Strange rash on my feet, ankles and shins

[eDeal]

I have had a rash for at least the past 3 years which I just re-noticed recently.  Because of its location, I have not been able to see it well (just looked like a darker patch of skin from a distance).  Anyway, after reading about blood disorders, when I found out an old friend had died of Leukemia, I came across a reference to Petechiae (sp?) which in some cases seemed to resemble the more isolated patches of the rash that I could see on my ankle.  I never bruise though, and cannot remember the last time I saw a bruise on my body.

So, I broke out the digital camera and noticed that the spots were all over my feet and melded into a single mass around the toes.  The rash is completely flat, does not itch or burn.  Here is a link to the picture:

http://www.safehavenpointe.com/leftfoot.jpg
http://www.safehavenpointe.com/rightfoot.jpg

I went to the doctor and he was stumped.  My main purpose for going was to be checked for Pernicious Anemia, since I was having some of the symptoms and the disease runs in my family.  His recommended action was to await the blood work, and see if there was a cause to be found there.

If you notice in the picture, around the edges, the bumps are isolated and look like little cirlces.  The appearance on my shins and ankles are very sparse in comparison to my feet. I cannot tell if the discoloration is due to hemoglobin or melanin, as it seems almost a redish brown.

Here are some other symptoms I have had recently:

After recovering from the flu in November, I have had an elevated temperature in the low 99's.

I have been have recurrent sinus infections and a persistant occassional productive cough of clear mucous.

Have been avoiding stairs because they leave me drained.

Occasional boughts of breathlessness.

Always feeling hot, especially when trying to sleep.  I have to sleep with the heat off, or I wake up with my bed covered with sweat.

Occasional weakness in my arms or sometimes just the hands.

Inability to keep my balance with the lights off

Feeling sleepy no matter how many hours of sleep I get

Anyway, I have been usually healthy in my life, and the fact that I even had a bought with the flu was rare.  I don't think the above symptoms are related to the rash on my feet, as it has been around for at least 3 years, but to a lessor degree.

I have already seen a doctor, yesterday, I just want additional advice on the rash, as he seemed stumped.

[Alan Rockoff, MD]

I think you pigmented purpura, known as Schamberg's Disease.  This is an unimportant condition in which tiny capillaries burst and leave brown spots.  These may last a long time.  No treatment makes any difference.  The condition has no known cause and no internal significance.  A dermatologist should be able to make the diagnosis, so I advise you to consult one.

Take care.

Dr. Rockoff

[eDeal]

Well, that would be a relief.  

I did notice today that after wearing a different type of sock (one that did not end at the ankle, like I usually wear) more appeared on my upper ankle.  This is the first time I have seen more appear and they seem to have appeared where the "pressure lines" of the sock left an imprint.

When I return to the doctor, I will get a referal to a dermatologist if the blood work comes back negative.

[eDeal]

I went to a dermatologist yesterday, and he immediately diagnosed it as PPP or Schamberg's disease.  Thanks for the advice.

Is this condition always diagnosed without any form of biopsy?

[TheMusicGuy]

A related discussion, Ankle Spots was started.