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Q: Rashes on feet and ankles ( Answered,   1 Comment )
Subject: Rashes on feet and ankles
Category: Health > Conditions and Diseases
Asked by: septemberfrost-ga
List Price: $30.00
Posted: 19 Jun 2006 17:05 PDT
Expires: 19 Jul 2006 17:05 PDT
Question ID: 739478
Red rashes have formed on feet nearest my ankles, these rashes if
spreading have spread very slowly and are small almost to the size of
a pinpoint and hard to the touch. They range in colour from red to a
light brown. Shortly after they started to appear nail growth on my
feet had seemed to have stopped. Now nail growth has resumed some but
very slowly. My nails on my feet have been dry and hard. This supposed
rash has not cleared in several months.

About myself I am a 29 yr old male living in a very dry climate if
this would have any effect on the answer.

Help would be deeply appreciated
Subject: Re: Rashes on feet and ankles
Answered By: crabcakes-ga on 19 Jul 2006 14:46 PDT
Hello Septemberfrost,

    The commenter below may be on the right track (and I suspect s/he
is), but beware that a rash as you described can have other causes.
This answer is for informational purposes only, and is not intended to
diagnose or treat.

   Schamberg?s disease (progressive pigmented purpura, PPP) is one of
several forms of  capillaritis. The cause is unknown, but it is
suspected of being triggered by a virus, or a reaction to medication.
?No one knows what causes it, but if a biopsy is done, inflammation is
seen around the tiny capillaries in the skin. The blood leaking
through the damaged walls forms the little red dots. The iron from the
blood "rusts" (turns into hemosiderin) giving the distinct color. A
biopsy may be done to confirm the diagnosis.

Occasionally PPP is caused by a reaction to a prescription drug,
allergy to clothing dye and rubber, food preservatives and artificial
coloring agents, or another skin disease. When it is limited to a few
small patches, it may be due to an abnormal veins or arteries
underneath. This may need support stockings or surgery to clear it

   ?The capillaries are small blood vessels near to the skin surface.
For unknown reasons they sometimes become inflamed. Blood cells may
pass through small gaps that arise between the cells, which make up
the capillary walls. The result is tiny red dots appear on the skin,
described as cayenne pepper spots. They group together to form a flat
red patch, which becomes brown and then slowly fades away over weeks
to months.?

?There is no known cure for most cases of capillaritis. It can
disappear within a few weeks, recur from time to time, or frequently
persist for years.
?	Consider if a medication could be the cause: discontinue it for
several months to find out if the capillaritis improves
?	Try avoiding food preservatives and artificial colouring agents.
Return to a normal diet if there is no improvement after several
?	Topical steroids can be helpful for itching but rarely clear the capillaritis. 
?	If the lower leg is affected, consider wearing graduated compression
elastic hose.
?	Currently available lasers are not particularly helpful for this condition.

   ?The term pigmented purpuric dermatoses includes Schamberg disease
(ie, progressive pigmentary dermatosis), purpura annularis
telangiectodes (Majocchi disease), lichen aureus, itching purpura,
eczematidlike purpura of Doucas and Kapetanakis, and the pigmented
purpuric lichenoid dermatosis of Gougerot and Blum. Many consider
itching purpura and eczematidlike purpura to be variants of Schamberg

Pathophysiology: The etiology is unknown. Venous hypertension,
exercise, and gravitational dependency are important cofactors that
appear to influence disease presentation. Histologically, a
perivascular T-cell lymphocytic infiltrate is centered on the
superficial small blood vessels of the skin, which show signs of
endothelial cell swelling and narrowing of the lumen. Extravasation of
red blood cells with marked hemosiderin deposition in macrophages is
also found, and a rare granulomatous variant of chronic pigmented
dermatosis has been reported.

?	In the US: Pigmented purpuric dermatoses are uncommon. 
?	Internationally: During a 10-month period, the authors' United
Kingdom hospital-based dermatology practice, which serves a population
of 300,000 persons, identified only 10 such cases. Five cases were
diagnosed as having lichen aureus, and the remainder had more
extensive capillaritis.? 

   ?Episodes of purpura may last up to several weeks and sometimes
longer. The exact cause of Schamberg's disorder isn't known. But it
may be associated with a recent viral infection or allergic reaction.
This disorder occurs most often in males.

Before making a diagnosis of Schamberg's disease, your doctor will
likely want to rule out other more serious causes of purpura, such as
inflammation of the blood vessels (vasculitis). A common type of
vasculitis in children is Henoch-Schonlein purpura, a condition that
can lead to inflammation of the joints, abdomen or kidneys.

A doctor can confirm a diagnosis of Schamberg's based on the results
of a skin biopsy. If purpura persists or is associated with pain or
discomfort in other parts of the body, consult your doctor.?

   ?Schamberg's disease. This is an uncommon eruption characterized by
progressive, asymptomatic petechiae and patches of brownish
pigmentation that may occur in any age range from children to elderly
persons. The lesions may occur in any location but most often affect
the lower extremities. Characteristic "cayenne pepper" spots appear
within and at the edges of old lesions, caused by erythrocytes
breaking down outside the capillary and leaving hemosiderin deposits.
The skin lesions are nonpalpable macules that may persist for months
to years and are typically asymptomatic except for the cosmetic
appearance. Males tend to be affected more than females.

The exact etiology is unknown, but a cellular immune reaction may play
a role. Occasionally, Schamberg's disease occurs secondary to a drug
reaction, and withdrawal of the medication may improve the lesions.
(1) Histologic examination shows a lymphocytic vasculitis involving
the blood vessels of the upper dermis (i.e., mainly the capillaries),
with endothelial swelling and extravasated red blood cells.?

   ?Schamberg's disease is classified as a capillaritis of unknown
cause; cases due to drug (acetaminophen) [1]and hepatitis B
antigenemia [2]have recently been described. This is the first report
of a clear familial occurrence of Schamberg's disease.?

To read the entire article would cost $15, USD

   ?Graduated compression elastic hose may help on the lower
extremities, because this condition is thought to be caused by
capillary leakage. Laser ablation of lesions has been attempted but
has not proved successful.?

Medications - Some people on this forum realized they came down with
Schamberg?s after using Azmacort for asthma. Acetominophen has been
know th be associated with Schamberg?s. Some blood pressure
medications can casue the ?leaky vessel? problem that leads to

   ?Schamberg's Disease itself causes no other symptoms. But that
doesn't mean you don't have pain. Perhaps your spots mean something
else, or maybe the pain is from a different cause entirely. (The same
question comes up with varicose veins. Many women have them, and some
have leg pain, but it's awfully hard to line up what you see with what
people feel, since many people with leg pain have no visible veins,
and vice versa.)?

   ?Schamberg's disease, or progressive pigmented purpuric dermatitis,
is a chronic discoloration of the skin which usually affects the legs
and often spreads slowly. This disease is more common in males and may
occur at any age from childhood onward.?

There is no permanent cure for Schamberg's disease; however, the
itching can be controlled by a cortisone cream.?

I?d recommend you see your doctor before attempting any treatment
yourself. While rare, capillaritis can indicate the start of cutaneous
T-cell lymphoma.

   ?Pigmented purpuric dermatoses must be distinguished from early
cutaneous T-cell lymphoma, purpuric clothing dermatitis, stasis
pigmentation, scurvy, leukocytoclastic vasculitis, purpuric
generalized lichen nitidus, and drug hypersensitivity reactions (eg,
allergy to rituximab, carbamazepine, meprobamate, chlordiazepoxide,
furosemide, nitroglycerin, or vitamin B-1). A case of
glipizide-induced pigmented purpuric dermatosis has recently been
reported. Topical fluorouracil has been implicated in a pigmented
purpuric dermatitislike skin eruption. Pharmacologically induced
regressed Kaposi sarcoma lesions may be misdiagnosed clinically and
histologically as pigmented purpuric dermatitis.?

For diagnosing:
Lab Studies: 
?	A complete blood cell count is necessary to exclude
thrombocytopenia, and coagulation screening helps to exclude other
possible causes of purpura.
Imaging Studies: 
?	Dermoscopy has been reported to be a useful tool for assisting the
clinical diagnosis of pigmented purpuric dermatoses.
Other Tests: 
?	Capillary fragility may be assessed by the Hess test.
?	A skin biopsy helps to confirm the diagnosis of a pigmented purpuric
eruption and aids in excluding cutaneous T-cell lymphoma, which in its
early stages may closely mimic a pigmented purpuric dermatitis both
clinically and histologically.

?Before making a diagnosis of Schamberg's disease, your doctor will
likely want to rule out other more serious causes of purpura, such as
inflammation of the blood vessels (vasculitis). A common type of
vasculitis in children is Henoch-Schonlein purpura, a condition that
can lead to inflammation of the joints, abdomen or kidneys.?

You can see a broad range of photos of Schamberg?s here, from minor
cases to severe ones:

Please also  notify your doctor first, if you consider trying the
herbal or alternative products for your rash. They may not be
compatible with any prescription medications you may be taking, not to
mention, they simply  may not work.

These past answers may be useful to you:

I hope this has been helpful to you. Please request an Answer
Clarification, and allow me to respond, if anything is unclear.

Sincerely, Crabcakes

Search Terms
pigmented purpuric dermatitis
medications causing Schamberg's
Schamberg?s Disease
Schamberg's acetaminophen

Clarification of Answer by crabcakes-ga on 19 Jul 2006 16:41 PDT
Ooop, I forgot to address your toes. This is likely a coincidence.
Toenail fungus can make nails thick and hard.
"Perhaps you have noticed some of these symptoms or signs?

    * thickening of the nail
    * brownish or yellowish discoloration of the nail
    * "toe jam" accumulating under the nail and along its edges
(sometimes that toe jam can smell pretty rank)
    * brittle crumbling or breakage of the nail 

If you're saying yes to some or all of these points, you indeed may
have described or identified a fungal toenail infection. And yes,
check in with a health care provider to find out what kind of
treatment is best for you. You don't want to wait till you lose your
toenail, or until the infection spreads to other nails on your foot.
You could go to a podiatrist, a dermatologist, or your general or
family health care provider, all of whom can help diagnose and treat
this fungus."

"Toenail fungus, also called onychomycosis, is a relatively common
condition that disfigures and sometimes destroys the nail. This
problem can be caused by several different types of fungi (microscopic
organisms related to mold and mildew). These fungi thrive in the dark,
moist and stuffy environment inside shoes. As they grow, fungi feed on
keratin, the tough protein that makes up the hard surface of the
toenails. In most cases, the fungus belongs to a group of fungi called
dermatophytes, which include Trichophyton rubrum and Trichophyton
interdigitale. Other, less common causes of onychomycosis include
yeasts and molds.

Toenail fungus affects 2% to 18% of all people worldwide and 3% to 5%
of people in the United States. It is relatively rare in children,
affecting only about 1 out of every 200 people younger than 18.
However, the likelihood of getting toenail fungus increases with age.
Up to 48% of people have at least one affected toe by the time they
reach age 70. Although 2.5 million Americans see a podiatrist annually
for treatment of toenail fungus, many more are infected but never seek
help. Some people consider toenail fungus just a cosmetic problem and
don't bother seeking treatment."

"Toenail fungus rarely heals on its own. It is usually a chronic
(long-lasting) condition that gradually worsens to involve more and
more of the nail. Even if the affected nail comes off, the new nail
that grows usually is infected with fungus.


To help to prevent toenail fungus:

    * Wear comfortable shoes and hosiery that allow your feet some
"breathing space."
    * Wear shoes, sandals or flip-flops in community showers or locker rooms.
    * Wash your feet every day, dry them thoroughly, and use a
good-quality foot powder.
    * Wear clean socks or stockings every day.
    * Keep your toenails trimmed.
    * Disinfect pedicure tools before you use them."

Sincerely, Crabcakes
Subject: Re: Rashes on feet and ankles
From: jashoeuh-ga on 19 Jul 2006 12:19 PDT
I have similar rashes.  It is most likely Schamberg's Disease, which
has no known cause and is not dangerous.  It is red blood cells that
escape from blood vessels and lodge in the skin.  As the red blood
cells deteriorate, they burst and the iron in the blood cell turns a
rust brown color.  As a result, you get a "rash" of red to light brown

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