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Having colorless bumps on hand, arm and trunk. Having itchiness. Suggest

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female, age 61, history of obesity, stent placement in coronary artery, neurofibromatosis. Have had NF in left hemisphere all my life, with the only symptoms being scattered colorless bumps on the left side of my body, primarily on arm, hand and trunk. Now have noticed similar, but smaller and more uniform bumps on the dorsal surface of BOTH feet. They seem to itch for a while, then the itching subsides and the bumps remain. The bumps and itchiness seem to be migrating up to my R ankle. I was thinking it was scabies, but the bumps are colorless, and the itching is not intense and stops after a day or so. Any ideas?
Posted Wed, 12 Jun 2013 in General Health
Answered by Dr. Rahul Kumar 11 hours later
Thanks for the query and photographs.

Though there can be many reasons for the bumps. In your case it seems to be:

1. New lesions of neuro-fibromatosis.
2. Urticaria.

Please let me know the details about your symptoms, like duration of rash, any other symptoms, etc.

It does not seem to be scabies.

Since itching is present, you may take some anti-histamine tablet daily for a week. If it is urticaria, you will get relief.

Let me know if you have any other doubts.

Thank you
Above answer was peer-reviewed by
Follow-up: Having colorless bumps on hand, arm and trunk. Having itchiness. Suggest 6 hours later
Thanks for the reply, Dr. Kumar!

I don't believe it's urticaria--I've had that before and there was much more inflammation and erythema and irritation. Plus I realized that I have the lesions on the posterior surface of my R hand now, also, but very small and not as raised.

But if it *is* NF, why at this time would it jump all of a sudden over to my R side when I've only had it on my L side all my life? And why would it itch when it's never itched before?
Also, I've seen the lesions on my feet now for about 8-months to a year, and on my right hand for about 8 months. The L foot lesions were itchy about 8 months ago and on the R foot about 4-5 months ago. The lesions & itching on the R lateral ankle are current. There is no (and has not been any) itching in the lesions on my R hand. The itching of the foot lesions has happened more in the evening, if that's relevant. But only for a short duration of time (like 1/2 hour); then I force myself to stop scratching and it goes away.
Answered by Dr. Rahul Kumar 9 hours later
Thanks for the follow up.

I will try to answer all your queries.

1. I agree with you that chances of urticaria is less, although it can present in a way similar to your lesions but the lesions should disappear in few hours.

2. New lesions of NF can appear in that way and even sudden eruption on other side is possible, as NF is either restricted to just one segment of body or is present throughout body.
It cannot be unilateral, though it may present with symptoms only on one side, there is a sub clinical disease present on other side also, which may erupt any time.

3. Regarding itch, an occasional itch can be present in NF due to involvement of mast cells and again not necessary that all the lesions should itch.

Apart from the above diagnosis, I can consider the following in my differentials.

1. Xanthomas - These are soft nodules, slightly yellowish, mild itch and persistent.

2. Calcinosis cutis - It presents as hard lesions with slight itch.

The photographs submitted by you are quite clear, but I want to know following additional things.

- Is the lesion soft or hard ?

- Can you compress the lesion, I mean when you press it goes inside and comes up again ?

- Have you got lipid profile done, I would like to know the report.

Waiting for your reply.

Thank you
Above answer was peer-reviewed by
Follow-up: Having colorless bumps on hand, arm and trunk. Having itchiness. Suggest 2 hours later
Thanks again for your reply!

I have to quickly reply here, then I can't respond again until Saturday.

Regarding your differential:

1. Xanthomas- I don't have time to look this up, but if I remember correctly isn't this some sort of subcutaneous "cholesterol deposit"? If so, I'm pretty certain that's not what these are. But, yes, my lipid profiles usually are pretty bad. I haven't had one recently, but just assume the worst and that's me, except my triglycerides weren't too horribly high. LDL & HDL= bad, total cholesterol somewhere in the 240's, and I'm on a statin. I'll try to find the last profile I had done and forward the results to you. My mom had the "cholesterol deposits" on her face--I might have one or two tiny ones on my face, but nothing like what she had.

2. Calcinosis cutis. Again, I don't have time at the moment to look this up, but judging by the name it sounds like hard skin and that is definitely not it.

Almost without exception, the lesions are rounded, dome-shaped, soft, and compressible. I do have a few larger ones on my hand that are harder (feel more fibrous) and less compressible.

Questions: is it typical for NF to have an exacerbation and/or proliferation with increased age? Post-menopausal? Is there any condition/medication which might be stimulating the increase in numbers and locations of the lesions? Can I assume that the lesions are proliferating internally as well as externally? In the same regions where I have them externally, or just randomly along the nerve pathways? Could they grow inside my brain or along my spinal cord? I've heard of auditory nerve tumors, but I don't know about optical nerve or others.

Thanks so much!

Answered by Dr. Rahul Kumar 24 minutes later
Thanks for your quick response.

You have good medical knowledge; I must appreciate this.

You are very correct in saying that xanthoma is collection of cholesterol.
But it is not only subcutaneous, It can also be on tendons, muscles etc.

Sometime Xanthoma presents with multiple lesions, similar to that seen on your skin. This is called as eruptive Xanthoma.

Again, you are correct about calcinosis cutis, it is deposition of calcium under skin.

Now regarding your questions,

1. NF exacerbates with age but no relation has been documented post menopausal.

2. It is genetic condition, so there is no relation with drug. It has its own course.

3. Lesions can proliferate internally as well as externally, but XXXXXXX lesions should be associated with symptoms pertaining to that organ. They can occur randomly. It is not necessary that XXXXXXX lesions will be seen only in those areas where external lesions are there.

4. They can grow inside spinal cord also; here they are called as dumbell tumor. It can cause compression on spinal cord.

5. It can involve any cranial nerve, though involvement of auditory nerve is common ( NF 2).

Let me know if you have any other doubts.

Thank you
Above answer was peer-reviewed by
Follow-up: Having colorless bumps on hand, arm and trunk. Having itchiness. Suggest 47 hours later
Thank you so much Dr. XXXXXXX You have answered all my questions for now. I appreciate your responses.
Answered by Dr. Rahul Kumar 1 hour later
You are most welcome.
Above answer was peer-reviewed by
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