Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

192 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Suffering from cutaneous hematomas on lower legs. History of sarcoidosis, Sjogren's syndrome, GERD, narcolepsy. Now?

Answered by
Dr.
Dr. Stephen Christensen

General & Family Physician

Practicing since :1986

Answered : 212 Questions

default
Posted on Wed, 12 Dec 2012 in Skin Hair and Nails
Question: i have recurring cutaneous hematomas on my lower legs that are unrelated to trauma. My clotting factors are fine, my thyroid is fine. I do have venous insufficiency but imaging scans at a vascular specialist don't indicate a connection. Long history of anemia (20 years) corrected 2 years ago by TAH/BSO, iron infusions and transfusions. History of sarcoidosis, Sjogren's syndrome, GERD, narcolepsy. Current medications are 20 mg Prednisone every other day, 30 mg Prevacid daily and 200 mg Provigil. The hematomas start as painful, raised reddened skin, about the size of a dime, then spread to about the size of a quarter and turn into hard brown/black stains. Black woman, 45 years old, moderately obese, non-smoker, not diabetic. I'd appreciate any help!
doctor
Answered by Dr. Stephen Christensen 3 hours later
Hello,
Thanks for writing to us.
I'm sorry you're having problems with your legs. Without an examination it isn't possible to identify the cause of your symptoms, but I suspect you're dealing with a condition called erythema nodosum. This is a form of inflammation that occurs in the fatty layers of your skin. It typically starts as a small, reddened, raised area of skin that may gradually enlarge. As the inflammation subsides, patients typically develop post-inflammatory hyperpigmentation (darker areas) that can persist for many months. Black women are more likely to develop erythema nodosum, and this condition is often seen in people with sarcoidosis.
Your doctor can confirm whether you have erythema nodosum by performing a biopsy (a very small piece of skin taken from an affected area). At that point, it will be important to determine if your sarcoidosis is adequately controlled; if so, you and your physician can discuss other approaches to specifically deal with your skin problem, such as nonsteroidal anti-inflammatory drugs, potassium iodide or colchicine.
I suggest you follow up with your doctor. If you have any additional questions, I'll be available, but I'll be away from my computer from time to time.
I hope this helps!
Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
default
Follow up: Dr. Stephen Christensen 32 hours later
Thank you for your very helpful response; it gives me a solid direction to pursue. To follow up, is the biopsy something my primary would do or should I get referral to a dermatolgist? The sarcoid is eing managed by my pulmonologist and I have a rheumatolgist for the Sjogren's syndrome; would either of these suffice?

Again, thank you very much!
doctor
Answered by Dr. Stephen Christensen 8 hours later
Sorry for the delay in getting back to you. Our server crashed last night.
Your primary care physician should be able to perform the biopsy, which involves taking a small, circular specimen from one of the lesions on your leg (it's called a punch biopsy). This is done under a local anesthetic, and most doctors can do it in their office. If your PCP doesn't have the necessary supplies, I'd bet your rheumatologist could do it, as they often have to investigate skin lesions that are associated with autoimmune disorders.
Good luck!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,   ,   ,   ,   ,   ,  
Drug/Medication ,  
Medical Procedures
Lab Tests

Recent questions on  Biopsy

doctor1 MD

My mother is 89 and on hospice care for advanced A.D. she has developed, over past year, an indentation on the top of her skull running left to right about three inches back from the front of the scalp. She has several large nodules on her thyroid, but her endocrinologist declined to pursue with needle biopsy or surgery due to her age and advanced disease, A.D. what do you think could be the cause of the changes in the top of her skull, indentation. She also has had significant loss in brain mass in past 12 years per MRI studies ren years apart.

doctor1 MD

i m an SLE patient but it is controlled..since 5 years..and i didnt suffer except from arthritis in my first months only....but in my last periodic examination..i found my albumin in urine ++ the doctor told me to repeat the test ...coz it may be of wrong diet habits..so please what food should i avoid coz this result will determine wheather i ll do biopsy or not...thnxx

doctor1 MD

I am a renal transplant patient. Surgery done 6 months back. After transplatation I used to take immuno suppresents like Pangraf, Cellcept and Prednisolon. Immediate after surgery my S.Creatin levels were 1.4, 1.3, 1.2 then 1.5 etc..After one month of when I checked my Tac level it was very high ie, 14.4. Then Pangraf dosage reduced for next one month.But there was no significant reduction in Creatin and then checked Tac level it shows 14.1. At that time S.Creatin was 1.7.Then stopped Pangraf and started Certican .25. A sudden increase in S.creatin and it became 2.6. My Biopsy shows ATN+ and other readings were quite normal. My Potassium and RBS are quite normal. Then started Neoral 50mg and tried 25mg, but again S.creatin level gets increased and now it is 3.6. My Doppler test parameters are normal. What would be the remedy on this problem??How it is happened like this? My donor is my brother. I am 42 Years old.

doctor1 MD

prescribed fluocinonide (.05%) for itchy, indeterminate rash on legs and thighs. Slight improvement, but more bumps are appearing in different areas. Biopsy inconclusive. Rash continues to erupt, although lesser in degree. Continue the fluocinonide?

doctor1 MD

Hi there I’m a 42 yo healthy male with mild psoriasis and psuedogout. Recent routine blood tests were normal. Three weeks ago whilst I had a mild sore throat and cold, I discovered a raised lymph node on my right side of neck 2 inches down from...

doctor1 MD

Hi I have been diagnosed with prostate cancer from a biopsy . They think it is confined to prostate. GS 3+4. 19/12 probes positive. 15% of tissue cancerous. 1) do you recommend radiation or surgery 2) for surgery do you recommend open, laproscopic...

doctor1 MD

My father is 70 years old and has been detected with out of bound reports for some of the Tests related to Kidney . Attached are prescriptions and reports. I need your guidance on how to proceed further. Here are some artifacts: 1. He underwent...