Fibromyalgia & Skin Problems

"My skin is always so itchy, it drives me crazy," says Shayne, who has recently been diagnosed with fibromyalgia. "I get red rashes, like heat rash, with lots of little red bumps across my chest and shoulders and face, and my skin feels sore and painful to touch. I also get this crawling feeling," she adds, "as though little gnats are crawling over my skin. I keep reaching up to wipe at my face thinking there is something there, it must make me seem a little crazy!"

Antonia, who has had fibromyalgia for many years, can reassure Shayne that she isn't alone. She also started experiencing problems with her skin around the same time that she developed fibromyalgia. "I get spots that itch like mad and strange rashes that come and go for no reason," she explains. "The itchiness is always worse at night in bed or when I overheat and it really hurts to scratch as my skin is so sensitive."

Around 50% of people with FM suffer with skin problems according to Dr Mark Pellegrino from Canton, Ohio, who has treated over 20,000 fibromyalgia patients. "Patients report tingling, numbness, crawling sensations and a burning or sunburn type feeling," he reports. "The main skin symptoms you will see on examination are areas of dry, flaky skin, non-specific red rashes, blotchy or mottled skin and bruising."

Karen finds the bruising on her legs and ankles makes her feel embarrassed and self conscious. "Bruises appear on me quite easily from just a simple knock. I find it very embarrassing as the marks on my legs and ankles are quite ugly and take ages to heal," she relates. She finds herself choosing clothing that will hide her legs, sticking to jeans or opaque tights. "I find now that with everything I buy I am thinking about my bruising. It definitely affects my body image and makes me feel unattractive," she adds. "I am sure that people are noticing my bruises and wondering about them. I find myself doing all kinds of contortions trying to hide my legs, which probably ends up drawing more attention to them!"

"Easy bruising all over the body occurs often in women with fibromyalgia and sometimes these bruises can be quite extensive and shocking," explains Claudia Marek, a specialised nurse and medical assistant working with FM patients in Los Angeles. "Other times they are faint, like a dusky ink stain, and you might try to scrub them off, thinking they are a smudge of some kind. Minor scratching, especially in sensitive areas around the breasts can cause capillaries to break and tiny red dots to appear, or very faint spotting bruising under the skin."

At first, neither Karen nor Antonia linked their skin problems to fibromyalgia. "I had so much wrong with me and when you think of pain in your joints and muscles, well you don't really associate it with skin do you?" says Antonia. "But I guess we are so sensitive in every other area of our body that I suppose we can't expect our skin not to be affected too!"

Our skin is in fact the largest organ of our body whose primary function is to act as a protective barrier against foreign invaders. It is made up of two layers, the epidermis and dermis, with a layer of cushioning fat underneath. The epidermis provides an outer protective layer of dead skin cells formed by an active band of cells beneath the surface, that constantly divide and move upwards to replace the dead cells as they are repeatedly brushed away. The next layer, the dermis, consists of collagen fibres and elastin giving strength and flexibility to the skin. It is well supplied with blood vessels, sweat glands, white blood cells and contains millions of tiny nerve endings that relay messages to our brain. It is the hypersensitivity of these nerve endings that is primarily responsible for our abnormal skin sensations.

"Studies show overactive skin pain receptors¹," explains Pellegrino. "So the skin can indeed be painful and hurt at the lightest touch. The hypersensitivity of the autonomic nerves result in the symptoms of itching, numbness, tingling, burning and crawling sensations, as well as neurovascular changes leading to cold, dry, sweaty or mottled skin. There is also a phenomenon known as dermatographism where scratching your finger along the skin will cause a raised red mark welt or rash to form,” he adds. “This is most pronounced in the skin overlying painful muscles and thought to be due to dysfunctional autonomic nerves overreacting to the pressure and causing a low-grade skin irritation."

A Swedish study published in 1997 in the Scandinavian Journal of Rheumatology² also suggests immune system involvement. The researchers took skin biopsies from 25 patients with FM and compared them with healthy controls, patients with rheumatoid arthritis and patients with local chronic pain following whiplash injury. They found that the biopsies from fibromyalgia patients had significantly higher values of immunoglobulin G deposits in the dermis and blood vessel walls and a higher number of mast cells. Mast cells are white blood cells that release histamine, which is known to cause itching, allergies and rashes. Increased mast cell activity indicates that the immune system is overactive and is likely to be adding to the oversensitivity of the skin nerve endings increasing the overall dysfunction of the autonomic nervous system responses.

Mast cells also release another major chemical called heparin, an anticoagulant that thins the blood. "Mast cells release heparin to thin the blood around mosquito bites, for example, so that the swelling doesn't cause a clot," explains Marek. "Increased heparin release from overactive mast cells explains why you see little bruises when you scratch your skin as the capillaries break and leak more easily."

Easy bruising could also result from nutritional deficiencies often associated with fibromyalgia. "Vitamin deficiencies, like vitamin C, can also increase blood vessel friability, making the vessels more likely to collapse under pressure," adds Pellegrino. "It also reduces the ability of the skin to restore and repair itself leading to an increased vulnerability to bruising."

Intense itching and rashes can also be a reaction to prescribed medications or yeast infections. "Yeast infections can cause rashes due to toxins released by the overgrowth of Candida in the intestines," says Pellegrino. "These toxins circulate in the bloodstream and irritate the skin, probably due to the body trying to remove the toxins through the skin. Prescribed medications, such as antidepressants and anticonvulsants, can cause dry skin, increased sweating and make people more sensitive to sunlight leading to sunburn," he continues. "The patient needs to work with their prescribing physician to determine if skin reactions are occurring and how to tackle them."

Andrea has a vivid red rash that spreads across her chest that other people often attribute to sunburn, but she is not convinced. "My chest area can look red and purple, so when I wear a v-neck top people often comment that I have caught the sun," she says. "I think, yes, very likely in the middle of winter!"

Surprisingly, these vivid red rashes can also result from a reaction to what own bodily secretions. "All bodily secretions are acidic and can burn," explains Marek. "It's common especially in the areas where you perspire to see red irritated spots. These usually occur on the forehead, under the arms or breasts, and behind the knees, especially if you wear nylon stockings. The lining of the nose, bronchial tubes, vagina and rectum all produce mucus that may be acidic and irritating. Women may notice red, chemically burned areas on their inner thighs from their vaginal secretions following intercourse, for example."

Itching without a visible rash may be a sign of subcutaneous trigger points (small lumps under the skin) or dysfunctional pressure-plate receptors called Merkel's discs creating a sensation called sensory itch. "Merkel's discs translate the tactile messages received by the skin to the brain." explains Dr Devin Starlanyl in her book The Fibromyalgia Advocate. "When they don't know what message to send, they have a default mechanism. Unfamiliar sensations are translated as itch. Cold helps to numb the itch because it numbs the pressure plate receptors. Dryness makes it worse because it creates an enhanced pressure reception by the discs. Some itches specifically follow trigger point referral patterns," she adds, "in which case the trigger point must be broken up. There is a maddening, inner ear itch which is often on the masseter trigger point."

With your skin driving you mad, you can end up spending a lot of time and money shopping around for that magical skin lotion that will soothe your skin and make it baby soft once more. We are endlessly bombarded with amazing new skin products in magazines and on the TV, which promise all kinds of miracles. The most important thing is to treat your skin gently and use skin products with only a few ingredients as there is less chance they will contain something that will irritate your skin. For very dry flaky skin a preparation that contains lactic acid (often represented as alpha hydroxyl on skin product labels) or urea is a good choice, for example, cocoa and shea butters. It can be a process of trial and error to find out what works best for your skin, but remember the most expensive option is not always the best.

It is essential to keep your skin well hydrated and Karen finds that the best time to apply skin lotion to achieve this is straight after a warm bath. "I put the tube of lotion in the water while I am in the bath so that it is warm when I come to put it on," she explains. "This makes it sink in very well, and the effects last a lot longer, making my skin lovely and smooth. I have found that doing this routine about three times a week has made a big difference. If I try and skip it for any reason, I soon regret it and the itching becomes unbearable again."

Here are some other tips on what to avoid and how to soothe sore, itchy, dry skin:

What to avoid:

• harsh toners, cleansers and alcohol
• commercial wipes loaded with chemicals and fragrance
• irritating plant extracts such as mint and citrus
• skin peel treatments
• a hot bath (makes itching worse)
• the temptation to pick, squeeze, scratch or rub
• nylon stockings
• tight bras
• tight clothing, especially in warm weather
• synthetic fabrics and wool
• prescription medications with skin side effects
• any medical advice given at cosmetic beauty counters!

What to try:

• a warm (not hot) oatmeal bath
• a cold compress to help numb the area
• antihistamine medications
• cortisone sprays or creams
• keep skin clean and well hydrated
• moisturise regularly
• clean skin gently, don't scrub
• fragrance free baby products
• loose fitting cotton underwear
• light cotton bed clothes
• a cooler bedroom at night
• wash clothes in a mild detergent
• a good sun cream

Useful Supplements:

• Vitamin C-bruising
• Vitamin A-skin irritation
• Vitamin D-skin inflammation
• Zinc-skin repair
• Colostrum-body repair

You are certainly not alone if you struggle with intense itching, red rashes or look down in perplexity at a huge bruise that you have no memory of creating. These are not symptoms that you would naturally link to fibromyalgia syndrome, but it may be a relief to know that it is all interconnected and not yet another medical mystery. If you work at controlling your overall symptoms of fibromyalgia then it is likely that these symptoms will also subside.

1. Kim SH, Jang TJ, Moon IS. Increased expression of N-methyl-D-aspartate receptor subunit 2D in the skin of patients with fibromyalgia. Journal of Rheumatology 2006; 33(4):785-8.

2. Enestrom S, Bengtsson A, Frodin T. Dermal IgG deposits and increase of mast cells in patients with fibromyalgia-relevant findings or epiphenomena? Scandinavian Journal of rheumatology 1997; 26(4):308-13.