June/Fentanyl patch

[Guest guest]

Hi, June,

>Thanks from me, too, Jacqui about the article and the definition of

mottling. <

You're very welcome.

>I noticed a few days ago that my husband's fingernails have a thin

blue line that follows the curve of the finger where the nail meets it.

Looks a little like dirt way back under the nails, but of course, he

does nothing to get his hands dirty, so that's not it. Has anyone seen

this, and if so, does it signify something regarding medicine?<

Is it at the cuticle where the nail grows out, or at the end of the

fingernail at the tip of the finger? Blueness in the nailbed can be due

to pulmonary problems. If the fingernails themselves are blue, it can

indicate circulatory problems.

>Also, he was itching terribly last night, from the

>Fentanyl patch on his back for pain

>(morphine-related), and they finally got an order for

>a cream to put on it. Tonight he was itching just as

>bad, and his back looked almost like dried up sores or

>hives. THe nurse put on some more ointment, but he

>still complained about itching. I'm sure it's a

>reaction to the medicine, and my feeling is that it

>should be discontinued. He is due for a new patch

>tomorrow, and I told them I didn't want it on, but

>they have to unless dr. orders not to.

>

Is the itching localized to the area where the patch has been placed?

If so, it sounds like an allergic reaction to the adhesive of the

patch. If he is having a reaction over his entire back, not just where

the patch has been placed, then it may be a reaction to the medication,

but likely there would be other areas of his body that would be reacting

with hives as well.

The dermatologist for whom I transcribe recommends a topical medicine

for the itching (which has been prescribed in your husband's case) and

also use of moisturizer to help stop the itching. What he recommends

most often is Vaseline petroleum jelly to be used to moisturize the

skin. If you don't want to use it straight from the jar, thin it with

water and it makes a nice cream. It is a nice, hypoallergenic way to

moisturize the skin at a very affordable price. Alternatively, he often

recommends the use of Cetaphil cream. Lotion is pretty thinned out, but

if the skin won't absorb heavier preparations easily, you may want to go

that route.

If he has dry skin on his back, I suggest that you use warm salt water

to gently remove any flaking or scaly skin, pat dry and then apply the

moisturizer. It should help decrease the itching for a time, at least.

Every time a new patch is applied, it is supposed to go on a different

site on the chest, back, flank, or upper arm. The area to which it is

applied is supposed to be clean and dry skin which is intact and not

irritated. It sounds as if one reason for what you're seeing on his

back is the reaction at the various sites where the patch has been

placed previously.

Finally, I suggest that you tell the doctor that you want the patch

discontinued and an alternative form of the medication introduced. If

he is tolerating the Fentanyl itself well, certainly the patch is the

easiest method for the staff, but it can also be given by injection.

Good luck! Mom has had skin reactions to medications, too, and it is no

fun - and oddly, the medical staff often seems to think of it as just a

minor problem. For Mom, the itching becomes an obsession.

jacqui (from Puget Sound)