist who froze them twice, used tons of Compound W wart remover, and it took over a year to beat them all. I was on remicade, prednisone, and 6mp at the time, all immuno-suppression, and you need an immune reaction to beat them. It was a slow process to rid myself of all of them.

I'd suspect you're going to have some difficulty fighting off it. Going to take lots of time, frustration, and persistence to get rid of it. Try multiple things at once. Expect multiple dermatoligist office visits. See another dermo if you think that one is crap. As second opinions are always great!
Posted 9/19/2019 3:27 PM (GMT -7)

iPoop said...
I cannot comment on athlete's-foot specifically, but I can say that you should expect a lot more difficulty in conquering those things while under immuno-suppression. Not entirely analogous, but the wife and I were sitting outside in summer and she looked at the bottoms of my feet and said "oh my god did you realize your feet are covered in plantar warts?" Me: "no, I never look at the bottom of my feet." She, being the analytical scientist, started counting and tallied up over 40 of them. Saw a dermatoligist who froze them twice, used tons of Compound W wart remover, and it took over a year to beat them all. I was on remicade, prednisone, and 6mp at the time, all immuno-suppression, and you need an immune reaction to beat them. It was a slow process to rid myself of all of them.

I'd suspect you're going to have some difficulty fighting off it. Going to take lots of time, frustration, and persistence to get rid of it. Try multiple things at once. Expect multiple dermatoligist office visits. See another dermo if you think that one is crap. As second opinions are always great!

Thanks for the heads up. This really sucks hard.

The crapty thing is that I started treating it fairly late (and I spotted the itchy bumps fairly early). I also started wearing sandals late (and it spread because of this, even with all the stuff I put on my skin).

I don't even know how the hell I am going to get through the winter. Can't have my foot freezing, but I also can't have it sweating. I can't go to the freaking gym. Every sweat my foot releases is not good for it.

I have an appointment with my GI in 3 weeks. During every appointment, she asks me whether I have some changes on my skin. So I'll see what she has to say about this.
Posted 9/23/2019 3:05 PM (GMT -7)
I have received additional results from the lab. The results said that:

"Fungus was found. Dermatophytes were not isolated"

This made me think that it's Eczema. The dermatologist I went to at first said that it's Eczema (before the results came in). I guess she concluded that because she expected the fungus to have spread to my other foot, but it did not.

After the results came in, she said that it is a combo of fungus and Eczema. After these additional results, I began to think that it might be Eczema after all. But then I did some googling. It turns out that Imuran is prescribed to patients with severe Eczema. So it can't be Eczema. If this is so, I don't know what the hell she was thinking telling me this. Maybe she lied to me. But this would be highly unethical. Or maybe she just simply didn't know.
Posted 9/24/2019 5:08 AM (GMT -7)
We're much more prone to having skin issues as UC patients (psoriasis, eczema, contact-dermatitis, and dry and itchy skin). We already know our immune system's are crazy, as they are relentlessly attacking our intestines, and well sometimes they get bored of it and also attack other things, skin, joints, eyes are all common targets.

I had some rashes and my primary care doctor said it presented like a-typical location eczema (around arm pits, on shoulders, and sides of torso) or perhaps a contact-dermatitis. A dermatologist said it was a contact-dermatitis and it was treated with a steroid cream, and by switching to mild eczema-safe soaps, shampoos, and laundry detergents. Pretty much contact-dermatitis is an allergic reaction to something that sits on your skin for long periods of time (thus the harsh perfumed soaps and laundry detergents being problematic). Not saying that's what you have, but saying eczema like rashes can be other things too.
Posted 9/24/2019 1:55 PM (GMT -7)
I had a bunch of plantar warts spreading and some other weird scaly kind of thing going on on my feet after a couple of years on Prednisone. I was amazed when I used some Nair (because I thought shaving might be spreading them) and it got rid of everything!! Maybe not so great if you're a guy, but still, maybe worth a try!
Posted 9/26/2019 9:16 AM (GMT -7)
That doctor sounds like she sucks. I wouldn't go back to someone who treated me like that and told me I was "being negative." Plantar warts are notoriously hard to get rid of even without UC (I had issues with them in high school, years before I got UC). I've not had athlete's foot, but I've taken oral Diflucan many times for yeast infections. It's never affected my UC. Is it known to? What's the anti-fungal med that can cause liver damage?

Good luck!
Posted 10/3/2019 5:29 AM (GMT -7)
My blood test results just came in.

My Lymphocytes = 20.5 (normal range is 25 - 40). Which is lower than I expected. It used to be just bellow 25. But my Leukocytes are in the normal range.

I also have low RBC which explains why I have been so tired lately. But that's a different topic.

My skin issue calmed down last week. I guess thanks to "Whitfield's ointment". Which has an antiseptic effect. But then over the weekend it worsened. It went from "almost normal" skin to red, dry, peeling and itching. I don't know why. I suspect it's not (just?) Athlete's foot, but (also?) Eczema. From what I've read, Athlete's foot can't just suddenly get worse. But Eczema can.
Posted 10/3/2019 5:32 AM (GMT -7)

Sara14 said...
That doctor sounds like she sucks. I wouldn't go back to someone who treated me like that and told me I was "being negative." Plantar warts are notoriously hard to get rid of even without UC (I had issues with them in high school, years before I got UC). I've not had athlete's foot, but I've taken oral Diflucan many times for yeast infections. It's never affected my UC. Is it known to? What's the anti-fungal med that can cause liver damage?

Good luck!

All anti-fungal medications can cause liver damage.
Posted 10/10/2019 10:08 AM (GMT -7)
I went to a more expensive clinic. Where the dermatologist listened to what I have to say.

She said that it's Atopic dermatitis. Which I think is another word for Eczema. She prescribed me Octenisept spray (an antiseptic) and Elocom lotion (a corticosteroid). My next appointment is in 14 days.

By this point, I am also pretty sure that it is Eczema.

She also said that it is probably a reaction to Imuran.

So yea, that's that.
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