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i seen a patient yesterday with a red/purple rash on the dorsum of both feet extending up to the mid tibia predominantly on the medial side the rsah doesnt extened to the toes and is not itching flaky or suggestive of contact dermatitis or eczema or psoariasis.

the rash? is blancable on pressure and the capillary refill time is in excess of 10 seconds both on the rash and nrmal skin, the limbs are both cold and patient complains that the pain gets worse when she is in the shower and can not tolerate a hot shower, she also commented that she gets cramps. Foot pulses unpalpable. she has had the rash for 2 years now. also complains of cramps after walking. Also pins and needles.

there is a family history mother has MS, (one of the symptoms of MS is Intolerance to heat). the girl is only 14 years old.

any ideas on diagnosis differential or otherwise will be greatly appreciated. i have written to the GP for refferal dont know whether to suggest vascular or neurological.

i have considered cushings syndrome due to the hyperpigmentation, but doesnt have the striae markings, systemic sclerosis, or PVD. currently taking no medications and no medical history.

 

From your description, I would plump for vascular, but difficult to advise without a pic.

 

FYI

Case report:
Age, Sex, chief complaint, chronicity, past history, comorbidities.
objective findings, in this case, the rash.

Also: "I saw a patient...."

Steve

 

Indeed. See here; Presenting patients for clinical advice

 

Sure she is not diabetic??
The symptoms you have stated would fit with Neurovascular insufficiency, Neuropathy, intermittant claudication?

But as has been said, without some pictures and a more detailed case history it is difficult to give a firm opinion
cheers
Derek;)

 

Since we're being picky, referral is not spelt refferal either, and blancable is not a word, although we know what you mean.
I see unpalpable from time to time in podiatry casenotes. I don't like it - it isn't a word either as far as I know. Not palpable is more correct, and would be more easily recognised by GPs.

Small things in themselves, but they all add up to an impression, both of you and podiatry generally, hence the importance.

Interesting case presentation though. Well done for taking the time to post it.

 

thanks people for the heads up regarding presenting a case just tried to cram the essentials in.

I'll see if can get a picture or video of the cap refill time.

i was leaning towards heamosiderosis but wasnt the classic brown colour and pt commented that the legs dont swell (possible venous insufficency) and given the family history of MS and intolerance to warmth.

for the blanchable could have put erythematous. and the unpalpable i did think whether not palpable would be better.

 

heamosiderosis

Stasis hyperpigmentation will start out as stasis dermatitis. The hemosiderin deposits come later. The location you described is classic. On magnification you may find depression (pre ulcer) areas overlying the deep perforators.

Steve

 

Cheers thanks for the feedback much appreciated

and found out more re stasis dermatitis

 

Lichen planus?

 

Lemon curry?


Rocky, Be good to see the pic....;)

 

I sometimes wish we had a 'like' button as on Facebook as often the replies make me LOL!

 

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