Spots on the hands and feet in a child and adults: causes of appearance

Symptoms such as red, pink, white, brown and even blue spots on the arms and legs occur due to various reasons.

Initially, they appear on the skin of the upper and lower extremities in the form of limited areas of morphologically modified epidermal cells that do not extend beyond its surface. Although, depending on the specific pathology, papules can form on the spots (and then the exanthemas acquire a maculopapular character), erosions, as well as squamous secondary elements - in the form of separating plates or scales of the stratum corneum of the epidermis.

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Causes spots on the arms and legs

In dermatology, it is customary to distinguish between inflammatory and non-inflammatory causes of spots on the hands and feet.

In some cases, round or oval roseola - red spots on the skin of the arms and legs, as well as pink spots on the legs and arms - have an inflammatory pathogenesis and are often accompanied by pruritis. Large, bright red spots of irregular shape, caused by the expansion of skin capillaries, are called erythema. With blood stagnation, such spots can acquire a bluish or purple tint, and after disappearing, the skin in their place becomes slightly darker or lighter.

White and brown spots do not appear due to inflammation, but due to either a lack of the skin pigment melanin or a loss of melanocytes (cells that produce melanin), or its excess. Read more - Skin Pigmentation Disorders

In addition, there is no inflammatory process when the appearance of red and red-violet spots is associated with telangiectasia. Their pathogenesis lies in the expansion of skin capillaries, which, in turn, is the result of either a decrease in vascular tone and disruption of local hemodynamics, or an imbalance of hormones (primarily estrogen and corticosteroids), which negatively affects the collagen of the vessel walls and increases their permeability. Such spots never itch or flake.

Red spots on arms and legs

Among the most common causes of red spots on the skin of the arms and legs are allergic diseases and the hypertrophic form of lichen planus, a non-contagious autoimmune disease (mediated by a T-cell autoimmune reaction), which is characterized not only by itchy red spots on the arms, legs and abdomen (with a slightly thickened stratum corneum), but also reddish-purple spots on the lower back, wrists and ankles.

Also, if the red spots on the arms and legs itch, the cause may be idiopathic eczema, including discoid eczema, when round spots appear on the arms and legs. Eczema is considered endogenous if the internal factors causing it are unknown. And exogenous eczema is, in fact, contact dermatitis, which can be caused by any weak acid or alkali, including household detergents and cleaning products. Thus, dyshidrotic eczema (dyshidroid dermatitis), in which dry spots appear on the arms and legs, develops with local exposure to irritants on the skin and is associated with a delayed hypersensitivity reaction - type IV (that is, arising from the release of proinflammatory cytokines by T-lymphocytes).

When pruritis is caused by scaly patches on the arms and legs of adults (on the backs of the hands, wrists, forearms, elbows, ankles, popliteal fossa and thighs), dermatologists immediately suspect neurodermatitis. The pathogenesis of this type of atopic dermatitis is seen in damage to the membrane β2-adrenergic receptors of mast cells (producing histamine) and B- and T-lymphocytes that produce antibodies (immunoglobulins IgE). Many dermatologists support the version of the psychosomatic origin of this disease: itching and rashes on the skin often appear with increased nervousness or in response to stress and emotional tension.

But red spots on the folds of the arms and legs (that is, on the elbows and knees) are symptoms of psoriasis. Details on the causes of rashes in this disease and their features in the material - Spots in psoriasis

Small red spots on the arms and legs of a child - in the form of a rash localized on the extensor surface of the limbs, as well as on the skin of the face and back - appear with Rubella virus infection and the development of rubella. The rash lasts for about a week. With morbillivirus infection and the development of measles (against the background of high temperature, cough, hoarseness, rhinitis, hyperemia of the conjunctiva and pharynx), red spots (on the extensor surfaces of the legs and arms) appear on the fifth day from the onset of the disease (the first rashes are noted in the oral cavity, on the skin of the face and body). There are nodules (papules) on the spots, which can grow and merge.

Maculopapular or erythematous types of spots on the inner surface of the arms and legs in children can be one of the symptoms of juvenile rheumatoid arthritis, in which the child or adolescent constantly has swelling of the joints of the limbs; in some cases, the joints hurt, give a general fever and limit movement. The rash and fever can appear and disappear very quickly, recurring from time to time.

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Pink spots on legs and arms

Pink spots on the legs and arms appear with pityriasis rosea (scaly roseola, pityriasis rosea or Gibert's lichen), which is considered to be the result of skin damage by Herpes Virus type 7 and manifests itself during or immediately after respiratory diseases. The first signs are reduced to the appearance on the body of one, but quite large round or oval pink macule, in the center of which the skin turns slightly yellow and peels. Then, within a few days, smaller pink spots covered with scales (limited from the intact skin by a border) appear on the limbs and trunk.

Pink round spots on the hands and feet are also characteristic of microsporia of smooth skin (caused by Microsporum fungi). These spots of different diameters also have secondary elements: in the center - squamous, and around the circumference - small vesicles covered with a crust.

Leprosy, an endemic infectious disease, begins with pink spots on the inner surfaces of the arms and the backs of the legs (as well as on the skin of the face and buttocks). In place of these spots, specific nodular bumps (lepromas) of a bluish and reddish-brown color subsequently form.

Pink spots on the legs and arms of a child may be a sign of dry streptoderma (lichen simplex). More information in the material - Different types of rashes in children

White spots on arms and legs

Most often, white spots on the arms and legs in adults are observed in diseases such as vitiligo and leukoderma.

In vitiligo, the shapes and sizes of the whitish spots with clear boundaries vary greatly; small spots can grow and merge, expanding the area of skin deprived of melanocyte pigment cells. Vitiligo can also affect the mucous membranes.

Leucoderma is also often called hypopigmentation, hypomelanosis, hypochromia or dyschromia of the skin. This pathology is also characterized by a progressive course with an increase in the size of the spots, which do not cause itching or other unpleasant sensations. The guttate form of leucoderma is most often diagnosed in fair-skinned middle-aged women who have been exposed to sunlight for a long time.

Read more - White spots on skin

The appearance of white spots on the skin of the extremities in children is possible with the so-called Ito hypomelanosis - a congenital pathology of melanin synthesis, which usually manifests itself during the first two years of life. In addition to skin pigmentation anomalies, the disease has neurological symptoms, including defects in the bone tissue of the skeleton (leading to short stature, scoliosis, micro- and macrocephaly, asymmetry of the face and limbs), seizures, and significant mental retardation.

Brown spots on arms and legs

Dermatologists say that brown spots on the hands and feet in adults can be caused by a lack of ascorbic acid (vitamin C) or cyanocobalamin (B12), Fanconi anemia, liver failure, or cumulative skin damage from sun exposure.

In order for brown spots to appear on the extremities, a deficiency of vitamin C (which is not synthesized in the body) must cause scurvy, which is what causes small dark spots to appear on the skin.

Deficiency of vitamin B12, which is produced in the liver in two biologically active forms (adenosyl- and methylcobalamin), is associated with changes in cell biochemistry - increased synthesis of homocysteine, which must be transformed into methionine. And methionine is necessary for a number of important biochemical reactions, including the synthesis of proteins, fatty acids, phospholipids and neurotransmitters. It has already been established that vitamin B12 deficiency can lead to orthostatic hypotension, strokes and retinal hemorrhages, depression, mood disorders and memory impairment. Dermatological manifestations of cyanocobalamin deficiency (hyperpigmentation of the skin on the hands, in the folds of the palms and soles, on the mucous membrane of the cavity) were described in the mid-1940s and have not yet been fully studied.

In cases of genetically inherited Fanconi anemia, the bone marrow fails to produce enough red blood cells, and the primary symptom of the disease is brown spots on the skin. Adults diagnosed with the disease, in addition to brown spots on the arms and legs, have symptoms related to the genitals and reproductive system.

In addition, experts note multiple pigmented spots of all shades of brown in cutaneous hemosiderosis and congenital neurofibromatosis type 1 (Recklinghausen syndrome).

Weakened liver function, as well as excessive sun exposure, have long been considered one of the causes of brown spots. Apparently, the liver does not filter the blood well enough, and harmful chemicals containing free radicals cause damage to the skin at the cellular level. Well, sun exposure itself increases the production of melanin, which in some cases does not become an even tan, but stimulates the activity of certain groups of melanocytes, which leads to their hyperplasia and the appearance of brown spots.

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Blue spots on arms and legs

Blue spots on the arms and legs may appear due to bleeding of skin capillaries. First of all, these are subcutaneous hematomas, which are called bruises and which, after going through the "blooming" stage, disappear safely 10-15 days after the soft tissue injury.

But when subcutaneous hematomas are not associated with bruises, then purple, bluish-purple or blue spots can be a symptom of:

• hemorrhagic diathesis, primarily of the vascular-purple and petechial types, when small bluish-purple rashes cover the surface of the skin of the lower and upper extremities.
• telangiectasia - a long-term dilation of small venous vessels of the skin, accompanied by vascular purple spots, which are often identified as spider angioma.
• diffuse acrocyanosis, which can be either congenital or caused by distal vascular obstruction or stenosis, peripheral atherosclerosis, thromboangiitis obliterans (Buerger's disease), or diabetic microangiopathy.
• Janeway syndrome (septic embolism) in bacterial endocarditis or gonococcal sepsis, which manifests itself due to a decrease in venous outflow in the form of painless violet-blue macules on the palms and soles.
• paucinuclear leukocytoclastic vasculitis (Schonlein-Henoch purpura) – inflammation of the capillaries of the skin and subcutaneous tissue.
• fulminant (rapid) meningococcemia - hemorrhagic syndrome and shock toxemia at the onset of meningitis.

Risk factors

The main risk factors for the appearance of symptoms in the form of spots on the hands and feet are the development of corresponding diseases. Thus, the development of pink lichen is facilitated by respiratory infections during the off-season, which reduce the body's defenses.

Increased skin sensitivity and contact with allergy-causing substances increase the likelihood of eczema and red allergic spots, while stress and emotional instability increase the likelihood of neurodermatitis and psoriasis.

The white patches associated with vitiligo can occur in anyone, but people with certain autoimmune diseases (such as hyperthyroidism) or a family history of the condition are much more likely to develop the condition.

Dermatologists consider fair skin, red hair, frequent sun exposure or visiting a solarium to be risk factors for the appearance of brown spots.

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Epidemiology

Statistics also do not take into account how many patients develop spots on their hands and feet. But the overall prevalence of lichen planus in the general population, according to the Journal der Deutschen Dermatologischen Gesellschaft, is about 0.1-4%, and it is one and a half times more common in women aged 30-60.

Neurodermatitis is observed in women aged 35 to 50 years approximately twice as often as in men. And psoriasis, according to the Federation of Psoriasis Associations (IFPA), affects about 3% of the world's population.

Vitiligo is a less common disease than psoriasis: worldwide, it affects about 1% of people, and the onset of the pathology in half of the cases falls in the age category of up to 20 years.

The epidemiology of hypomelanosis of Ito is unknown, but the incidence rate is estimated at one case per 8.5-10 thousand children from birth to 2-2.5 years of age.

Juvenile rheumatoid arthritis has been diagnosed in nearly 300,000 American children and adolescents. Experts at the Fanconi Anemia Research Foundation estimate the prevalence of congenital Fanconi anemia in the United States at one case per 131,000 newborns.

And WHO statistics on the prevalence of leprosy show that at the end of 2015, new cases were registered in two dozen countries and in just one year exceeded 211 thousand people.

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Diagnostics spots on the arms and legs

Now it should be noted that diagnostics of spots on hands and feet is not always carried out by dermatologists. Although doctors of this specialization examine patients, prescribe the necessary tests (blood, skin scraping, etc.) and carry out instrumental diagnostics (dermatoscopy, fluorescent visualization) - in cases of eczema, pink pityriasis, neurodermatitis, psoriasis, microsporia, streptoderma, hypomelanosis and brown spots.

Details in the publication - Skin and nail research

In the listed cases, differential diagnostics is also performed by dermatologists, for example, differential diagnostics of psoriasis and neurodemy, eczema and allergies. With blue spots on the skin of the extremities, the patient will receive an appointment with a phlebologist, angiologist or vascular surgeon. Diagnostics of juvenile chronic arthritis - with completely different tests and instrumental examination - is performed by rheumatologists.

And spots on the arms and legs of a child under 14 years of age are first examined by the local pediatrician, who decides on the need to contact a specialist.

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Treatment spots on the arms and legs

The fact that the treatment of spots on the hands and feet depends on their origin, and in many cases only symptomatic therapy is carried out, the doctor explains to each specific patient. Moreover, there are diseases, the etiology of which does not allow achieving complete recovery, despite all the drugs and folk remedies used: we mean neurodermatitis, psoriasis, idiopathic eczema, vitiligo, which can be controlled, trying to prevent deterioration of the condition and relapses.

More useful information in the material - Creams for psoriasis

Treatments for eczema spots include eczema ointments and antihistamines to reduce itching, such as Fexofenadine tablets (Telfast) - 0.12-0.18 g once a day.

For contact and atopic dermatitis, anti-itch ointments Tacrolimus (Protopic) and Pimecrolimus (Elidel) or creams with corticosteroids are used: Beloderm, Diprosalik, Flucinar (Sinaflan), etc. Triderm ointment (with gentamicin and betamethasone) is prescribed if the skin became infected when scratching the spots and inflammation appeared.

Lichen planus is treated with the same antihistamines (orally), and locally - with creams and ointments with GCS. Additionally, Retinoic ointment or Videstim is used, and Acitretin is taken orally (one capsule two to three times a day).

Pink lichen often resolves spontaneously, and only vitamins C, E and D are prescribed, but in some cases it is necessary to treat pink lichen with ointments

Griseofulvin is considered the most effective drug for microsporia of smooth skin: the dosage is determined by body weight - 20-22 mg per kilogram (once a day). Terbinafine ointment should be applied locally (except for children under two years of age and pregnant women up to 12 weeks) or Nizoral (Ketoconazole, Mikosept and other trade names).

For leukoderma and vitiligo, dermatologists can prescribe Melagenin lotion (with placenta extract) externally, Ammifurin tablets and solution (of plant origin) internally and externally, as well as vitamins C and B12.

It is recommended to lubricate blue spots on the hands and feet with ointments containing heparin.

In the complex therapy of juvenile rheumatoid arthritis - to relieve symptoms - non-steroidal anti-inflammatory drugs (Ibuprofen, Naproxen, etc.); Sulfasalazine (sulfapyridine + aminosalicylic acid); Methotrexate in small doses (to avoid side effects of the drug on the liver); corticosteroids (orally or intravenously), as well as monoclonal antibodies that inhibit tumor necrosis factor alpha (Infliximab, etc.) are used.

To lighten age-related brown spots on the hands and feet, bleaching creams containing hydroquinone, retinoids (tretinoin), and mild steroids are often used.

Physiotherapy treatment

Some patients with neurodermatitis, psoriasis or vitiligo are helped by physical therapy: PUVA therapy, narrowband UVB phototherapy.

Also see more details - Physiotherapy for dermatitis and dermatosis

Treatments for increased melanin production, such as laser or pulsed light therapy, destroy melanocytes without damaging the skin's surface, but may cause slight discoloration. And dermabrasion and microdermabrasion (i.e., sanding the surface layer of the skin) also carry side effects such as temporary or permanent redness and infection.

Folk remedies

More useful information about folk remedies for psoriasis - in the article Treatment of psoriasis at home

For red spots associated with eczema, propolis ointment, thuja and tea tree oil are recommended. And herbal treatment should be done with compresses with a strong decoction of calendula flowers, chamomile, sweet clover, meadowsweet and mountain arnica.

Folk remedies used for brown spots include fresh lemon juice (applied to the spots several times a day); apple cider vinegar and a mixture of table vinegar with horseradish root juice, red onion juice, and 3% hydrogen peroxide (used in a similar manner).

Spots covered with scales can be treated with soda paste (half a teaspoon per tablespoon of warm water), and dry spots on the hands and feet - with stone or burdock oil, as well as a mixture of glycerin and liquid honey (1:1).

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Homeopathy

Among the homeopathic remedies that can be used for spots on the hands and feet, the following should be mentioned:

• Acidum nitricum, Thuja, Urtica (for lichen planus);
• Aconitum, Causticum, Aurum iodatum, Mercurius solubilis (for pityriasis rosea);
• Apis, Agaricus muscarius, Hypericum, Borax, Graphites (for atopic dermatitis and endogenous eczema);
• Acidum fluoricum, Arsenicum album, Thuja (for vitiligo).

The combination remedy Varipulsum helps treat blue spots on the arms and legs.

Complications and consequences

First of all, bacterial complications develop due to scratching of spots, causing severe itching: infection of damaged areas of skin can lead to suppuration, intradermal abscess and even septicemia.

Given the etiology of blue spots in diffuse acrocyanosis, the consequences may manifest themselves, for example, in obliterating thromboangiitis or diabetic microangiopathy - in the form of thinning of the skin, intermittent claudication, tissue necrosis and gangrene.

Juvenile rheumatoid arthritis can lead to a destructive form of joint inflammation and limitation of movement, even to disability. And brown spots with melanocyte hyperplasia can become malignant, that is, degenerate into a malignant skin disease.

And, as you understand, this is far from a complete list.

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Prevention

It should be borne in mind that prevention of autoimmune diseases, as well as genetically determined pathologies, in which rashes appear on the skin of the extremities, is, in principle, impossible. However, dermatologists offer some methods of preventing psoriasis

To avoid contact dermatitis and eczema, it is recommended to protect the skin with creams, but vitamin B12 and tyrosine, which are necessary for the production of melanin, are considered a preventive measure against hypopigmentation (vitiligo and leukoderma) (although no one guarantees that this will help if there is a predisposition to these pathologies).

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Forecast

Many dermatological diseases become chronic, and patients fight them with varying success, hoping for a cure. The prognosis of the disease and the desire to remove spots on the hands and feet depends on a number of external and internal factors that are often not taken into account. After all, the function of human skin, which is a universal organ, is to protect the internal space of the body from harmful environmental influences.

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