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Question: Hi, I am a 49-year-old male of mixed genetic heritage. My father is from Panama and my mother was Caucasian. She died at age 56 from colo-rectal cancer. I noticed today several, dark-brown, freckle-like spots on the inside surface of my left ankle; just above the ankle bone and well below the calf. They are not painful nor do they itch. I notice that the skin on my legs is dry. In the past I have gone out walking in the sun without sunscreen; but limiting my exposure to about 10-15 minutes a day in summer. I always wear socks and shoes, though.. and long trousers in the cooler months. I rarely go to the beach; but when I do I always apply liberal amounts of sunscreen with a SPF of at least 30. Even then, I limit sun exposure while wearing sunscreen to just 2-3 hours. I usually wear socks that are ankle to calf-length and sometimes they are a bit tight to where they leave elastic marks on my ankles. I work at a job where I usually am sitting at a desk cumulatively from two to six hours a day; although will periodically get up to walk around. Last year in late October, I was diagnosed as having both the HSV-1 and HSV-2 antibodies in my blood; based on the results of an IgM and IgG serological blood test I had done at a local skin clinic. I have not experienced what are the classic, textbook kind of breakouts where painful blisters appear, break, and eventually crust over. Just 2-3 weeks prior to getting back the test results, I had developed what one other dermatologist and a general practitioner described as "eczema with secondary infection" on a portion the shaft and glans of my penis. Prior to this, I had been using a topical ointment containing 1% hydrocortisone and 1% clotramatzole (not sure of the spelling) that had been prescribed by the same dermatologist that had done the serological tests for STD's. It was prescribed for what I thought was a fungal infection of my genitals; because I had been experiencing some intermittent itching and burning. When the ointment was prescribed, I had not yet gotten back the blood test results. I had been tested earlier in July 2012 for all STD's and the only one that been positive was for HSV-2. A previous test that was done a year earlier had yielded all negative results; so the doctor decided to have me tested again to rule out a false-positive. The second test was negative; but I still wasn't convinced. After doing some online research, I learned that I needed to specifically request the more accurate serological tests that are type-specific and so I went back to be tested again. This time the HSV-2 test came back positive. I should add at this point that I live and work in South Korea and have been over here for 5 years now. All tests have been performed at a reputable skin clinic in Seoul; where the doctors had trained in both Korea and the US and where they speak English. Anyway, I had also taken photos of the affected areas and posted them here in a message to one of your fellow dermatologists. His assessment was similar; that I had developed eczema with secondary infection. The areas were red, itchy, and painful to the touch. They also had patches of white/yellowish, pus-like secretions. I kept thinking that what I had was a first outbreak of Genital Herpes; but the doctor had said that the symptoms were not in keeping with those that accompany such an outbreak. There were no frank blisters that eventually crusted over; just patches of raw, red skin. The other dermatologist I had visited (not the one who tested me for and diagnosed me with HSV 1 and 2) prescribed oral antibiotics, pain-relievers, and anti-histamines; along with topical ointment containing just hydrocortisone and a cream for regenerating new skin cells. In about one week I was completely healed and have not had a recurrence. It was believed that I had developed an allergic reaction to the other ointment containing Clotramatzole. The primary dermatologist said that was not uncommon. On other occasions I have developed what has been diagnosed as contact dermatitis on the back of my right hand and sometimes also on the left; presumably from frequent hand-washing. On those occasions (the most recent one was in late September/early October) I would usually develop what look like hives on side of my hand; just below the base of the thumb and near the wrist, They would not be weeping or oozing, but they were sometimes in clusters. Because they always seem to recur in the same location; I'm wondering if I'm having an asymptomatic herpes outbreak. Last night around 7:30 PM I started experiencing itching on my scalp, my face and my neck. I was a weird itching, tickling sensation that would come and go. I've experienced this about 5-6 times in the past year. Because I have not been having classic herpes outbreaks I believe that I am asymptomatic and that these periods of itching (sometimes accompanied by slight stinging/burning sensations) are "prodome" symptoms. Backing up a bit... last November I began to experience problems with my eyes. I kept experiencing intermittent itching and burning and watering of the eyes. I ultimately went to see an eye specialist at a local university hospital; because I was afraid that I somehow had infected my eyes with either the HSV-1 or 2 virus. If the "eczema" that I had developed had actually been a herpes outbreak and somehow I had accidentally touched it and then during the middle of the night had touched my eyes; then perhaps I had developed "ocular herpes" The other Korean dermatologist I had seen for the "eczema"; said "Herpes is skin,,, not eye"; so apparently he had never heard of ocular herpes. I went to see one eye doctor and he said I had "allergic conjunctivitis and dry-eye syndrome". When I went to the eye specialist at the hospital, he said the same thing. Unconvinced, I requested that he do a "slit-lamp" eye exam; whereby colored dye is inserted in the eyes with an eye-dropper and then they are examined using a slit-lamp. I asked the doctor if he should see any evidence of a viral infection and he said no. Bothe eye doctors prescribed allergy eye drops and also artificial tears to lubricate/moisten the eyes. I have been doing so for a year, now. On some days my eyes are very red and other days a little clearer but still having visible capillaries. I'm sorry to go off in so many different directions in describing my problem; but I wanted you to know my medical history so that you an better understand the situation. I have a history of bronchial asthma and numerous allergies to pet dander, bird feathers, dust mites, and certain foods (whole milk, wheat, oats) that went into remission when I was 12-13. Yesterday, about 2 hours before I started itching (and sneezing twice); I had eaten 2 slices of pizza. Prior to that I had eaten two sandwiches made with white bread and containing ham, eggs, chicken salad, lettuce and mayonnaise. Now, I have eaten all those things before in the past and not had any kind of reaction as far as I can tell. So, I don't know if what I was having was a prodome stage that herpes patients get before an outbreak. I also noticed that the red bumps were back again on my right hand. The night before, I had been doing some laundry and had put my hand inside the washing machine with the soapy water; to redistribute the clothes. So, my hand had been exposed to laundry detergent even though I washed my hands with regular soap and water immediately afterwards. I also had been cleaning work surfaces with a rag and some spray glass cleaner. I wasn't wearing gloves and so my hands had come into contact with the spray cleaner (ammonia and alcohol-based) and also dirty water. When I got home last night I put some steroid ointment that was left over from the last recurrence on my hand and this morning the hives are almost completely healed. In September I went home to the United States for a visit... this was nearly a year after having been diagnosed. While I was there I purchased some L-Lysine amino acid supplement (200 tablets, 500 mg. each); because I had read that it is helpful in the treatment of herpes symptoms by breaking down the amino acid L-Arginine (which the herpes virus needs in order to replicate). So far, I haven't been able to find out if I can obtain it here. I took one tablet last night with a late-night meal and it seems to have alleviated the itching a bit. I have also been taking a multi-vitamin/multi-mineral supplement (one tablet only, every other day) that contains no iron but has a high B-vitamin complex. I also take medication for mild hypertension: 50mg. of Amlodipine Camsylate and Losartan K.
Brief Answer: Details below Detailed Answer: Hello Thanks for the query, an excellent detailed history and photographs. Indeed you have suffered a lot. Considering your present problem, The photographs clearly show two conditions. 1. Schamberg purpura. manifesting as asymptomatic red dots on ankle region. These are age related changes and you dont need to worry about these. Just apply some moisturizer like white soft paraffin. 2. Mild varicosities, which may be related to hypertension. I suggest you to give mild foot elevation by using two pillows below your feet while sleeping at night. This will maintain a good circulation and prevent the varicosities. Let me know if you have any other doubts. Thank you
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
The User accepted the expert's answer
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