Hi XXXXXXX

Welcome and thanks for posting your query to Healthcare Magic.

I can understand your concern for the problem of rash over the ankle region.

By the short history provided by you the closest possibility appears to be of "Schamberg's purpura" also know as "Progressive pigmentary dermatosis" or simply we call it as "Schamberg Disease".

This problem is characterized by the appearance of reddish to brown or orange colored spots which we call as ""cayenne pepper" spots (from the red color of the pepper).

These spots are basically present around the ankle region on both the legs and appears as a rash from the distance. The most important distinguishing feature of this particular problem from any other type of rash is its long term presence without any symptoms of itching, pain or any irritation.

Now to tell you regarding the reason for its formation- we human beings are doing most of our daily and routine work in standing position. Even during our sitting job our legs are always the dependent portion of the body where blood is always pooling downwards. This means that our legs get rest only during sleep time when the blood is not pooling downwards.

Due to continuous pooling of blood the Red blood cells at this site extravasate (pass out from the vessel) from the blood vessels and then are collected under the skin. This is basically seen in blood vessels of skin only. The Red blood cells contain iron in the for of hemoglobin which after deposition forms "hemosiderin". This hemosiderin is the main product which actually get deposited in the skin and then manifest as reddish to orange brown or different dark colored rash.

Now probably you got some idea regarding your problem. To tell you further about this condition- In today's world of continuous walking and standing and sitting jobs most of us have this kind of pigmentation in lesser or higher side. So this depends on the status of pooling of blood according to job and sitting status. As the age advances it may progress up to calf also but never beyond knee joint.

As this is a simple problem and not a disease in itself so there is no cure for the same. For the betterment and slight improvement there are certain skin lightening creams such as "hydroquinone" or "Azelaic acid" creams to be continued for long time.

In our clinical practice we basically reassure the patient for the benign and simple nature of the problem. This would never ever going to cause any problem through out life and would not also be changing to any serious diease in future.

For further prevention I recommend you to eat a lot of vitamin C containing fruits which actually helps in strengthening the blood vessels as well as bit helpful in reducing the pigmentation also.

Hope I have answered your query. If you have any further questions, I will be happy to help.

"Wish you good health"

Regards,

Dr Sanjay Kumar Kanodia
(MD- Dermatology & Sexually Transmitted Diseases)

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