Have you ever suddenly felt a lump, swelling, or pain under the skin of your arm or leg? Maybe it happened after a good workout. Have you ever experienced something like this? So, here's a little-known condition that may be important to you.
What is Eosinophilic Fasciitis?
Simply put, Eosinophilic Fasciitis is a condition in which the tissue that covers our muscles and tissues under our skin – we call it fascia in medical terms – suddenly becomes inflamed, thickened, and tight. Think of it like the mesh that holds our skin and muscles together and helps them move around, just like the mesh that we put in the trunk of our car when we go shopping.
This is classified as an `autoimmune disease` . This means that our body's defense system, the immune system, mistakenly starts attacking healthy parts of our own body. It's like attacking our own family members when they think they've been robbed.
If not detected and treated early, it can cause permanent skin changes and loss of joint range of motion . Therefore, it is very important to seek medical advice as soon as symptoms appear.
How does this situation affect the most? Who does it affect?
Eosinophilic Fasciitis can affect fascia anywhere on the body, but it most commonly affects the hands and feet . For many people, symptoms, such as pain or swelling, may first appear after strenuous exercise or a job that requires standing all day.
These symptoms, such as muscle pain and swelling, can be similar to those of other common diseases, so it's important to see a doctor right away if you notice any new changes or pain in your skin, muscles, or joints. You may also need to see a rheumatologist, a doctor who specializes in joints and other inflammatory diseases.
There is currently no cure for this disease. However, the good news is that for most people, symptoms resolve within a few years, meaning the disease goes into `remission`, or a dormant state. However, some people may experience a recurrence of symptoms.
Difference Between Eosinophilic Fasciitis and Scleroderma
When talking about these two diseases, some people may confuse them with another disease called `Scleroderma`. `Eosinophilic Fasciitis` and `Scleroderma` are both very rare `autoimmune` diseases. Also, in both of these diseases, the tissues of the body become thick and stiff.
So what's the difference? The difference lies in the types of tissues affected.
- In Eosinophilic Fasciitis, as we discussed earlier, the fascia, a thin, elastic connective tissue beneath the skin, is affected. Over time, this fascia thickens and expands, making it difficult to move the affected body part.
- But in `Scleroderma`, the immune system stimulates other cells to produce more of a protein called `collagen` (something that gives strength to our skin and tissues). This excess collagen is deposited in the skin and internal organs, making them thick and hard, like an old scar. But instead of healing a wound, this excess collagen can also damage healthy tissue.
Eosinophilic Fasciitis and COVID-19
People with autoimmune diseases such as Eosinophilic Fasciitis are considered to be at slightly higher risk of contracting COVID-19 than the general population.
Experts are still unsure whether people with this condition are more likely to have severe symptoms from COVID-19. Therefore, it is best to follow the recommendations of health authorities, such as the Centers for Disease Control and Prevention (CDC), to protect yourself from infection.
Who is most likely to get this disease?
Eosinophilic Fasciitis can affect anyone, but it most commonly affects people between the ages of 30 and 60.
Additionally, people with certain chronic health conditions are more likely to develop this disease. Some of these conditions include:
- Aplastic anemia (aplastic anemia - an anemia in which the production of blood cells decreases)
- Hemolytic anemia (an anemia in which red blood cells break down quickly)
- Lymphoma (cancer of the lymphatic system)
- Leukemia (cancer of the blood cells)
- Some types of `Thyroid disease`
How common is this?
Eosinophilic Fasciitis is actually a very rare disease . So far, only a very small number of cases, about 300, have been reported in scientific journals worldwide. However, perhaps due to underdiagnosis or underreporting, the number of cases may be much higher.
How does Eosinophilic Fasciitis affect my body?
As we've discussed before, this condition is caused by inflammation of the fascia, a thin, flexible connective tissue beneath the skin. This layer of fascia covers and protects our muscles and some internal organs. It also holds the skin and muscles in place and supports them when they move.
Think about it, this fascia helps keep our limbs flexible, but not just hanging down. But in someone with `Eosinophilic Fasciitis`, this fascia membrane becomes inflamed, gradually thickening, and stiffening. Eventually, this inflammation makes it difficult to move the skin and muscles around it. If left untreated, this fascia can become stuck in one place and become tight. This is sometimes called `contracture`. That is, a condition where a joint cannot be extended or bent.
Instead of the normal elasticity of fascia, the affected body parts become painful or difficult to move.
The body parts most often affected are:
- Hands (especially the palm, that is, the inside of the hand)
- Legs (especially the front, right at the hip bone)
- Joints or surrounding areas
Although rare, this condition can also affect the skin on the face, chest, and abdomen.
Some patients with Eosinophilic Fasciitis may also develop joint inflammation similar to Rheumatoid Arthritis. If this joint inflammation is not controlled, the cartilage in the joints can be damaged, leading to long-term arthritis.
Also, if this disease affects the fascia in your hand or wrist, the inflammation can cause the median nerve, one of the main nerves in the hand, to become compressed, causing a condition called Carpal Tunnel Syndrome (numbness, pain, and weakness in the hand).
The important thing is that Eosinophilic Fasciitis is a condition that can change and develop very quickly. You can start to notice visible effects within a short period of time, like a few weeks. Therefore, if you notice any symptoms or changes in your body, see a doctor immediately.
What are the symptoms of Eosinophilic Fasciitis?
So, how should you suspect this disease? Here are some of the main symptoms:
- Muscle pain .
- Tender skin.
- Inflammation or swelling .
- Symptoms of `Carpal Tunnel Syndrome` (such as numbness, pain, weakness in the hand).
- Arthritis (arthritis - joint swelling, pain, morning stiffness).
- The skin feels thicker and tighter than normal.
- In some areas, the skin looks puckered and rough, like the peel of an orange (`puckered skin` or "peau d'orange" appearance).
What is the reason for this?
To be honest, experts still don't know the exact cause of Eosinophilic Fasciitis. Like many autoimmune diseases, it can come on suddenly, sometimes for no apparent reason.
However, some studies have found that these autoimmune diseases can be ``triggered`` by certain things. That is, the disease can develop because of something else. For example:
- Some types of infections .
- Some allergic reactions.
- Using certain medications .
- Using certain drugs .
Some people with Eosinophilic Fasciitis say that their first symptoms occurred after strenuous physical activity , such as running, lifting weights, or exercising, or while doing a job that requires a lot of effort on their arms or legs.
It's a good idea to talk to your doctor about your risk factors for developing an autoimmune disease like this.
How do doctors diagnose this disease? (Diagnosis)
If you have these symptoms, a doctor may do several tests to find out if you have Eosinophilic Fasciitis:
1. Fascia Biopsy: A biopsy is when your doctor takes a small sample of your tissue and sends it to a lab to look at it under a microscope. This involves taking a small piece of the affected skin and the fascia underneath it and examining it. In most cases, this is the most reliable way to diagnose the condition.
2. Blood test: If you have Eosinophilic Fasciitis, you may have high levels of a type of white blood cell called Eosinophils in your blood (which is where the disease gets its name). However, blood tests alone cannot confirm the disease. Often, a biopsy is needed.
3. Imaging tests: Tests such as MRI (Magnetic Resonance Imaging) can help identify inflammation within the body, especially in the fascia and surrounding tissues. However, like blood tests, they are not as specific as a biopsy to diagnose the disease.
Treatment for Eosinophilic Fasciitis
Very rarely, symptoms may go away on their own without any treatment. But most of the time, doctors treat Eosinophilic Fasciitis with a type of medication called corticosteroids . These are a type of steroid.
Corticosteroids work by reducing inflammation in the body and suppressing the overactive immune system. Prednisone is the most commonly prescribed corticosteroid.
Your doctor may also prescribe other treatments in addition to corticosteroids, such as:
- `NSAIDs`: Non-steroidal anti-inflammatory drugs (NSAIDs) available at the pharmacy – for example, ibuprofen and diclofenac – can reduce symptoms such as pain and swelling. However, if you are already taking `corticosteroids`, talk to your doctor before taking `NSAIDs`. Do not take `NSAIDs` for more than 10 days at a time without your doctor's approval.
- Immune system suppressing medications: Depending on the severity of your condition, your doctor may prescribe other medications (e.g., Methotrexate) that suppress the overactive immune system that causes Eosinophilic Fasciitis.
- Physical therapy: Physical therapy can help stretch and loosen your fascia when it is tight, and help maintain joint mobility. Your doctor or physical therapist will teach you exercises and stretches that are appropriate for your symptoms.
- Treating other conditions: You may feel more comfortable by treating the symptoms of other conditions, such as carpal tunnel syndrome or arthritis.
- Surgery: If your Eosinophilic Fasciitis is severe enough to cause contractures, you may need to have surgery to release or remove part of your fascia (fascial release). This is often a last resort.
How to manage symptoms?
- It is very important to take the medicine exactly as the doctor says, for the duration prescribed.
- If your doctor or physical therapist gives you stretches or other exercises, do them as many times as they tell you to help stretch the affected fascia. Although this may be difficult, it can be beneficial if you continue to do them.
- If you have Carpal Tunnel Syndrome, you may need to wear a brace to keep your wrist in place while you sleep. Use it as directed by your doctor.
How quickly will I feel better after treatment?
The inflammation caused by Eosinophilic Fasciitis should begin to subside within a few hours of taking the first dose of corticosteroids. This relief may be temporary, and symptoms may return as the medication wears off. Therefore, it is important to take the medication for the full duration prescribed by your doctor.
Can Eosinophilic Fasciitis be prevented?
Unfortunately, there is no specific way to prevent this disease. Experts don't know exactly what causes autoimmune diseases or how they are triggered, so they can't say when or why you will develop one.
What should someone with this disease expect?
If you are diagnosed with Eosinophilic Fasciitis, you should expect to manage your symptoms for a while. If you notice any changes in your symptoms, especially if they get worse, talk to your doctor right away.
As we've said before, there is no cure for this. Many people live with it for a few years, then the symptoms go away (go into `remission`). Some people never get it again, but others may have symptoms come back later (`recur`).
Will you be unable to go to work or school?
If you can do your job or schoolwork without putting too much strain on your affected fascia, you should be able to return to work or school until you recover from Eosinophilic Fasciitis. However, your doctor will tell you what activities you should avoid until you recover. It is important to follow these instructions.
Be sure to talk to your doctor and get permission before resuming strenuous physical activities like running, lifting weights, or exercising.
When should you see a doctor?
- If you notice any new symptoms in your hands, feet, or joints – especially if you have pain or swelling that doesn't go away after a few days of rest – see a doctor right away.
- If you have already been diagnosed with Eosinophilic Fasciitis, tell your doctor immediately if your symptoms worsen, or if you notice any part of your body becoming stiff or numb.
When should you go to an Emergency Treatment Unit (ETU) ?
If you suddenly become unable to move or use a part of your body, or if you experience unbearable pain, go to the nearest emergency room immediately .
What questions should you ask the doctor?
When you go to see the doctor, you can ask questions like these:
- Do I have Eosinophilic Fasciitis, or is it something else?
- How quickly can my symptoms worsen?
- What kind of treatment do I need? How long will I need treatment?
- Will I need surgery?
- When can I resume normal physical activity?
- How does this situation affect my daily life?
Some of the most important things we need to remember from this story are
Eosinophilic fasciitis is a rare but serious condition that can affect you quickly. If you notice new pain, swelling, or tightness in your hands or feet, especially if it doesn't go away within a few days, don't delay seeing a doctor. Since this condition can develop very quickly , the sooner you get your symptoms checked, the sooner your doctor can find the cause and start the necessary treatment.
Your doctor will add corticosteroids and other treatments if needed to help control your symptoms. Don't panic, but be aware of your symptoms and follow your doctor's instructions carefully. Wishing you a speedy recovery!
` Eosinophilic Fasciitis, Eosinophilic Fasciitis, Skin Diseases, Fascia, Joint Pain, Muscle Pain, Autoimmune Diseases
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