DEAR DR. GOTT:
My 77-year-old husband has a bizarre skin problem. On his left lower arm (elbow to wrist) on the top side only he has red blotches that appear and then disappear every several days. He has seen dermatologists in Atlanta, GA, Tucson, AZ and Santa Maria, CA but none can give him a diagnosis. All referred him back to his internist who also had no idea what the problem is.
The problem is now starting to happen on the top of the lower right arm. I have also noticed that following treatment for a blood clot in his leg (after hip replacement in 2006) with Coumadin, the blotches seem to be worsening. He also has some minor bleeding. He is tested once a month to ensure his Coumadin is working. The spots are not itchy or painful, they are only unsightly.
Aside from the Coumadin (2.5 mg four times a day, five days a week and six times a day, two days a week) he is taking Celebrex 200 mg, Sular 20 mg, Clonidine 0.2 mg, B6 50 mg, B12 500 mcg, folic acid 400 mcg, one calcium plus D pill, one multivitamin/mineral and one glucosamine/chondroitin pill (1500mg/1200mg). These were all started at different times but he has been on the clonidine since 1991. Please help us figure out what is happening.
DEAR READER:
Your husband is on several prescription and over-the-counter medications. Judging from what he is taking, it appears he has arthritis, high blood pressure and a clotting disorder.
I believe that he may be suffering the side effects of one of his medications. You do not say when the skin condition started but based on your letter, it was sometime before 2006. Had these blotches appeared after the Coumadin was started, I would have immediately recommended your husband return to his physician for testing that would have most likely shown that his levels were too high.
Because Coumadin is an anti-coagulant, doses that are excessive can cause bruising, slow healing wounds, easy or hard to stop bleeding and more. Because the spots worsened after the Coumadin was started, its leads me to believe that they are somehow related to the vascular system.
You claim your husband has had some minor bleeding but don’t say if it is spontaneous or caused by simple bumps, scraps or minor injuries. He should be seen by his physician because the Coumadin may still be to blame for at least worsening the condition. The physician is correct to monitor his INR (a type of clotting) levels, but if your husband is having symptoms, it is indicative that the dose is too high, meaning the blood is unable to clot quickly enough. Make an appointment to discuss this possibility right away.
Following the Coumadin review, I urge you and your husband to also review his other medications, including the OTCs. Clonidine, Celebrex and Sular can all cause various types of rashes. Sular can also cause skin discoloration, bruising, petechiae (pinpoint, round, purplish red spots caused by tiny hemorrhages in the skin) and maculopapular rash (stains or spots on the skin distinct from the surrounding tissue, usually not raised or painful).
I would also be curious to know his physicians stance on the OTC meds. Your husband is taking a multivitamin daily which by itself is good but he is also taking B6, B12, folic acid, and calcium plus D which is likely in the multivitamin already. I would suggest he stick to just the glucosamine/chondroitin and the one multivitamin unless he was directed by his doctor to take the additional supplements.
If this approach fails to provide positive results, I would recommend your husband be seen by a blood specialist who can determine if the blotches are caused by an abnormality in the clotting factors or other component of the blood.
Your husband needs to know what is causing his skin discoloration. If he has had it for more than 3 years, chances are it is harmless and benign. But, it is always better to be on the safe side. Don’t give up and remember to see as many doctors as it takes to get the answer you need. If dermatologists have failed, try another type of physician; someone out there will be able to help, even if it means a bit of hunting.
Let me know how this turns out.
To give you related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
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