Have You Ever Seen This?

[bollweevil]

small punctate red macules on a shin, no itching, burning, drainage, no known etiology

We are calling in Infectious Disease (not sure why), Allergist, Dermatologist, Cardiologist, not sure who else; This was discovered a couple of days ago during a bath. Patient was not aware she had them and denies any problems with them, we are all curious as to what they are.

Have you ever had a patient with something like this?

History includes DM, HTN, s/p CVA; some evidence of poor circulation in legs, that is, longstanding brown deposits in skin.

Thanks.

[bollweevil]

I think they indicate liver disease or some type of circulatory trouble. Pt is asymptomatic, these are newly acquired, thus ruling out, I believe hemangioma and a-v malformations.

[StrwbryblndRN]

Interesting. I have no idea but keep us posted as to what it may be.

[chadash]

Could this be vascular? If her circulation to her extremities is compromised, could the capillaries be doing some sort of compensatory thingemagig?

[bollweevil]

Could this be vascular? If her circulation to her extremities is compromised, could the capillaries be doing some sort of compensatory thingemagig?

That's what I'm thinking but not quite sure.

[grandee3]

I may be out in left field with this one, but I had a pt last week with HHT. Some type of hemorrhage under the skin.

[nightmare, RN]

could be Necrobiosis lipoidica ,often seen in diabetics.

[chadash]

I may be out in left field with this one, but I had a pt last week with HHT. Some type of hemorrhage under the skin.

You mean like petechia? Could it be platelets are too low?

Sounds different that petechia....

[TiredMD]

We are calling in Infectious Disease (not sure why), Allergist, Dermatologist, Cardiologist, not sure who else; This was discovered a couple of days ago during a bath. Patient was not aware she had them and denies any problems with them, we are all curious as to what they are.

That's a lot of money being spent on a finding that doesn't bother the patient.

Was this in a primary care clinic? Do a punch biopsy (or if not comfortable with that, a skin scraping), send it to path and see what they say. Boom, you just saved the patient's insurance $3000.

[blueheaven]

Vasculitis syndrome of some sort?

[sirI, MSN, APRN, NP]

That's a lot of money being spent on a finding that doesn't bother the patient.

Was this in a primary care clinic? Do a punch biopsy (or if not comfortable with that, a skin scraping), send it to path and see what they say. Boom, you just saved the patient's insurance $3000.

Have to agree with this.

[Medic2RN, BSN, RN, EMT-P]

How about any thyroid problems? Hyperthyroidism can sometimes cause plaques specifically on the shins. Just throwing it out there....