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What could be the cause of brownish orange stains between toes of right foot only in the mornings ?

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Last week, I woke up in the morning and the sole of my right foot was covered with a brownish-orange dried stain that was splattered up between my toes as well. It may be likened to stain acquired form wood staining. Some areas were more concentrated brown and others that were more orange. It looked as if I had stepped in a puddle of iodine or wood stain. It was difficult to remove but it did come off with scrubbing making the cloth orange brown as well. In subsequent days, similar stains/spots (but not as much as the entire right sole as the first day) appeared on the sole of my left foot, palms, fingers and big toe including the nail bed of that toe. There was a bit on the back of my hand also. The internet revealed no answers, but there many people on two medical websites with the same issue, all prefacing with something like “I woke up in the morning with orange brownish stains”. It happens while you sleep yet not a speck is on the bedding as expressed by some of the others on the medical websites as well. I called my doctor, and he had no idea other than I was sweating out something. I went to my dermatologist, but I had removed the stain earlier that morning. She did not know, nor did anyone on the websites ever get an answer. There is no itching, burning, swelling, odor or anything like that. Again, it appears only in the morning after sleeping all night. There is no cut or bruise. It is not a skin pigmentation issue. I had blood work done for an annual recently and all was OK. The spots/stains are DEFINITELY NOT there when you go to sleep. None of the people on the websites could identify anything in common really. My doctors did not feel it was XXXXXXX since it wipes off although not easily. The entries on the website noted that other family members would wake up the same morning with the stains, and all ages from 19mos old to older people. What could this be?
Posted Wed, 11 Apr 2012 in Skin Hair and Nails
 
 
Answered by Dr. Bharat Chawda 2 hours later
Hi,

Thank your for the query,

Since you said it appears as a stain and not a pigmented skin, and they appear only in the morning; I suppose its the colored sweat on the sole which is causing the problem.Such a condition is called Chromhidrosis.

It's a rare condition characterized by the secretion of colored sweat.

We have two sweat glands on our skin : Apocrine and Eccrine gland.

Chromhidrosis is apocrine in origin. Sweat glands produce a compound known as lipfuscin,a pigment responsible for the colored sweat.Oxidation of this is responsible for the characteristic yellow, brown, XXXXXXX blue, or black secretions observed in apocrine chromhidrosis.

In contrast, eccrine chromhidrosis is rare and occurs with ingestion of certain dyes or drugs. At times when clear eccrine sweat becomes colored on the surface of the skin as a result of extrinsic dyes, paints, or chromogenic bacteria. then it is called pseudochromhidrosis.

Now probably in your case either it's the external reason or the sweat itself is colored.
I strongly see this as a possibility .

I would like to ask you to kindly keep a note of any change of socks or any bed sheet or even slippers/shoes have been done which could be responsible for as external source of pigment.

Are you on any medications for any medical reasons?

I would suggest you to consult a competent dermatologist for second opinion.

I would also like to have a clinical view of the same,so you can even consider sending me a close up picture of the lesion which would help me further. You can send it at YYYY@YYYY and kindly mention "ATTN Dr.Bharat Chawda" as a subject.
Please do confirm the sending of the photos by writing here, so that I can reply you back at the earliest.

Please reply back with the above answers and send the pictures if possible, as this will help me in answering you better.

Awaiting your reply.

Regards,

Dr.Bharat chawda
Above answer was peer-reviewed by
 
Follow-up: What could be the cause of brownish orange stains between toes of right foot only in the mornings ? 54 minutes later
Thank you for your response, but your answer did not take in all the facts that I noted in detail.

1) You focused on the soles yet I stated it appeared on my palms and fingers as well in subsequent days. (as it did on teh many entries on the medical help websites)
2) Importantly, as also mentioned, THERE WAS NO LESION OR ANY XXXXXXX OR BRUISE WHEN IT IS SCRUBBED OFF.
3) I stated that I went to a competent dermatologist, and she did not know the reason.
4) I also stated that there is not a XXXXXXX on any bedding. The first time, I went to sleep on a white sheet and woke up with the "stain" all over my right sole and up between my toes, but none on the white sheet.
 
 
Answered by Dr. Bharat Chawda 58 minutes later
Hi!,

Thank you for the reply,

I did read the detailed description you stated earlier. To answer your questions step by step :

1)Chromohidrosis can and does occur on the palm and fingers also. In fact it can also be seen on the armpits.

2)Since it just a sweat, it can be removed just by scrubbing and it may not leave any bruising or marks when scrubbed.

3)I would like to state that ,since it is a rare condition ,any dermatologist would not take it as her or his first diagnosis.Even I would take this as a possibility only , since you had already consulted a competent dermatologist.As far as other possibilities are concerned there is only one condition which leads to brown discoloration and that is Erythrasma.But this condition cannot be scrubbed off at all and is mostly seen over arm pits.Since I have not seen the lesion clinically ,it makes all the more difficult to predict the exact diagnosis.Chromohidrosis is the only thing which comes close to the findings.

4)Lastly, since there is no external factors responsible (as you were using a white sheet) ,we can rule out the possibility of pseudochromohidrosis.

I would advise you to consult your dermatologist again and discuss the possibility of chromohidrosis as well.

I can understand your worry and apprehension regarding this unusual finding .I will be available for any help or assistance needed in future.


Hope I have answered your query. I will be available for follow up query if any.

Regards,
Dr.Bharat chawda

Above answer was peer-reviewed by
 
Follow-up: What could be the cause of brownish orange stains between toes of right foot only in the mornings ? 4 hours later
Thank you again for your prompt response. I do not mean to come across unappreciative, however, I am still unclear.

Lesion? You keep referring to a "lesion". There were no lesions if I am understanding lesion to be a break in the skin, an infected area, a diseased area, or a damaged area. Not even a XXXXXXX or scratch. It looks like you got iodine or wood stain splattered on your soles or palms. When you wash it off, it looks as smooth and clear as it did before the stain appeared.

Chromohidrosis? The stains/spots appear ONLY when you WAKE UP not when you sweat throughout the waking hours. This was a commonality shared by all those with blog entries on WebMD and MedHelp websites when I searched for "brownish orange stains or spots on palms of hand and soles of feet". They are ONLY brownish orange for us all. (iodine colored). No other color. They DO NOT STAIN the bedding or anything else they come in contact with at all. The information available for chromohidrosis associates this condition with apocrine glands which my dermatogist explained are mainly confined to the armpits (axilla) and the anal-genital area. It is also common on the face she said. Plus according to her, eccrine glands are the glands in the palms and soles. The specifics as detailed in my previous emails to you and this one just do not fit with chromohidrosis descriptions. I am at a loss.
 
 
Answered by Dr. Bharat Chawda 7 hours later
Hi!,

Thank for the reply,

I am sorry if I had mentioned "lesions" anywhere and I understand that there are no marks or scratches either.

And yes Apocrine glands are more responsible for the Chromohidrosis which we see on the face and armpits. We have Eccrine glands present on the soles which too can lead to Chromohidrosis especially the Pesudochromohidrosis.

Since we could not find out any external factors responsible for this we had to rule out that. But as mentioned in books even some food items or medicines can cause such Eccrine Pseudochromhidrosis.

Medicines like quinine can lead to this. Also dyes, paints, fungi and chromogenic bacteria(eg:corynebacterium species) can lead to Eccrine Chromohidrosis of soles.

Other differential diagnosis of the same are Alkatonuria(Ochronosis) & Hyperbilirubinemia. This text has been taken from text book of dermatology-Fitzpatrick.

I would like to see the picture of the same if it is possible with you, as this would help me in suggesting you better. You have a feature to upload the reports / image by yourself at the right side of the query page, please utilize that so that I can answer your queries better.

I would also like to know if your dermatologist has any differential diagnosis which he/she can share with us.

Wish you good health.

Regards.
Dr.Bharat chawda.
Above answer was peer-reviewed by
 
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