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What is the cause and treatment for Raynaud's phenomenon when suffering from parasitic infection in intestine?

Dec 2013
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Practicing since : 2002
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What is happening with my skin? 3 months ago I noticed a few things about my skin and my nails, but before I delve into what I may have, I have to warn you that I have (likely) a parasitic infection in my intestine (possibly reached my liver), as of right now I'm waiting for the results of 2 biopics (from a colonoscopy, duo to 16th Jan), normal methods of detection have failed, I'll start a more severe treatment Monday (23rd) (despite not knowing what I have by name, the gastroenterologists are pretty sure it's a parasitic infection) A second warning would be that I have “Fatty liver” disease, or I used to have I guess, according to my latest ultrasound, my diet has ridden me of fat in the liver. Now with that out of the way, Symptoms: Blood Spots (low occurrence) Black birth mark-like spots (I'm white) (low occurrence) (some vanish with time, some get blacker and some get softer with time) The flesh under my fingernails has become somewhat blue/purple Blemishes appear, primarily on my right leg, like I was struck by something (dark blemishes, Grey and somewhat caramel colored around the edges), but I haven't, I also have them appear in other areas of the body like my left arm and my bum All of the symptoms seemed to cease once I took Flagyl (for 30 days treatment total, symptoms vanish on 5th day) (to combat the parasitic infection) and all of them came back once I stopped taking Flagyl, but correlation does not equal causation, and my 2 gastroenterologists said I should talk to a rheumatologist and a hematologist, thanks to the holidays I have no access to any of those so I'm posting here in the hopes of at least having an idea of what could possibly be the problem or what path to take to ensure I figure out what I have I stopped taking Flagyl on the 1st of this month 6 days ago, I was in the shower and I had this,“heat” sensation on my middle finger on the right hand, soon after it started to get purple, it stayed purple for a couple of days before vanishing (I do have pictures of it), it hurt at the time, and no I didn't hit anything with it at all, I was just showering! My doctor tested my my circulation (by pressing against my skin) to see if bad circulation was causing the issue with my nails, she said that my circulation appears to be really good, my hands and feet are usually warm, even when it's cold, it only starts to get cold at temperatures below 10 degrees (Celsius) My last blood test (few weeks ago) accused that my red blood cells are a bit high (54%), My uric acid is at 7.2mg (mildly high), and my TSH is 5,94 everything else is normal, I'll do another one shortly as the high TSH may be a result of using Flagyl (according to another doctor) So, there is a picture, but I believe that is all of the information I could possibly give, any inputs will be appreciated, I'll book appointments for the new years as soon as they're available
Posted Sun, 19 Jan 2014 in Skin Hair and Nails
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer: Raynaud's phenomenon Detailed Answer: Hi, Welcome and thanks for posting your query to XXXXXXX After reading your query with complete diligence and analyzing the picture with the history I can make the diagnosis of Raynaud's phenomenon. In Raynaud's there is initial redness then bluish discoloration and then it turns to purplish areas. To tell you simply: This process is due to cold injury to the blood vessels which are contracted because of chilling effect of cold. This is also to conserve the heat inside. Now in your case you felt the purple color of skin means this time the cold injury was too high and your skin was not able to manage the constriction of vessels. SO the blood vessels got very much contracted and lead to purple discoloration. It is quite common some persons that after exposure to cold there is progressive redness and then bluish to purple discoloration of the skin accompanied with warmth and pins ad needle sensation at the affected area. Generally it is due to the high intensity of the cold but if you feel it even with simple cold water or recurrent episodes of purple color in future then it is better to consult a dermatologist for best further guidance. There can be multiple other causes including many diseases and drugs along with occupation which can cause it, but as it has happened for the first time so we have to wait and watch the condition. If it recurs again and again for multiple times then you may have to undergo certain tests Doppler ultrasound : to assess blood flow; Thyroid function tests: to rule out hypothyroidism and Tests for autoantibody screen including rheumatoid factor with C-reactive protein. That is why your gastroenterology doctor have suggested you to meet a rheumatologist or a hematologist. For the betterment and prevention: The most important thing is cold protection and preventing any abrupt change in temperature which are the initiating factors for the same. For the relief you wear cotton gloves and socks in twin layers with best of cold protection. Do not rewarm the area rapidly on heaters or warmers. You can take a pain killer such as paracetamol by mouth for one to two times a day. Stop any substance abuse such as alcohol and smoking. I hope these information's will help you. If you have further queries I will be happy to help. "Wish you good health" Regards, Dr Sanjay Kumar Kanodia MD (Dermatology )
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Follow-up: What is the cause and treatment for Raynaud's phenomenon when suffering from parasitic infection in intestine? 12 hours later
That seems unlikely, I live in the southern hemisphere, it's not only summer over here, it's averaging on 31°C on a daily basis, my problem comes from multiple blemishes like the one I showed you on my photo in other places, like my right leg, my left arm for instance, not to mention that there are blood spots all over the place and the black spots (small, black or brown, defined edges like birth marks or "beauty" marks) that keep showing up, the skin under my finger nails is a little bit purple right now, current temperature is 29°C, that is not a normal occurrence, and I can pretty much guarantee that none of my problems are duo to cold, simply because it isn't anywhere near cold in my area, if anything the dry and hot climate is giving me allergies! I urge you to read my listing of the symptoms once again, they are varied, I only posted this picture because it was the one thing that stood the most out of all of them duo to the weird spot it showed up Adding info: There are more black blemishes on my body, actually currently I have at least 3, and last week I topped at 5, in both of my legs and my left arm I get 3 to 0 blood spots a day The black marks, I get about 1 to 5 new ones a week, new old ones some times vanish on their own
Answered by Dr. Sanjay Kumar Kanodia 19 hours later
Brief Answer: kindly see the suggestions below Detailed Answer: Hi XXXXXXX Welcome again to the forum and thanks for adding information and pictures which will help us out in reaching to the most probable cause of all the issues you are suffering from. As your problems are multidisciplinary involving different specialties so I discussed your problem with dermatology, gastroenterology and hematologist colleagues. It took bit of the time but worth to discuss the problem as a whole and reaching to some important point. I will discuss each problem according to the pictures you sent and correlating these with the details you provided: FingerIssue.jpg & NailIssue.jpg : These pictures actually shows less blood perfusion to that particular area. In the first query the whole series of symptoms indicated towards tissue hypoxia in your skin. The Purplish color of the skin along with the color change in your nail all indicates towards less perfusion of skin by oxygen to your skin. The one very important cause of this type of tissue hypoxia and color change is due to raynaud’s phenomenon. That is why I told you the possibility of Raynaud’s first. Though it is most commonly seen as cold induced injury but many a times it can be due multiple internal causes too. I tried to give you the commonest possible cause of the tissue hypoxia as cold induced, causing the color change and the symtopmatology of warm sensation in fingers. As you are from the southern hemisphere, so cold induced part of raynaud’s is out. But still I suggest you to discuss the other causes of raynaud’s and tissue hypoxia with less perfusion with your doctor. There are important of causes in form of certain systemic problems which must be ruled out. So whenever you personally meet you doctor then should discuss the points and if at all any investigations are required then can be done accordingly. It is always better to rule out any serious cause at the initial part. As already told, the best part would be to go for doppler’s study to rule out any perfusion issues in yourself. Thyroid function tests, Tests for autoantibody screen including rheumatoid factor with C-reactive protein are the other of the tests to rule out any of the important cause of less tissue perfusion. You have already gone for thyroid function tests along with other blood tests and specifically TSH and uric acid are high. A repeat test would be better to report the exact status of thyroid abnormality. LegBlemish.jpg : The other of the part of leg blemishes are basically bruises which can occur as a normal system or can be due to abnormality of bleeding and clotting system. For the same I suggest you to go for Bleeding time, clotting time and platelet functions which are the main determining factors in bruises. If these are normal then there is no worry at all. Regarding disappearance of your blemishes (which are bruises) after taking falgyl: This is quite surprising to know that till the time you took flagyl you remitted from the bruising. I have not found such kind of incidence ever in my clinical practice. I even discussed your problem with other of the gastroenterologist colleagues and there was no correlation found in their clinical experience too. Black Spots.jpg & BloodSpot.jpg : These are basically angiomas which are quite commonly seen. You try and recollect if these are present from a long time or just recently appeared. I can see one large one with small ones around. You kindly let me know if you have sudden appearance in last few months. Many times in liver issues these can suddenly increase in number. Otherwise these are quite normal in occurrence in general population after the age of 40 years. As I can see you are young man of 26 years so makes an issue. The crux of our discussion lies in to go for Bleeding time, clotting time and platelet functions with special investigations doppler’s study, Thyroid function tests, Tests for autoantibody screen including rheumatoid factor with C-reactive protein in perusal of your treating dermatologist. Additionally I suggest you to go for liver function tests to rule out any liver abnormality and so therefore for the angiomas. I hope these information's will help you. If you have further queries I will be happy to help. "Wish you good health" Regards, Dr Sanjay Kumar Kanodia MD (Dermatology )
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Follow-up: What is the cause and treatment for Raynaud's phenomenon when suffering from parasitic infection in intestine? 2 hours later
Re: The black spots, and blood spots have indeed increased in the last few months, the blood spots are more rare, the black spots on the other hand, I have quite a few new ones, the new ones are usually smaller, and some times they appear and then disappear a few weeks later or they grow and get lighter in coloration, as of late this process has slowed down, but till a few weeks ago they were particularly common, today I have a significantly larger blood spot however Tomorrow I'll do a complete blood work testing for liver enzymes alterations and thyroid function (gastroenterologists recommendation), and soon I'll schedule an MRI of my liver making sure (hopefully) that everything is ok Am I in any imminent danger? Because as of late my nails are getting more and more purple, it is still a pretty slow progression in a way, but worrisome I'll try and get Bleeding time, clotting and platelet functions done tomorrow as well, I'll talk to the lab and the hospital and see if they can assist me directly I'll hopefully be able to reach my dermatologist by the 1st, till then, should I avoid physical exercise? considering a clotting problem in my blood it seems like my exercise routine may be a bad idea Considering Flagyl interaction, is there any parasite that can cause this type of symptom? I'm sorry about the many questions, I know this is site is not the most profitable thing in the world for doctors so I appreciate it greatly, thanks you! Seriously! Thank you Just to add more info I had an x-ray of my lungs taken about a month ago (nothing found) and A colonoscopy with biopsy also with nothing found
Answered by Dr. Sanjay Kumar Kanodia 3 hours later
Brief Answer: Kindly follow the details below Detailed Answer: Hi XXXXXXX Welcome again t the forum and thanks for adding more information to your query. First and for most you are most welcome to ask as many queries you can. I can understand your state of mind and quite empathic to multiple of your problems. Atleast I can help you out a bit in some of your queries to be worth of it. So do not hesitate to ask any queries. I will try and help you beyond my limits and branch as I can. As I can get you got more of angiomas in recent few months so it is one of the important thing to check for the exact status of liver. In young age many times if any liver issue is present then we get angiomas. Though there can be incidental increase in angiomas too which is actually the most common cause but it is always better to be safe and rule out any thing related to our health issues. For the bruises: as I asked earlier to go for the Bleeding time, clotting time and platelet functions. This would be the most appropriate step to know any cause in relation to bleeding and clotting system. For the part of purplish change in hands: It is quite common to see such kind of problem once a while. You do not worry about this and wait for your dermatologist opinion who has the facility to examine you in person and with best of the efforts. So definitely we will come out of some good notes to get you better. Do give me a follow up after the investigations and the dermatological meet up. "Just enjoy the weekend and the forthcoming new year ahead with best of health and wealth" Regards, Dr Sanjay Kumar Kanodia MD (Dermatology)
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Follow-up: What is the cause and treatment for Raynaud's phenomenon when suffering from parasitic infection in intestine? 10 hours later
I'm sorry to ask you again, but something huge appeared on my skin in just a few hours, I'm checking most of my body about 4 times a day, this appeared in between one of those checks and it is huge, almost the size of my pinky finger's fingernail, it doesn't seem to be a blood spot, it appeared on a stretch mark I have (as stated I'm overweight), the white part in the picture (at the tip of the anomaly) is a reflection from my desk light as you can see from my poor design work, What is this? It doesn't hurt or itch, it doesn't have any breaking or piercing of the skin like an insect byte would have, it's just a bulge that seems to be full of blood! The lack of access to doctors because of the holidays is killing me, once again thank you!
Answered by Dr. Sanjay Kumar Kanodia 4 hours later
Brief Answer: pyoderma- collection of basically pus Detailed Answer: Hi XXXXXXX Welcome again t the forum and thanks for follow up. I hae gone throufhg the pictures sent by you -MonsterSkinIssue.jpg; MonsterSkinIssue2.jpg. After thoroughly analyzing the pictures I can make out the appearance of pyoderma. It is a collection of basically pus under the skin. It is quite common to find due to infection by bacteria. As it is under the stretch mark which is quite thin layer of skin so the underlying blood vessels are visible as full of blood. If you can see the picture again then you can make out a pus point on the tip of the bump. Do not try to pinch or pop the area or even not to touch the area as it can get further infected and proliferated. The increased size appearance is just because of the thin skin of stretch mark which is not bale to contain it. You need to worry about the same. It is quite commonly observed to see. The only part is as yo are quite conscious about multiple of things so making you tense in addition to all the problems. You can apply any over the counter antibiotic cream such as mupirocin or fucidin over it in a thin layer so that it should not be visible to the naked eye. DO not worry it will be alright soon. Regards, Dr Sanjay Kumar Kanodia MD (Dermatology)
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