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Hi All thanks for reading over this and your feedback -

I have a 81 year old male patient in regional Queensland, Australia who I see for general nail care every 2-3/12. At the first consultation several years ago he described an issue that he has suffered from for the past 7 years ago -

The plantar aspect of the feet become painful and blotchy and red dots come out and these dots then bleed and feet remain painful for several weeks and months. There is no pattern to when the issues occur - hot or cold weather. He has travelled and lived and worked in Africa as a missionary and has had GIT health issues at times. He has seen many doctors and specialist has had biopsies done of the red spots and blood test all have come back with nothing. He has taken oral steriods when the pain is bad but this does not really help.
Things have been good for several years since he was advised to take magnesium but had a flare up last week possibly from changing magnesium supplements. The following are pictures of the feet and specific areas of redness. Any thoughts?

 

Hi Mark,

After a quick look around on the below link I wonder if a cutaneous vasculitis is a possibility.

I see he has had them biopsied with no joy, have you been able to see the biopsy result or is that what the patients verbally reported?

That aside, I'm leaning that way based on my limited look around the web.

http://www.dermnetnz.org/vascular/vasculitis.html

A couple of quotes from the link :)

"In many cases the diagnosis of vasculitis can be made on the basis of its appearance without requiring any further tests. Sometimes a skin biopsy is performed to confirm the diagnosis but this rarely explains what caused it, as vasculitis is the common endpoint of many different events. "

" In the majority of patients no underlying cause is found in spite of extensive investigations. "

Sounds like it gets pretty painful, which didn't seem to feature so much with vasculitis?, which makes for more questions.


Regards

Greg

 

Hi Greg

Thanks for the reply and the link.

I did not see the report just verbal for patient.
It does match some symptoms but not all but often all is never achieved.

Again thanks