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Mysteriors rash on extremities with swelling
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Mysteriors rash on extremities with swelling

Two months ago (when my baby was 10 months old) she developed a rash on her extremeties with a small patch of rash on her right cheek.  This rash has been re-occuring for 2 months now.
It started out on the back of her thigh and looked like a sunburn with swelling.  It moved to her hands (slight swelling), feet (slight swelling), arms and legs and seemed to move around.  She also had some redness on the linings of her lips - but no swelling there. It did not itch and she had no fever.  The following day her legs had a purplish color so I took her to the doctor who thought it was "intriguing" but of no concern - some form of vasulitis.  Three days later she got an ear infection and was put on antiobiotics (the rash preceded the medication and ear infection).  
The rash went away and appeared again a few weeks later - this time begining on the hands and moving to her extremitiies (she got the stomach flu 2 days prior to the rash flu but had no fever) - in addition she woke one morning with one eye red, swollen and glued shut - no fever. The eye remained red for a couple of days but no more puss or swelling appeared. I took her back to the pediatrician who then sent me to a pediatric dermatologist. He said it was certainly atypical but still thought it was viral. He said to watch it for another 6-8 weeks (which would mean four months after the initial rash) and that if she had trouble moving her joints her would refer her to a rheumatologist. The rash went away again.
In the mean time she got another ear infection and was put on amoxocillan (remember the rash preceded the amoxocillian 2 months ago)
10 days after the most recent rash got the rash again - very red and inflamed sunburned looking skin.  I noticed the redness on her hands first and then it appeared on her arms, legs and feet.  At the end of the day her feet were bright red, hot to the touch and swollen on top. She was cranky and in pain especially if I touched her feet.I showed it to my father (who is a cardiologist) who also thought it was mysterious.  What should I do?  Are there any specific things she shoud be tested for or any other type of doctor she should see?  It has been 8 weeks since she first got the rash and they seem to be getting worse not better.  The rash does not itch her.  They have not been preceded by any fever and she only seems uncomfortable and cranky when the rash is peaking and accompanied by swelling.  At its peak the bright red areas are hot to the touch and exhibit some swelling.  When the rash begins to fade the rashy areas have a purplish hue to them.  The rash fades when it blanches. Aside from a little bit on her buttocks, the rash has nver appeared on her trunk.
One last note, I did notice a very mild form of this rash several months ago.  I thought she may have gotten a mild sunburn, but in retrospect I know it was the same rash - as I am very careful about the sun with my children since I have had melanoma.
What do you recommend I do
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I don't pretend to know what this either, but it has a vaguely rheumatologic flavor.  I recommend a repeat consultation with the dermatologist and referral as well to a pediatric rheumatologist.  Blood tests such as a sedimentation rate and related studies and perhaps a skin biopsy may be able to clarify what is going on.  That's the direction I would take were such a case to my attention.

Good luck.

Dr. Rockoff
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