Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Does Hardened Skin On The Joints Of Thumb And Ring Finger Indicate?
Question: Hi :)
I have think and hardened skin on the metacarpophalngeal joints of my thumb and ring finger on both hands. Its started out as small bumps then progressed. Has happened in escalating waves over the last. Once the skin gets hard enough, it falls off. Then looks normal for some weeks, before starting again. A dermatologist saw it when it was fine and guessed eczema or psoriasis. Another doctor saw it and thought the small bumps might have been Gottron's papules so thought dermatomyositis. I have had joint issues that seem like RA symptoms during the last year too. And a rash on my shoulders and torso that looks like tinea versicolor. Dermatomyositis, scleroderma, or psoriatic arthritis all seem possible.
Or possibly, systemic candidiasis causing joint inflammation? (also have chronic toenail fungus, flaky skin on feet, and recently, very bloated intestines).
Would love to hear your thoughts. Thank you!XXXXXX Schmachtenberger, 6-20-14
Symptoms:
Joint pain (wrists, knuckles, knees; sometimes other places/ spine), stiff for first hour upon waking, easily injured from intense exercise, symmetric. (RA symptoms)
Nerve pain (easily pinched nerves in back, neck and shoulders. Lasts for several days). Sometimes pain into heart and solar plexus areas, better with chiropractic.
Skin, hard and darker skin on proximal hand knuckles, (thumb, index and middle finger, both sides). Started out with raised bumps/ nodules. Itches. Cycles. First outbreak occurred immediately after trying Clenbuterol and getting intense headaches from it (discontinued).
Tinea Versicolor. Chronic Toenail fungus.
Lower libido/ erection frequency, energy levels and sustained focus/drive
Sluggish digestion/ bloating. Occasional nocturnal anal itching (recent).
Timeline/ etiology:
All started in the last 2 years. Has progressed during that time, particularly the last 6 months. Joint and nerve pain exacerbated by strenuous exercise. (Have not exercised in several months because of this.)
Had similar symptoms, much more intensely, come on quickly when I was 18. No gut barrier at that time. Got off gluten, got better in a couple months.
Still always had mild joint weakness. Tested positive for Blastocystis hominis several years later. Treated but did not retest.
Removed 10+ mercury fillings 2 years ago (potential heavy metal exposure).
Had a major oral infection 1 year ago, 10 day round of Flagyl. 50 canker sores with the infection. Seems the symptoms started getting worse after that.
Family history of PMR on moms side.
Only dietary change was adding a lot more plant based protein powders. Possible allergic reaction? Or heavy metals in them? I don’t think this is likely a contributing factor.
Recent Lab Results:
Mucosal Barrier elevated across the board. High total SigA. (Low SigA in the morning, high the rest of the day.)
Stool test showed abundant enterobacter.
Low free T
Possible Diagnosis:
Abstract: autoimmunity/ immune dysregulation with systemic inflammation and endocrine dysregulation caused by a combination of: pathogens (parasites, yeast, mycoplasma, virus, etc.), toxins (heavy metals, environmental toxins), and maybe food sensitivities.
RA, Psoriatic Arthritis, Scleroderma, Dermatomyositis (Gottron’s papules), ?
Tests Im interested in:
Baseline
CBC, U/A, ESR, SMA, 25 hydroxy D level, ASO titer, CK, CPK, anti-CCP, HLA-B27
Immunosciences
Comprehensive Virus Panel # 2023
Lyme disease (multi-peptide elisa) #2017
Comprehensive autoimmune panel #2011
Stool parasite (GI effects)
Heavy metal test
Mycoplasma
Organic Acid Urine Test (Great plains)
Full Story:
XXXXXXX
I have think and hardened skin on the metacarpophalngeal joints of my thumb and ring finger on both hands. Its started out as small bumps then progressed. Has happened in escalating waves over the last. Once the skin gets hard enough, it falls off. Then looks normal for some weeks, before starting again. A dermatologist saw it when it was fine and guessed eczema or psoriasis. Another doctor saw it and thought the small bumps might have been Gottron's papules so thought dermatomyositis. I have had joint issues that seem like RA symptoms during the last year too. And a rash on my shoulders and torso that looks like tinea versicolor. Dermatomyositis, scleroderma, or psoriatic arthritis all seem possible.
Or possibly, systemic candidiasis causing joint inflammation? (also have chronic toenail fungus, flaky skin on feet, and recently, very bloated intestines).
Would love to hear your thoughts. Thank you!XXXXXX Schmachtenberger, 6-20-14
Symptoms:
Joint pain (wrists, knuckles, knees; sometimes other places/ spine), stiff for first hour upon waking, easily injured from intense exercise, symmetric. (RA symptoms)
Nerve pain (easily pinched nerves in back, neck and shoulders. Lasts for several days). Sometimes pain into heart and solar plexus areas, better with chiropractic.
Skin, hard and darker skin on proximal hand knuckles, (thumb, index and middle finger, both sides). Started out with raised bumps/ nodules. Itches. Cycles. First outbreak occurred immediately after trying Clenbuterol and getting intense headaches from it (discontinued).
Tinea Versicolor. Chronic Toenail fungus.
Lower libido/ erection frequency, energy levels and sustained focus/drive
Sluggish digestion/ bloating. Occasional nocturnal anal itching (recent).
Timeline/ etiology:
All started in the last 2 years. Has progressed during that time, particularly the last 6 months. Joint and nerve pain exacerbated by strenuous exercise. (Have not exercised in several months because of this.)
Had similar symptoms, much more intensely, come on quickly when I was 18. No gut barrier at that time. Got off gluten, got better in a couple months.
Still always had mild joint weakness. Tested positive for Blastocystis hominis several years later. Treated but did not retest.
Removed 10+ mercury fillings 2 years ago (potential heavy metal exposure).
Had a major oral infection 1 year ago, 10 day round of Flagyl. 50 canker sores with the infection. Seems the symptoms started getting worse after that.
Family history of PMR on moms side.
Only dietary change was adding a lot more plant based protein powders. Possible allergic reaction? Or heavy metals in them? I don’t think this is likely a contributing factor.
Recent Lab Results:
Mucosal Barrier elevated across the board. High total SigA. (Low SigA in the morning, high the rest of the day.)
Stool test showed abundant enterobacter.
Low free T
Possible Diagnosis:
Abstract: autoimmunity/ immune dysregulation with systemic inflammation and endocrine dysregulation caused by a combination of: pathogens (parasites, yeast, mycoplasma, virus, etc.), toxins (heavy metals, environmental toxins), and maybe food sensitivities.
RA, Psoriatic Arthritis, Scleroderma, Dermatomyositis (Gottron’s papules), ?
Tests Im interested in:
Baseline
CBC, U/A, ESR, SMA, 25 hydroxy D level, ASO titer, CK, CPK, anti-CCP, HLA-B27
Immunosciences
Comprehensive Virus Panel # 2023
Lyme disease (multi-peptide elisa) #2017
Comprehensive autoimmune panel #2011
Stool parasite (GI effects)
Heavy metal test
Mycoplasma
Organic Acid Urine Test (Great plains)
Full Story:
XXXXXXX
Brief Answer:
Follows.
Detailed Answer:
Dear Sir,
Thank you for posting your query on HCM.
Well looking into your problem I would like to tell you that I agree with the line of management your doctor has decided . Looking at the lesions they looked more scleroderma like to me but it is very difficult to comment as all these diseases are very similar in their presentation specially in initial stages and may overlap with each other .
I would like to add ANA , ENA profile , LDH and getting Xray hands done to look for erosions plus Xray pelvis to look for sacroillitis . Rest I think a good rheumatologist is looking after you as everything that is planned is appropriate .
Take care.
Dr. Shruti
Follows.
Detailed Answer:
Dear Sir,
Thank you for posting your query on HCM.
Well looking into your problem I would like to tell you that I agree with the line of management your doctor has decided . Looking at the lesions they looked more scleroderma like to me but it is very difficult to comment as all these diseases are very similar in their presentation specially in initial stages and may overlap with each other .
I would like to add ANA , ENA profile , LDH and getting Xray hands done to look for erosions plus Xray pelvis to look for sacroillitis . Rest I think a good rheumatologist is looking after you as everything that is planned is appropriate .
Take care.
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr XXXXXXX
Yes, those labs (other than the xrays) are included in the immunosciences comprehensive autoimmune marker panel. I will get xrays done as well.
Regarding the thinckened skin on the knuckles, It is only on those 6 knuckles and no where else. No harding on skin on the knees or elbows. Nothing showing up on my face. No darkening of my eyelids. And the skin on my knuckles ithes strongly. I havent seen that commonly in scleroderma or gottrons.
And given the gut bloating, chronic foot and toenail fungus that doesnt really respond to topicals, and the tinea versicolor...also factoring long term sugar cravings and low T...and the fact that it all progressed after a round of antibiotics, Systemic candidiasis seems like another possibility. I am going to test for that. And the parasites that may be symbiotic with it.
Any thoughts on that?
I would also love to get a dermatologists opinion given the pictures. Is there a way to do that on this system? Thank you :)
Yes, those labs (other than the xrays) are included in the immunosciences comprehensive autoimmune marker panel. I will get xrays done as well.
Regarding the thinckened skin on the knuckles, It is only on those 6 knuckles and no where else. No harding on skin on the knees or elbows. Nothing showing up on my face. No darkening of my eyelids. And the skin on my knuckles ithes strongly. I havent seen that commonly in scleroderma or gottrons.
And given the gut bloating, chronic foot and toenail fungus that doesnt really respond to topicals, and the tinea versicolor...also factoring long term sugar cravings and low T...and the fact that it all progressed after a round of antibiotics, Systemic candidiasis seems like another possibility. I am going to test for that. And the parasites that may be symbiotic with it.
Any thoughts on that?
I would also love to get a dermatologists opinion given the pictures. Is there a way to do that on this system? Thank you :)
Brief Answer:
Follows.
Detailed Answer:
Dear Sir,
Thanks for reverting back .
In autoimmune conditions any kind of stimulus namely infections can precipitate the autoimmune process and lead to formation of autoantibodies in already predisposed individuals so yes there definitely exists a possibilty for the same.
Your lesions are localised at this time but dont typically look like gottrons also , it will be difficult to comment at this stage as the disease is evolving I suppose . In my opinion you should wait for the tests to come and then seek a dermatology advise , that sounds more relevant .
Dr. Shruti
Follows.
Detailed Answer:
Dear Sir,
Thanks for reverting back .
In autoimmune conditions any kind of stimulus namely infections can precipitate the autoimmune process and lead to formation of autoantibodies in already predisposed individuals so yes there definitely exists a possibilty for the same.
Your lesions are localised at this time but dont typically look like gottrons also , it will be difficult to comment at this stage as the disease is evolving I suppose . In my opinion you should wait for the tests to come and then seek a dermatology advise , that sounds more relevant .
Dr. Shruti
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
