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Dry red patch on legs with JOCK ITCH, ATHELETES FOOT.

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I am a 29 year old male. A red patch showed up on my leg about a week ago. It is dry. It is not itchy. It has not increased in size. I tried to search different types of dermatitis or psorasis online but there are many different kinds. I have a dermatologist appointment but it's over 10 days away and would like to know if there is a cream I could use to begin addressing it. I don't have any allergies. I don't believe I came in contact with anything. Although I do work in health care in a nursing facility. Also Every once and awhile I get jock itch or athletes foot. I work long hours on my feet and try to keep my feet and genital area dry but sometimes I don't do as good as I should. I treat it with over the counter creams and it clears up very quick. I believe those are fungal infections. Could they possibly be related to my red patch?. Also I have shaved my legs since I was 16. Could another possible cause of my red patch have been a razor that was dirty and I didnt know it? Thank you

Category: Dermatologist

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Category: Sexually Transmitted Diseases(STD)Specialist
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Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
I have reviewed the image and it can be either contact dermatitis or a fungal infection. Does the skin on the affected spot feel a little thick than the surrounding skin? If so, then it is fungal infection, and you can apply Clotrimazole ointment 2-3 times daily and this will settle down. If there is no elevation and the skin feels normal, it is more likely to be a dermatitis. It is definitely not related to shaving.
Feel free to discuss further,
Regards.


Patient replied :

Hi. I recently had an appointment with a Dermatologist.
She diagnosed my skin condition as schambergs pupura. I appreciate your previous response stating it was either a fungal infection or dermatitis. I understand that assessment based on one picture online can be difficult. It may have been easier to charecterize as Schamberg today because I now have a few other smaller spots with lighther flecks of orange/brown on my legs. I believe the shamberg diagnosis is correct since the description more accurately matches how my legs look and the discoloration did not improve with the recommended antifungal clotrimazole.
I am a Physical Therapist and work very long hours >10 on my feet typically 6-7 days a week. The doctor stated that this can be a cause. She recommended to wear compression socks.
I searched online to understand a little more about the condition. Unfortunately the infromation is limited. Most sites explain that its from leaking capillaries. There is no treatment beyond the compression socks. It can take weeks to months for marks to disappear. New marks can appear in future. There appears to be alot of variabilty in the condition that makes it hard to make predictions about what each person will experience. Overall it is benign from what I can tell, andthe main problem is that it has a negative costmetic effect on appearance. Some sites list state that it is chronic and or progressive.
I didnt understand enough during the time of my dermatology visit to make additional follow up questions. The best I can tell, is that most people experience outbreaks every once in a while, and more or less resolve in between. Some people online state that they have identified certain triggers such as uses of tylenol, sun exposure, or use of alcohol. None of these apply to me.
I wanted to ask if my current understanding based on the limited information online coincides with your knowlegdge and experience. Should I expect random cycles?. Is it possible that my marks wont resolve but instead will accumulate?. Does this indicate that I would be more predisposed to have vascular problems in the future or not necessarily?. Does your understanding agree with what I have written that there is no treatment besides compression socks and marks can takes months to resolve? If your aware of any contradictory information to what I have discovered or additional information to help me understand the condition please let me know.
I appreciate your help
Thank you.


Hi,
Thanks for writing back.
Schamberg disease or progressive pigmented purpuric dermatosis usually presents as multiple asymptomatic cayenne pepper like red spots over lower limbs. These small red spots may coalesce to form bigger spots and over a course of time may increase in number. As you have rightly mentioned it is because of inflammed capillaries( capillaritis) that start leaking. It is usually seen in People who stand for long hours or exercise vigorously.
Ita not an uncommon condition. It is quite frequently seen in our OPDs. In your case we couldnt diagnose it as you presented with a single large patch without any history of multiple cayenne pepper like spots. Also schamberg disease lesions are usually not dry. Moreover it is actually difficult to come up with a definite diagnosis with just one pic.
Now what you can do to lighten and prevent progression of spots-
wear conpression stockings as suggested
Take oral vitamin c 500 mg twice in a day
Apply steroid cream like mometasone cream mixed with tretinoin cream twice.
While Sleeping keep foot end raised. This can be done by placing two pillows under your leg.
Usually it takes three to four weeks to see response. If no response is seen pentoxyfilline orally and Phototherapy ie PUVA can be tried.
It is a benign disease and there is no long term risk of developing vasculitis later on.
I would advise that you follow these suggestions and let us know after two weeks.
Lastly I regret that we couldnt provide you with most appropriate diagnosis but I hope that you understand our limitations.

warm regards


Dr. Kalpana Pathak
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
M.D. from Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak in 2011 with Haryana State Dental & Medical Council
M.B.B.S from MLN medical college allahabad in 2006 with Uttar Pradesh Medical Council
Dr. Kalpana Pathak and 4 other Medical Specialists are ready to help you

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