DEAR DR. GOTT: In 1998 I noticed the fleshy part of my palms were bright red. Eventually the redness extended to the entire palms and went up and over the tips of my finger. Later, the soles of my feet turned red and it progressed up and over my toes. Sometimes my knees and insteps are red. Now the redness has appeared as ragged splotches on my arms and face.
My showers, of course, increase the redness; however, lately the palms of my hands blanch after a shower, look almost translucent and the redness appears under the skin as pale pink. After an hour or so the blanching disappears and the redness comes back. I have no itching or pain.
Over the years I’ve asked many doctors what causes it and with few exceptions have been told “no idea”. The few exceptions were from my dermatologist who said she thought it pertained to the arthritis caused by Sjogren’s syndrome (I also have fibromyalgia) and was told to see my rheumatologist, which I did. He said he also had no idea, but thought it might be vascular. I had already seen a vascular surgeon and was due to go back for a checkup so at that appointment I asked him if he could explain it. He’s a diva and informed me that he is a vascular surgeon and is not concerned with anything except arteries and to ask someone else. I do not have Raynaud’s. My mother, now deceased, has permanent redness on the fleshy part of her palms but it never progressed beyond that.
Lately, the same time as my hands start blanching, the skin on my hands becomes so dry and wrinkled that I can’t use enough lotion. And my feet become very wrinkled around the edges.
DEAR READER: I’ll attempt to give you some direction but it won’t be easy, primarily because the rash “travels“ extensively and no one else who has visually seen the rash has been able to determine the cause. Rash and blotching may come from a variety of sources to include contact dermatitis, heat, stasis dermatitis (a form of eczema), scabies, allergies, fungal infection, bacterial meningitis, psoriasis, exposure to an abrasive irritant and a host of other possibilities. High on my list of possibilities for you would be an allergy — either inhaled, ingested, or injected. Are you on any injectible prescription medications such as insulin that could now be causing adverse effects on your body?
Your issue with dryness also makes me want to lean toward a variety of forms of dermatitis that can be present following wearing or touching some jewelry — even expensive pieces. Outbreaks ordinarily remain confined to the area of direct exposure but can include the crusting of lesions, itching skin, redness and more. Stasis dermatitis is brought on by poor circulation and the accumulation of fluid in tissues beneath the skin. It is characterized by red, scaly patches around the legs and ankles.
Psoriasis, another possibility, can appear in small or large areas and cause red, scaling patches of skin, dry surfaces, and ridged fingernails. The palms of a person’s hands are common areas for psoriasis eruptions, which can cause scaly white spots and inflammation. Most forms of psoriasis are cyclic, meaning they flare up and subside.
You may have an auto-immune disorder where your body inadvertently attacks its own tissues. Numerous viruses that occur during the typical flu season or viruses associated with childhood diseases such as chickenpox can produce a rash. Stress can produce physical mental and emotional symptoms, affecting any part of the body. Your body may be reacting to pressures at work, at home, from family, lack of finances, or other causes. And, these conditions can have a negative impact on your overall well-being, causing rash and other symptoms.
There is a possibility of Darier disease, an inherited condition characterized by wart-like blemishes that can appear as small pits in the palms of the hands and on the soles of the feet. This condition is not an infection, nor are the blemishes contagious. Darier is generally diagnosed by its appearance on the skin and by family history. You may require a skin biopsy to confirm such a disorder. Measures to manage Derier include using sunscreen, wearing cotton clothing, avoiding warm environments, the use of moisturizers with urea or lactic acid to reduce scaling, and prescription topical steroids for inflammation.
This may appear to be an over-simplification after what you have been through but let’s see if my recommendations make any sense. Begin by keeping a journal following your every outbreak. What preceded each one? Did you use a floor cleaner, spray your countertops, or inhale the fumes that could have caused an allergic reaction? Have you changed shower soaps or laundry detergents? Does your table have a fresh vase of flowers on it? Do you take a daily over-the-counter supplement? Do you have an allergy to peanut products, food dyes, or shell fish? Are you on any prescription medication you could have developed an allergy to? I could continue, but by now you can see where this is going. If you can find ANY common denominator, perhaps you and your plethora of specialists can zero in on possible causes.
Readers who would like related information can order my Health Reports “Allergies” and “Dermatitis, Psoriasis and Eczema” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order for each report to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.