I have painful lumps despite Prednisolone. What else can help?

Question

Hello doctor,

It all started about three years ago. I started to develop painful lumps that come and go on my arms, thighs, legs, buttocks, and sometimes my face. At times, they even extend to my eyelids.

The lumps are extremely painful and cause fever and intense itching, especially at night. Sometimes I can hardly sleep unless I take Piriton.

When the lumps appear, I can barely move, and they get worse during my menstrual period. I started taking Prednisolone, which makes the lumps go away, but they return after a while.

I have been on Prednisolone for almost three years now, and if I miss even one day, the lumps reappear and become worse.

I have also noticed that my flare-ups worsen whenever I walk or do anything physically stressful. Recently, the lumps have started appearing on my ankles and feet as well.

At this point, I have gained a lot of weight. My stomach is bloated even though I do not eat late-night meals, and I have severe lower back pain. I can barely walk without feeling like my back might break in two.

What exactly is wrong with me?

Please help me.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on the history you have shared, your symptoms are medically significant and require careful, structured management.

The recurrent painful swellings affecting multiple parts of your body, including your face and eyelids, along with itching, fever, and worsening symptoms at night, during stress, physical activity, and around your menstrual periods, are most consistent with chronic spontaneous urticaria with angioedema.

This is an immune-mediated disorder in which the body unpredictably releases inflammatory chemicals, leading to painful, itchy swellings rather than simple allergic rashes.

The fact that your symptoms improve with Prednisolone but return and worsen if you miss even a single dose indicates that you have developed steroid dependence, which occurs when steroids are used long-term for conditions that require alternative therapies.

Your symptoms, such as weight gain, abdominal bloating, and severe lower back pain, are particularly concerning and are most likely side effects of prolonged Prednisolone use, a condition known as iatrogenic Cushing’s syndrome.

Long-term steroid use can also suppress your body’s natural cortisol production and weaken your bones, which may explain your severe back pain and difficulty walking, possibly due to early osteoporosis or vertebral compression fractures.

This means that stopping prednisolone suddenly would be unsafe and could make you seriously unwell; any reduction must be done gradually under medical supervision.

At this point, you need to make changes to your treatment approach. Chronic urticaria should not be managed with long-term steroids.

You need evaluation by a physician or dermatologist to confirm the diagnosis, rule out related conditions such as urticarial vasculitis or autoimmune disease, and transition to steroid-sparing therapy, such as high-dose non-sedating antihistamines and, if needed, advanced treatments like Omalizumab.

Also, you should be assessed for steroid-related complications, including bone health and adrenal function.

With the right management plan, this condition can be safely controlled, your symptoms can improve, and the harmful effects of long-term steroid use can be reversed or minimized.

I hope this helps.

Thank you.