xifaxan

I was out in the sun this past weekend while on xifaxin and developed a tremendous tan but no rash or burn. Xifaxin mainly stays in your gut and is not systemically absorbed or is very poorly absorbed, so it's unlikely to cause such systemic effects like a rash or a burn, and it never has in my years of taking it. Usually the only side effects of xifaxin, as a result, are gastrointestinal like abdominal cramping or diarrhea.

Cipro, on the other hand, really sensitizes the skin to sun. If I have a good base tan I will be OK out in the sun but if it is the first time out while taking cipro, stock up on the suntan lotion when using cipro.

If you have been on other antibiotics prior to xifaxin, I would be concerned that any rash is a yeast infection due to the buildup of skin bacteria being killed. Did anyone scrape the rash and look at the samples under a microscope? It takes seconds to do. The one positive of being on xifaxin is that if it is a yeast infection, being on xifaxin should allow your skin bacterial levels to recover sufficiently so that treatments on the yeast infection will be swift and effective. I don't think a yeast infection is likely, but it should be ruled out-

By the ways were you wearing suntan lotion?

thx CT. but haven't been on other antibiotics in awhile - well weird iv ones early in the year. But no cipro as I am allergic to it.

No skin scraping as I was out of town and only made it to a "quack" doctor at a very non-urgent "urgent care". It was very obvious some kind of severe sun sensitivity though.

I know xifaxan is supposedly not systematically absorbed. I have triple confirmed there are no sun side effects with it. So much that my pharmacist investigated the clinical trial results in detail.

I really was hoping its a xifaxan thing, because otherwise its probably some strange new autoimmune problem. I was diagnosed by shen and a rheumy at CC last with a new autoimmune disease based on the NOD2/CARD15 gene which includes dermatological problems, waiting to hear from them if sun sensitivity has been documented with it.

Liz,

I have had all kinds of skin issues in the past year due to taking assorted antibiotics (and Entocort), including but not limited to yeast infections, warts, lentigos, and hemangiomas. Occasionally I will see a red patch in my armpits and it will go away after a day or two. I call it a "flash yeast infection."

I don't have any problems with the sun. I have an olive complexion and generally tan very well and quickly with my skin soaking up the sun. If you are a fair skinned person, there may be more issues with going out in the sun which may or may not be autoimmmune system related. I am fairly certain xifaxin is not the cause of your issue. I would get that rash scraped by a competent dermatologist just to rule out a yeast infection, and to get a proper diagnosis.

Liz,

My guess is that it's the antibiotic. It may not be listed as a known side effect of the drug, but it doesn't rule out it not happening in you. I experienced a similar problem when I was on various UC meds. None of my meds had sun sensitivity as a known side effect, and after numerous other rash tests by the dermatologist, no other cause was identified. I have not had a sun rash since (13 years) and I'm outdoors quite a bit. Fingers crossed.

Sue

I hate to even bring this up, but lupus is associated with sun sensitivity. There is also sun eczema, rosacea, psoraisis, etc., all autoimmune disorders.

Hopefully, it was just because you had not been in the sun for so long...

Jan

there goes that L word. Some docs suspected I had lupus last fall. Positive ANA and other symptoms - joint, gastrointestinal, etc. Local rheumy thought possibly early signs of lupus as some of the other lupus blood markers weren't showing. Had an appt with dr. shen because of IBS like symptoms and when I walked in he flipped out telling me I had a lupus rash on my face. Then he interrogated me further, sent me for chest xray right then and there. Found some mysterious fibrotic changes on chest xray. CT scan found more. Local lung doctor is monitoring it every 6 months now. Shen sent me to his rheumy colleague who ruled out sjorgrens and believes its the new disease not lupus. But now this rash... that is why I was so hoping it could be the xifaxan. And the real kicker is.. my mum had lupus and died from pulmonary fibrosis caused by lupus. So I did have the L word in my mind. But after I saw it in writing I realized how much my rash looked like my mums when she would get sun. oh my.

Right now I am wanting to write some censored words here.... I am sure you know that lupus diagnosis is not an easy thing (tougher than IBD). Plus, there are so many subtypes. Sometimes it takes a while for all the dominoes to fall into place. The positive ANA makes it pretty suspicious, but I know that by itself it is not diagnostic. Might be time for another rheumy follow up (dang!)

Jan

thx Jan, your support means a lot.

Yes, I know that lupus is not an easy or direct diagnosis. There's a list of 11 and you are supposed to have some number of them. This rash could take me to that winning level!

Waiting to connect with my CC rheumy. He left me a msg after I emailed him my lovely rash pictures. He is very focused on that new NAID disease which could be clouding his glasses so will see what he says. You have triggered me to think about going back to my local rheumy here who thought possible early lupus last year.

I know that if its lupus leaving things linger could mean bad stuff is going on causing damage to some organs that might be way more important than a measly old colon!

I had forgotten about NAID and had to go to my "way back machine" to look it up. Yeah, I suppose it could be this, although I am not sure it is a better diagnosis, just different. So, what is the treatment?

For those of you wondering what NAID is, read this:
http://www.ncbi.nlm.nih.gov/pubmed/23102769

Jan

Hi Liz, regarding NAID have you been tested for the NOD2 variants? I don't have full text on that CC paper but I know 23 and Me has three NOD2 SNPs that they consider associated with Crohn's, if it's the same ones you could check against that data. Just an idea... good luck with everything

oh yes dr. shen tested it all last fall. I have two of the NOD2/CARD15 mutations. They just happen to be two that are strong susceptibility for crohns. But ileoscope after ileoscope... no crohns.

But between the mutant genes. my symptoms, history, and ruling out other diseases, Dr. Shen and my CC rheumy diagnosed me with NAID end of last year. However, NAID doesn't have positive ANA and I have had a few positive ANA tests in the last year or so. Dr. Yao just kind of wrote that one off for my case. So now with this new rash.. gets me going back and wondering about that L word.

And jan as for treatment for NAID, first line is sulfasalizine, of course I am allergic to that. Then they just treat the symptoms... one at a time., like most other autoimmune diseases. Seems that what they have researched about NAID so far is that it is not near the extreme health situation as lupus.

and just got a call back from my CC rheumy. He is rechecking another lupus marker that was slightly elevated last year. Now I am getting concerned.

I suppose that is good news, unless it has been lupus all along and you have not been treated...

Jan

actually its bad bad news. Because this new rash leads him to go back and rethink that its lupus. And he is rechecking one marker in particular which was slightly elevated before to see if it is more elevated now that I have a potential new lupus symptom.

I'm sure the rheumy would love for it to be NAID, so he can gather data for his research (you too, for completely different reasons). From what I've learned with my enteropathic arthritis, the diagnosis with these autoimmune diseases often are not linear at all. I was having intermittent symptoms for probably 25 years, but it was not until a decade after my colectomy that things came together in a way for my primary doctor to send me to a rheumatologist and I was diagnosed. The tipping point was that I had to stop NSAIDs and everything fell apart.

It's like they have to collect a certain amount of crumbs before they have enough to agree.

The fact that you have the family history with a first degree relative too, makes a pretty strong argument. Try not to be scared, because if this is lupus, you already have been living with it, just in ignorant bliss! I know there are other treatments for it other than sulfasalazine...

Jan

love it. possibly been living in ignorant bliss with lupus!!! yes sulfasalizine isn't a treatment for lupus.. that's for measly old NAID. lupus drugs are far more potent. and you are so correct coming to a diagnosis is not linear. But now thinking about it, I have had several doctors the last year suspecting lupus. In fact, I even had major lupus testing about 7 years ago when some freak things were going on.

guess I should reschedule the 6 month lung doctor appointment I cancelled right before my vaca!!!

I have a friend with SLE that has maintained remission for the most part with Plaquenil (an antimalarial). She has only needed short courses of prednisone for flares, and has not needed the likes of methotrexate for maintenance. But, Plaquenil is not without potential side effects (what is?).

Jan

yes think positive. two different docs (including dr. shen) wrote me a script for plaquenil last year, funny how I just remembered that. Its the least harmful drug supposedly for lupus. Of course I never took it, because I didn't officially have lupus! And I seem to always get the rare drug side effects and I didn't want to add anything else into my system that would interfere with any potential butt wound healing!