Stains on the arms and legs of a child and adults: the reasons for the appearance

Symptoms such as red, pink, white, brown and even blue spots on the hands and feet, arise for various reasons.

Initially, they appear on the skin of the upper and lower extremities in the form of limited areas of morphologically modified cells of the epidermis, which do not leave beyond its surface. Although, depending on the specific pathology, papules can form on the spots (and then the exanthems acquire a maculopular nature), erosion, and also squamous secondary elements in the form of separating plates or scales of the stratum corneum of the epidermis.

[1], [2]

Causes of the stains on hands and feet

In dermatology it is common to separate the inflammatory causes of spots on the hands and feet and non-inflammatory ones.

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

White and brown spots appear not because of inflammation, but due to either a lack of skin pigment melanin or the loss of melanocytes (cells producing melanin) or its excess. Read more -  Skin pigmentation disorders

In addition, the inflammatory process is absent, when the appearance of red and red-violet spots is associated with telangiectasia. Their pathogenesis lies in the expansion of cutaneous capillaries, which in turn is the result of either a decrease in vascular tone and a violation of local hemodynamics, or an imbalance of hormones (primarily estrogen and corticosteroids) that negatively affects the collagen of the walls of the vessels and increases their permeability. Such spots are never itchy and do not scaly.

Red spots on hands and feet

Among the reasons for which red spots occur most often on the skin of the hands and feet, allergic diseases and the hypertrophic form of the  red flat lichen  -an uncontaminated autoimmune disease (mediated by the T cell by an autoimmune reaction) are prominent, which is characterized not only by itchy red spots on the hands, legs and the stomach (with a somewhat thickened horny layer), but also reddish-purple spots on the lower back, wrists and ankles.

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

When prurit spots on the arms and legs in adults (on the back surfaces of the wrists, wrists, forearms, elbows, ankles, in the region of popliteal pits and thighs) cause dandruff, dermatologists immediately suspect  neurodermatitis. The pathogenesis of this variety of atopic dermatitis is seen in the damage of membrane β2-adrenoreceptors of mast cells (producing histamine) and B- and T-lymphocytes producing antibodies (IgE immunoglobulins). Many dermatologists support the version of the psychosomatic origin of the disease: itching and rashes on the skin often appear with increased nervousness or in response to stress and emotional tension

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

Small red spots on the arms and legs of the 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 when Rubella virus is infected and rubella develops. The rash lasts about a week. When infection with morbillivirus and the development of measles (against the background of high fever, cough, sipot, rhinitis, congestion and throat congestion) red spots (on the extensor surfaces of the legs and hands) appear on the fifth day from the onset of the illness (the first rashes are noted in the mouth, on the skin face and body). On spots that can grow and merge, there are nodules (papules).

Macular-papular or erythematous types of spots on the inner surface of the arms and legs in children may be one of the symptoms of  juvenile rheumatoid arthritis, in which the joints of the limbs are constantly swollen in a child or adolescent; in some cases the joints ache, give a general fever and limit movement. Rash and fever can appear and disappear very quickly, from time to time repeating.

[3], [4]

Pink spots on the legs and hands

Pink patches on the legs and hands appear with  pink deprive  (flaky roseola, pink pityriasis or Zhibera zoster), which is considered the result of the skin lesions of Herpes Virus type 7 and manifests during or immediately after respiratory illness. The first signs are reduced to the appearance on the body of one, but large enough round or oval pink macula, in the center of which the skin slightly turns yellow and flakes. Then within a few days, scaly-covered pink spots of smaller size (bounded from the intact skin by a rim) appear on the limbs and trunk.

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

With pink spots on the inner surfaces of the hands and on the back surfaces of the legs (as well as on the skin of the face and buttocks), a leper - endemic infectious disease begins. On the spot of these spots in the subsequent formation of specific knotty hillocks (leprom) of cyanotic and red-brown color occurs.

Pink patches on the legs and hands of a child can be a sign of dry streptoderma (simple lichen). More information in the material -  Different types of rashes in children

White spots on hands and feet

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

With  vitiligo, the  forms and sizes of whitish spots with clear boundaries are very different; small spots can increase and merge, expanding the area of skin areas devoid of pigmented melanocyte cells. Vitiligo can also affect the mucous membranes.

Leukoderma  is also often called hypopigmentation,  hypomelanosis, hypochromia, or skin dyshromia. This pathology is also characterized by a progressive course with an increase in the size of spots that do not cause either pruritus or other unpleasant sensations. The form of the drop-shaped leukoderm is more often diagnosed in light-skinned women of middle age, exposed to sunlight for a long time.

Read more -  White spots on the skin

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

Brown spots on hands and feet

Dermatologists argue that brown spots on the arms and legs in adults can be caused by a lack of ascorbic acid (vitamin C) or cyanocobalamin (B12), Fanconi anemia, functional liver failure, or cumulative skin damage by solar radiation.

To make the spots appear brown on the extremities, a deficiency of vitamin C (which is not synthesized in the body) should cause scurvy, in which small dark spots appear on the skin.

The lack of vitamin B12, which in two biologically active forms (adenosyl- and methylcobalamin) is produced in the liver, is associated with changes in the biochemistry of cells-an increase in the synthesis of homocysteine, which must be transformed into methionine. A methionine is necessary in 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, stroke and hemorrhage in the retina, depression, mood disorders and memory impairment. Dermatological manifestations of the lack of cyanocobalamin (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 explored.

In cases of genetically inherited Fanconi anemia, bone marrow can not produce enough red blood cells, and the primary symptom of the disease is brown spots on the skin. In adults diagnosed with this disease, in addition to brown spots on the hands and feet, there are symptoms associated with the genitals and the reproductive system.

In addition, specialists note multiple pigmented spots of all shades of brown with cutaneous hemosiderosis and congenital neurofibromatosis of the first type (Recklinghausen's syndrome).

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

[5], [6]

Blue spots on hands and feet

Due to hemorrhages of the skin capillaries, blue spots on the arms and legs may appear. First of all, these are subcutaneous hematomas, which are called bruises and which, after passing through the "flowering" stage, disappear safely 10-15 days after a soft tissue injury.

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

• hemorrhagic diathesis, first of all, vascular-purple and petechial types, when small bluish-purple rashes cover the surface of the skin of the lower and upper extremities.
• telangiectasia - prolonged expansion of small venous vessels of the skin, accompanied by vascular purple spots, which are often defined as spider angiomas.  
• diffuse acrocyanosis, which is both congenital and conditioned by distal vascular obstruction or stenosis, peripheral atherosclerosis, obliterating thromboangiitis (Buerger's disease), or diabetic microangiopathy.
• Janevei syndrome (septic embolism) with bacterial endocarditis or gonococcal sepsis, manifested due to a decrease in venous outflow in the form of painless violet-blue macula on the palms and soles.
• malonuclear leukocytoclastic vasculitis (purpura Shenlaine-Genoh) - 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 the corresponding diseases. So, the development of pink depriving is facilitated by respiratory infections during the off-season, reducing the defenses of the body.

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

Vitiligo-associated white spots can appear in any person, but people with certain autoimmune diseases (eg, hyperthyroidism) or having this pathology in the genus are more likely to face this diagnosis.

And the risk factors for the appearance of brown spots dermatologists consider light skin, red hair, frequent sun exposure or a visit to the solarium.

[7], [8], [9]

Epidemiology

Statistics also do not take into account how many patients have spots on their arms and legs. But the overall prevalence of red lichen 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 30-60 years old.

Approximately twice as often as men, neurodermatitis occurs in women aged 35 to 50 years. And psoriasis, according to the information of the Federation of Psoriasis Associations (IFPA), affects about 3% of the population of our planet.

Vitiligo is less common than psoriasis: around 1% of people worldwide suffer from it, and the onset of pathology in half the cases falls on the age category up to 20 years.

The epidemiology of Ito's hypomelanosis is unknown, but the incidence rate is estimated within one case for every 8,5-10,000 children from birth to 2-2,5 years.

Juvenile rheumatoid arthritis is diagnosed in almost 300,000 American children and adolescents. Experts of the Fanconi Anemia research fund estimate the prevalence of Fanconi congenital anemia in the US - one case for 131 thousand newborns.

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

[10], [11], [12], [13]

Diagnostics of the stains on hands and feet

Now it should be noted that the diagnosis of spots on the hands and feet is not always carried out by dermatologists. Although the doctors of this specialty conduct the examination of patients, the necessary tests (blood, skin scrapings, etc.) are made and instrumental diagnostics (dermatoscopy, luminescence imaging) is performed - in cases with eczema, pink pitiriasis, neurodermatitis, psoriasis, microsporia, streptodermia, hypomelanoses and spots Brown color.

In detail in the publication -   Study of skin and nails

In these cases, differential diagnosis is also carried out by dermatologists, for example,  differential diagnosis of psoriasis  and neurodismitis, eczema and allergies. With blue spots on the skin of the limbs, the patient will receive an appointment to the phlebologist, angiologist or vascular surgeon. Diagnosis of juvenile chronic arthritis - with very different analyzes and instrumental examination - is done by rheumatologists.

A stain on the hands and feet of a child under 14 years old first examines the district pediatrician, making a decision on the need to contact the narrow specialists.

[14], [15], [16], [17]

Treatment of the stains on hands and feet

The fact that the treatment of stains on the hands and feet depends on their origin, and in many cases only symptomatic therapy is performed, the doctor explains to each particular patient. Moreover, there are diseases, the etiology of which does not allow to achieve full recovery, despite all the medications used and people's treatment: referring to neurodermatitis, psoriasis, idiopathic eczema, vitiligo, which can be controlled, trying not to allow deterioration and relapse.

More useful information in the material -  Creams for psoriasis

Methods for treating eczema spots include  ointments from eczema, as well as antihistamines to reduce itching, for example, Fexofenadine (Telfast) tablets - 0.12-0.18 g once a day.

At contact and atopic dermatitis, ointments are used from the itch Tacrolimus (Protopic) and Pimecrolimus (Elidel) or creams with corticosteroids: Beloderm, Diprosalik, Flucinar (Sinaphlan), etc. Tridentum ointment (with gentamycin and betamethasone) is prescribed if the skin was combed infected, and there was inflammation.

Red flat lichen is treated with the same antihistamines (inside), and locally - with creams and ointments with GCS. In addition, use Retinoic ointment or Videstim, and inside Acitretin (one capsule two or three times a day).

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

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

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

Blue spots on the hands and feet are recommended to lubricate with ointments containing heparin.

In the complex therapy of juvenile rheumatoid arthritis - to alleviate the symptoms - use 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.).

To discolor age brown spots on the hands and feet, bleaching creams with hydroquinone, retinoids (tretinoin) and soft steroids are often used.

Physiotherapeutic treatment

Some patients with neurodermatitis, psoriasis or vitiligo are helped by physiotherapy: PUVA therapy, narrow-band UVB phototherapy.

Also for more details see -  Physiotherapy for dermatitis and dermatosis

Procedures for increased production of melanin - laser or pulsed light therapy - destroy melanocytes without damaging the surface of the skin, but such a procedure can lead to a slight discoloration of the skin. A dermabrasion and microdermabrasion (that is, polishing the surface layer of the skin) is also fraught with side effects in the form of temporary or permanent redness of the skin and its infection.

Alternative treatment

More useful information about the alternative treatment of psoriasis - in the article  Treatment of psoriasis in the home

When red spots associated with eczema, advise ointment with propolis, oil of thuja and tea tree. A treatment with herbs should be done with lotions with a strong decoction of calendula flowers, chemist's daisy, sweet clover, vulgar and arnica mountain.

Alternative treatment, applied with brown spots, includes fresh lemon juice (which need to be lubricated several times during the day); apple cider vinegar and a mixture of table vinegar with horseradish root juice, red onion juice, 3% hydrogen peroxide (used similarly).

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 - stone or burdock oil, as well as a mixture of glycerine and liquid honey (1: 1).

[18], [19], [20]

Homeopathy

Of the number of homeopathic remedies that can be used for spots on the hands and feet, it should be mentioned:

• Acidum nitricum, Thuja, Urtica (with flat red diarrhea);
• Aconitum, Causticum, Aurum iodatum, Mercurius solubilis (with pink lichen);
• Apis, Agaricus muscarius, Hypericum, Borax, Graphites (with atopic dermatitis and endogenous eczema);
• Acidum fluoricum, Arsenicum album, Thuja and (with vitiligo).

Blue spots on the hands and feet help to treat the combined Varipulsum.

Complications and consequences

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

Given the aetiology of blue spots in diffuse acrocyanosis, the consequences can occur, for example, with obliterative thromboangiitis or diabetic microangiopathy - in the form of thinning of the skin, intermittent claudication, tissue necrosis and gangrene.

Juvenile rheumatoid arthritis can lead to destructive form of joint inflammation and restriction of movement, up to disability. And brown spots with hyperplasia of melanocytes can be malignant, that is, degenerate into a malignant skin disease.

And, as you know, this is not a complete list.

[21], [22], [23], [24], [25]

Prevention

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

To avoid contact dermatitis and eczema, it is recommended to protect the skin with creams, while vitamin B12 and tyrosine, which is necessary for the production of melanin, is 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 struggle with them - with varying success, hoping for a cure. The prognosis of the development of the disease and the desire to remove stains 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, protects the internal space of the body from the harmful effects of the environment.

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