Rash on legs and feet

Rashes affecting the lower legs

Advertisement

Skin cancer

App to facilitate skin self-examination and early detection. Read more

Text: Miiskin

  • Dermatitis of the lower legs
  • Scaly rashes of the lower legs
  • Infections often affecting lower legs
  • Other red conditions of the lower legs
  • Lower leg ulcers

Dermatitis

Most often, a rash affecting the lower legs is a type of dermatitis. The terms ‘dermatitis’ and ‘eczema’ are often used interchangeably. Acute dermatitis presents as red, swollen and blistered plaques. Chronic dermatitis accompanied by rubbing and scratching results in darkened (hyperpigmented), and thickened (lichenified) plaques.

There are several different types of lower leg dermatitis, which is common at all ages:

  • Atopic dermatitis
  • Discoid eczema
  • Varicose dermatitis
  • Gravitational dermatitis
  • Contact dermatitis
  • Lichen simplex
  • Prurigo nodularis

Scaly rashes of the lower legs

Scaly conditions affecting the lower legs include:

  • Psoriasis
  • Lichen planus
  • Superficial basal cell carcinomas

Infections favouring the lower legs

  • Cellulitis
  • Folliculitis
  • Tinea corporis

Redness of the lower legs

Other red or purplish conditions favouring the lower legs include:

  • Pretibial myxoedema
  • Panniculitis
  • Necrobiosis lipoidica
  • Vasculitis
  • Capillaritis

Lower leg ulcers

  • Detailed descriptions of leg ulcers
  • Differential diagnosis of leg ulcers

Management of lower leg rashes

Management depends on making a correct diagnosis. General advice should include:

  • Avoid and treat dry skin, using non-soap cleansers and thick simple emollients. Avoid exposing the legs to direct heat or the hot air of the heater in a car.
  • Minimise swelling – avoid standing for prolonged periods, take regular walks, elevate the feet when sitting or overnight and wear special graduated compression stockings long term.
  • Prescription treatments may include oral antibiotics for secondary infection and topical steroids of varying potency – weak products can be used long term if necessary but potent topical steroids should be used once or twice daily for short courses of one to four weeks.

Avoid topical antibiotics, topical antihistamines and multi-ingredient fragranced or herb-containing emollients because of the risk of provoking contact allergy.

Podiatric physicians are often presented with dilemmas when diagnosing various dermatological conditions as these conditions may have overlapping symptoms. An accurate diagnosis is dependent on the patient history, physical examination and asking key questions to elicit telling answers from the patient. Accordingly, we have launched a new bimonthly column, “Dermatology Diagnosis,” that will test one’s skills in diagnosing dermatological conditions. Without further delay, let us consider the first case. A 26-year-old male presents with a four-day history of red, itchy bumps on his lower legs. He says he woke up four days before with itching on both lower legs and noticed small red bumps beginning below both of his knees and progressing down toward his feet. After approximately 24 hours, the patient noticed that the condition started to itch more and appeared to get worse. During the history portion of the visit, the patient says he had no idea how the rash started and had no previous history of a similar rash anywhere on his body. He reported that he was otherwise in good health but recently had systemic symptoms of fatigue, joint pain, muscle aches and a mild headache, which he first noted two days after the rash appeared. The patient has no history of allergy to any medications, foods or other substances, and is not taking any medications or vitamins at this time. Furthermore, the patient maintains he had not started to use any new cleaning products, bath soaps, laundry detergents or topical preparations of any kind prior to this problem. He has not gone camping or hiking in the past month, and has not gone out of the state in the last two months. The patient says he checked his bed carefully for any bugs and found none. None of his roommates has a similar problem.

What Did The Examination Reveal?

The physical examination shows an array of small (3 to 8 mm) erythematous, pruritic, follicular papular eruptions, many with apparent pustules, confined to the lower legs. There are a few small areas of urticaria and a few small nodular lesions on the legs. There are no lesions on the hands, arms or feet. Upon careful questioning of the patient, he reveals that he has a few similar lesions around the groin area. Some of the larger lesions are tender to direct palpation. There is no increase in skin temperature and no edema. The remaining examination is negative for elevated oral temperature or other signs or symptoms. There are no other obvious dermatological findings other than those noted from the initial examination.

Inside Insights On Hot Tub Dermatitis

The most common misdiagnosis is that of insect bites. In this case, the patient has Pseudomonas folliculitis, which is also called “hot tub dermatitis.” He had been in his friend’s hot tub on two occasions just before the pruritic rash broke out. In this case of Pseudomonas folliculitis, perifollicular pustules began appearing one to two days after exposure to a contaminated hot tub. Although “hot tub” folliculitis is usually caused by Pseudomonas aeruginosa, one does not need to obtain a culture to establish this diagnosis. This can be a difficult diagnosis to make unless you recognize the pattern and ask the essential question about hot tub exposure. Other sources of this infection include contaminated whirlpools and spas. Folliculitis can also be caused by other bacterial organisms such as Staphylococcus aureus and Streptococcus pyogenes. Clinicians may take a specimen from some pustules for bacterial culture if there is uncertainty about the causative agent. Pseudomonal folliculitis presents as erythematous skin lesions any time from eight hours to five days or more (the mean incubation period is 48 hours) after using a contaminated hot tub, water slide, physiotherapy whirlpool or contaminated loofah sponge. Malaise and fatigue may occur during initial days of the eruption. Fever is uncommon and it is low grade when present. Pseudomonal folliculitis may present with just a few to dozens of small (0.5 to 3 cm) spherical urticarial plaques, with a central papule or pustule on all skin surfaces exposed to long-term soaking in contaminated water. Typically, this condition occurs on the legs, groin area, waist, under the breast in females and on the back area. The lesions are usually concentrated in areas covered by a bathing suit and usually spare the head, neck and hands. The rash can be a polymorphous eruption or a mixture of follicular, maculopapular, vesicular or pustular lesions. These lesions are often extremely pruritic. Usually, no treatment is necessary as the folliculitis clears spontaneously in seven to 10 days. However, one can treat the intense itch with 25 to 50 mg of diphenhydramine hydrochloride at bedtime. Some patients may have recurrent crops of lesions over an extended period of up to three months, which may leave round spots of red-brown postinflammatory hyperpigmentation. For severely symptomatic patients or those who have re-exposure, one can use ciprofloxacin for five to seven days.

In Conclusion

The differential diagnosis for a pruritic erythematous papular eruption is vast. Some of the more common possibilities include insect bites, viral exanthema, scabies, various fungal infections as well as allergic reactions to medication, foods, soaps, laundry detergents, topical preparations, plants or clothing. In this case, careful examination with a magnifying lens was necessary to determine that the lesions were observable around hair follicles and that some were pustular. This helped to make this diagnosis. The primary descriptive characteristics of Pseudomonas folliculitis include papules, pustules, urticarial plaques, macules and vesicles. Prevention requires meticulous cleaning of the hot tub and appropriate water chemical management. Dr. Dockery is a Fellow of the American College of Foot and Ankle Surgeons, and a Fellow of the American Society of Podiatric Dermatology. He is board certified in foot and ankle surgery. He is the Chairman of the Board and Director of Scientific Affairs for the Northwest Podiatric Foundation for Education and Research in Seattle. Dr. Dockery is the author of Cutaneous Disorders of the Lower Extremity (Saunders, 1997) and Lower Extremity Soft Tissue & Cutaneous Plastic Surgery (Elsevier Science, 2006). Editor’s note: For related articles, see “What You Should Know About Atopic Dermatitis” in the September 2005 issue of Podiatry Today. Also be sure to check out the archives at www.podiatrytoday.com.

Symptoms of Vein Disease

En Español

Vein disease may present with a variety of symptoms, many of which are painful, even debilitating.

If you begin to experience significant, persistent symptoms such as those mentioned here, it is best to seek evaluation and treatment by a physician as soon as possible. Left untreated, these conditions will progress and worsen over time. Early treatment prevents the progression of pain and further damage to your legs, as well as other medical complications.

Read more about these common symptoms of vein disease:

  • Leg pains and aches, including burning and itching sensations
  • Leg cramping, including nighttime cramps
  • Tired, heavy legs
  • Skin changes, including darkening, rashes, and dry itchy skin
  • Swelling / Lymphedema
  • Ulcers
  • Varicose or spider veins
  • Restless legs
  • Spontaneous bleeding
  • Recurrent cellulitis (skin infection)
  • Loss of hair on feet, ankle, and/or lower leg
  • Varicocele pain

Vein Treatment Options

Leg pains and aches

Including burning and itching sensations

Leg pain is caused by venous reflux (insufficiency) in many patients. Over time, patients often experience the gradual onset of leg pain in one form or another. Some describe their leg pain as a dull ache or throbbing. Others describe a pressure sensation in the lower leg. Many experience muscle cramping, especially at night. Some describe their leg pain as heaviness.

Leg pain and associated symptoms are usually worse when a patient is subjected to periods of prolonged standing. Many occupations such as teaching, health care, retail, and law enforcement require long periods of standing which can worsen symptoms. These symptoms usually worsen at the end of the day and improve when a patient can elevate their legs. These symptoms usually worsen with warm weather and improve in colder climates. Leg pain due to vein disease is usually worse with standing and lack of activity and improves with walking or exercise.

Leg pain can also be caused by other problems not related to veins. Diseases affecting the arteries limit the amount of blood and oxygen that can reach the legs. Leg pain due to arterial disease is usually brought on with exertion is quickly relieved by rest. When walking, patients can experience muscle cramping in the calves, thighs, or buttocks.

Leg pain can also be caused by back or nerve disorders not related to vein or arterial disease. The pain also may be a sign that a more serious condition, such as blood clots, could be present. All vein diseases will continue to worsen without treatment. Early detection and intervention can help you avoid developing more serious health issues.

Leg cramping

Including nighttime cramps

Leg cramping is commonly caused by venous reflux (chronic venous insufficiency). Many patients experience muscular tightening or painful cramping at night. The relationship between venous insufficiency and leg cramping is poorly understood. It is sometimes difficult to predict which patients with leg cramping will respond favorably to treatment for vein disease.

There are other causes of leg cramping in addition to venous disease. Muscular cramping due to vein disease is usually worsened by prolonged standing or inactivity. Cramping at night is also commonly due to vein disease. Calf cramping with exercise may be due to arterial disease, and unrelated to venous insufficiency. With arterial disease, the cramping, most often occurring in the buttocks, calves, and thighs, occurs after walking, exercise, or exertion and is alleviated quickly with rest. If leg cramping is causing you discomfort or keeping you awake at night, a diagnostic ultrasound can help determine the cause.

Tired, heavy legs

One of the symptoms patients with vein disease commonly experience is a tired, heavy feeling in the legs. This feeling may or may not be accompanied by aches and pains. However, this is not just caused by needing rest. In fact, the tired, heavy feeling often intensifies after periods of rest or inactivity. If that is the case, tired leg muscles are not the problem—vein disease may be to blame. The most likely culprit in these situations is venous insufficiency, or the dilation of superficial veins with incompetent valves, which leads to a gravity-dependent retrograde flow of venous blood.

If you are experiencing these symptoms, a medical examination by one of our expert vein doctors can help determine the true cause.

Skin Changes

Including darkening, rashes, and dry itchy skin

Significant changes in the skin of the lower leg may be a sign of vein disease, most commonly superficial and deep vein insufficiency (when superficial veins with broken valves become dilated) or arterial occlusive disease (when narrow arteries disrupt blood flow), though other conditions may be at fault. Skin changes may include:

  • Darkening of the skin, typically to a reddish-brown, dark-brown or rust color
  • Rashes, manifesting as tiny, usually itchy bumps around the lower calf or ankle
  • Cellulitis or similar skin infections
  • Painful, hard, dark-red or brown plaques (lipodermatosclerosis) around the lower calf and/or ankle
  • Venous ulcers around the inner or outer ankle
  • Thin, easily torn skin
  • Loss of hair on lower legs and feet (also a sign of arterial disease)
  • These changes may also be accompanied by aches and pains and/or heavy, tired legs.

The inflammatory changes caused by chronic venous insufficiency often leads to skin rashes that cause intense itching and redness. If this rash is due to vein disease it is usually referred to as venous eczema or venous stasis dermatitis. This usually affects the lower legs with patches of numerous tiny red bumps that may coalesce into diffuse red rashes covering the lower legs and ankles. The rash is usually very itchy and is often misdiagnosed as an infection of the skin called cellulitis.

Chronic venous insufficiency also frequently leads to a darkening of the skin called hyperpigmentation. Chronic inflammation damages the tiny blood vessels called capillaries. Fluid and red blood cells leak out, causing swelling and skin discoloration, respectively. The substance in red blood cells that carries oxygen is called hemoglobin — an iron-based pigment. When leaky capillaries allow red blood cells to escape into the skin and subcutaneous tissues, this iron-based pigment is deposited in the skin, causing the brownish, rust-colored discoloration that starts around the ankle and progresses up the lower leg in a gaiter distribution.

More advanced skin changes lead to lipodermatosclerosis, a dark-red or brown, plaque-like thickening of the skin that can be painful. This is usually associated with scarring and fibrosis of the underlying subcutaneous tissues and causes the tissues below the calf to shrink and become hardened. Patients may notice a caliber change in the diameter of their lower legs and narrowing of the lower legs from the lower calf down to the ankles.

The skin changes caused venous insufficiency are often misdiagnosed as a dermatological problem. This can prevent its true cause from being discovered, allowing the condition to get progressively worse over time. If vein disease is left untreated, the patient risks developing worsening skin changes leading to a stasis ulcer or open wound on the skin.

Swollen legs

When the valves in leg veins begin to weaken or fail, the blood cannot be pumped out of the leg properly. This causes fluid to become trapped in the leg. When the fluid begins to build up, the leg may begin to swell. Swelling due to fluid accumulation in the body is called edema.

The swelling may be accompanied by other symptoms, such as pain, cramps, or a heavy, tired feeling in the legs. Any swelling in the lower leg should be considered abnormal, and patients must visit a physician immediately to diagnose and begin treating the underlying problem. Swelling can also be a symptom of other, non-venous conditions such as heart disease, heart failure, obesity, high blood pressure, liver disease, or kidney disease, so it’s important to seek medical attention immediately.

Lymphedema is a form of long standing or chronic edema that occurs when the body’s lymphatic system doesn’t function properly. It is not the same as edema caused by vein disease, although vein disease can progress into a combined venous and lymphatic disorder. Lymphedema can be congenital, primary, or secondary. The cause of primary lymphedema is unknown, while secondary lymphedema can be the result of cancer, prior radiation treatment, certain tropical diseases, trauma, or surgical treatment. Lymphedema requires medical attention as soon as possible.

Venous Ulcers

Venous ulcers usually develop around the ankle and can vary in size from very small to several inches in diameter. While usually not very painful, venous ulcers can occasionally be quite painful or become infected.

Chronic vein disease causes an inflammatory reaction that leads to swelling caused by fluid leaking out into the tissues of the lower legs. A brown, rust-colored discoloration can begin around the ankle. It is crucial to seek medical treatment immediately for ulcers or pre-ulcerous conditions.

Visible varicose or spider veins

Varicose veins occur when veins become stretched out or enlarged over time, leading to non-functioning valves. These leaky valves cause the blood to pool and stagnate in the vein, causing it to stretch over time. A varicose vein will appear swollen and rope-like, bulging out from the surface of the skin. They are most commonly found on the thighs or calves. The varicose vein may be the same color as the skin, or it may appear blue or red.

Varicose veins can cause the legs to swell or feel achy, heavy and tired. A person with varicose veins also may experience itching, burning, numbness or tingling. Varicose veins also cause nighttime leg cramps and restless leg syndrome. In extreme cases, varicose veins may result in skin changes, rashes, swelling, and ulcers or open sores on the legs if left untreated. Some patients can experience clotting of varicose veins, which can be quite painful.

Spider veins are tiny, dilated veins that are visible on the surface of the skin. Spider veins are typically not painful, but some patients do complain of burning or itching. When numerous spider veins are visible at the skin’s surface, they may be an indicator that venous insufficiency of larger veins are present under the skin.

Restless legs

Approximately 15 percent of Americans are affected by restless leg syndrome. When it occurs, patients experience a constant urge to move their legs due to uncomfortable sensations. The symptoms usually appear while sitting or lying down, and tends to occur more often at night.

Restless leg syndrome in most patients is the result of vein disease. More than 90 percent of patients with restless legs suffer from venous insufficiency. When the valves in the leg veins weaken and fail to function properly, blood flows backwards into the legs, leading to venous congestion. In addition to causing significant leg discomfort, venous congestion in the legs presumably triggers a reflex to move the legs to clear the blood and fluid out of the muscles.

Studies have shown that 80 to 85 percent of patients have significant or complete resolution of restless leg syndrome following treatment of vein disease. If you have been diagnosed with restless leg syndrome, experience the frequent urge to move your legs while at rest, and you feel as if this condition is negatively impacting your work and life, contact us to set up an appointment. One of our doctors will examine you, review your medical history, and make the appropriate treatment recommendations.

Spontaneous bleeding

Spontaneous bleeding from superficial veins in the leg can occur due to untreated vein disease. The bleeding results from high pressure in superficial veins caused by venous insufficiency (reflux) caused by backwards flow of blood into the veins of the legs under the force of gravity. The veins and skin weaken over time, and if the affected area receives even a slight injury, the vein may rupture and bleed a substantial amount. This also may occur after bathing in warm water, which softens the skin and dilates the veins close to the skin surface. If spontaneous bleeding occurs from a vein in the leg, immediate actions must be taken to stop the bleeding. Patients should elevate the leg, apply pressure, and seek medical assistance immediately.

Vein disease will progress without treatment, and spontaneous bleeding is a serious warning sign of deeper problems. If you have experienced spontaneous bleeding, contact us to schedule an appointment.

Recurrent Cellulitis (skin infection)

Cellulitis is an infection that affects the skin making it red, painful, tender, and warm to the touch. Cellulitis is treated with antibiotics to eradicate the infection.

Patients with chronic vein disease have damaged fragile skin with decreased oxygen levels which can lead to repeated episodes of cellulitis.

Many patients with chronic vein disease are often misdiagnosed with recurrent cellulitis when they actually suffer from venous eczema (stasis dermatitis), an inflammatory (not infection) condition leading to a red rash on the lower legs that is usually very itchy. If you have been diagnosed with chronic, recurrent cellulitis and antibiotics don’t seem to help, you may be suffering from venous eczema (stasis dermatitis) caused by vein disease.

Treating the underlying vein disease can help prevent the physical conditions that increase the risk of recurrent cellulitis. If you have had a leg ulcer or have been diagnosed with cellulitis, schedule an appointment with us.

Varicocele Pain

A varicocele is an enlarged vein in the scrotum that can cause pain and decrease sperm production. Varicoceles develop over time and often don’t need treatment. However, if you experience symptoms, including pain that worsens with physical exertion or throughout the course of the day, learn about non-invasive treatment options. Texas Endovascular specializes in varicocele embolization.

Request Appointment

What causes dactylitis, or sausage fingers?

Any disease or infection that causes inflammation has the potential to cause dactylitis. The most common causes of swollen fingers or toes include:

1. Sickle cell disease

Sickle cell disease is a group of genetic disorders of the red blood cells. Normally, red blood cells are shaped like discs. In people with sickle cell disease, changes in hemoglobin can alter the shape of blood cells to a sickle or curved shape.

Hemoglobin carries oxygen around the body, so changes in hemoglobin proteins can affect the body’s ability to get enough oxygen. The lack of oxygen in the tissues causes sudden, severe pain and a person may need to go to the hospital for treatment.

Dactylitis may be the first symptom in people with sickle cell disease, especially in children. It can appear in infants as young as 6 months old.

When dactylitis occurs as a side effect of sickle cell disease, it can be accompanied by a fever, pain, and an increase in white blood cells. Children with swollen fingers should be evaluated by a doctor for sickle cell and other diseases.

2. Tuberculosis

Dactylitis is a rare complication of tuberculosis. Tuberculosis is an infectious bacterial disease that can cause inflammation in the lungs. In rare cases, it can cause bone inflammation.

This bone inflammation causes the bones of the hands or feet to swell, producing pain and changes in the shape of the fingers or toes. In most cases, only one side of the body is affected. Leprosy is another disease that can cause similar changes in the fingers.

3. Sarcoidosis

Sarcoidosis is an inflammatory autoimmune disease that can affect the heart, liver, kidneys, lungs, and other organs. It causes severe problems in the organs and can even be fatal.

Very rarely, sarcoidosis can affect the bones and muscles of the hands, causing painful swelling. People with this symptom may also develop lupus pernio, which causes lesions and plaques on the face, ears, and fingers.

4. Syphilis

Share on PinterestSyphilitic dactylitis may be caused by congenital syphilis.
Image credit: Internet Archive Book Images, (2015, September 17)

Syphilis is a sexually transmitted infection (STI). Pregnant women with syphilis can pass the disease on to their babies, resulting in congenital syphilis.

In rare cases, babies born with congenital syphilis can develop dactylitis of the fingers or toes. This is due to inflammation in the bone and tissue, and usually, affects both sides of the body.

5. Spondyloarthritis

Spondyloarthritis refers to types of arthritis that affect the joints and the entheses, which are the tissues where tendons and ligaments attach to bones. One of the most common forms of spondyloarthritis is psoriatic arthritis. Dactylitis can sometimes be a sign of advanced psoriatic arthritis.

Dactylitis is common in spondyloarthritis, affecting about a third of people with the condition. Researchers do not yet have a clear understanding of why so many people with spondyloarthritis get dactylitis, but they know it is due to swelling in the joints and surrounding tissues.

People with rheumatoid arthritis do not get dactylitis, so some doctors use the presence of dactylitis to help diagnose the form of arthritis a person has.

6. Infection

Some infections can cause swelling of the tissue deep below the skin or even in the bone. This swelling can cause symptoms of dactylitis.

A form of dactylitis called blistering distal dactylitis is due to an infection of the fatty pad of a single finger or toe. Commonly caused by skin infections, such as Streptococcus or Staphylococcus, this form of dactylitis occurs due to problems with circulation.

Blistering distal dactylitis can be extremely painful and may produce lesions or blisters on or near the affected area. The condition is more common in children than in adults.

You have arthritis pain, and the inflammation in your joints causes your fingers to swell up and resemble little sausages. Or maybe you’ve chowed down a salty meal, and now your wedding ring is stuck on your finger. Should you freak out? Probably not. Fingers swell for a lot of reasons-many of them harmless-but sometimes the puffiness (medical term; dactylitis) points to more serious health conditions.

© ChesiireCat – Getty Images There could be a number of reasons you have swollen fingers, including eating too much salt or having preeclampsia. Learn the common causes of swollen fingers.

Here are some of the common causes of swollen fingers, and when you should call your doctor.

It’s really hot outside

Heat causes blood vessels to expand, which allows more heat to escape through your skin so you can keep cool, explains Tammy Olsen Utset, MD, MPH, an associate professor in the rheumatology department at the University of Chicago. As the vessels stretch, some of their fluid can leak into your soft tissues and cause puffiness.

Dr. Utset says this type of swelling tends to go away as you use your hands and continue your regular activity. But if you notice puffiness only in your hands and fingers (and not your legs), accompanied by pain or a weak grip, that could be a sign it’s not just the heat and you need to consult your doctor.

Too much salt

General Tso’s chicken, lots of chips and guac, or anything fried could be the cause of your frankfurter fingers. Your body likes to keep a consistent salt-to-water balance. Taking more salt in means your body compensates by retaining more water, which explains the swelling, Dr. Utset says.

Typically, mild swelling brought on by salty foods goes away on its own within a day, although, it can lasts longer depending on how much extra salt is in your system. If you cut back on salt and the swelling persists, see your doctor, Dr. Utset advises.

It might be osteoarthritis or rheumatoid arthritis

If it’s the bony finger joints themselves that are enlarged (i.e., you can’t get your rings over your knuckles), osteoarthritis may be to blame, especially if your fingers are swollen in the morning. This age-related form of arthritis is caused by the wearing down of the cushioning tissues at the end of your joints. Osteoarthritis is often, but not always, accompanied by pain and stiffness, Dr. Utset says. Rheumatoid arthritis (RA), an autoimmune disease that attacks the lining of the joints, can also cause swelling. Unlike osteoarthritis, RA can happen to young people. Swelling in people with RA often happen in the wrists and finger joints.

It could be carpal tunnel syndrome

When the nerve that runs from the forearm to the palm of the hand is pinched or squeezed at the wrist, that’s when carpal tunnel syndrome develops, Dr. Utset explains. The resulting swelling is usually accompanied by pain, burning, tingling, or numbness in the hands and fingers-symptoms that often develop slowly over time. Research suggests carpal tunnel affects three times as many women as men. To help prevent and treat carpal tunnel syndrome, do these five stretches at your desk.

It might be a blockage in your lymphatic system

Lymphedema is a limb-swelling disease that results when lymph fluid (which carries waste, bacteria, and viruses out of the body) doesn’t adequately drain. Your fingers and toes may swell, and usually your arms and legs will swell, too. Your skin may also feel tight or thicker than usual, according to a report from the National Cancer Institute. Lymphedema has been linked with surgery or radiation breast cancer treatments. In rare cases, lymphedema can also be caused by the abnormal growth of your lymph system.

You might have preeclampsia

Some swelling is typical for expectant moms. But swelling in the hands and face-especially if pressing your thumb into your skin leaves a noticeable indentation-can be a red flag for preeclampsia. Preeclampsia is a pregnancy complication characterized by high blood pressure. If it goes untreated, it can lead to organ damage, including the liver and kidneys. Other symptoms that accompany swelling in the hands and face are severe headaches, nausea and vomiting, and shortness of breath.

The risk of preeclampsia is highest during the first pregnancy or pregnant women older than 40. It’s also common in women carrying twins or triplets, and those who are obese.

Got cold hands? It might be Raynaud’s disease

Raynaud’s is a narrowing of your arteries, often caused by cold weather or stress. That narrowing limits blood circulation. Swelling-along with prickling or pain-occurs when circulation returns (as you warm up or your stress dissipates). The condition is common and more likely to occur in women than men, Dr. Utset says. If you notice your fingers or hands are bluish or pale before they swell, that’s one indicator of Raynaud’s.

RELATED: 7 Signs You Have Allergies Not a Cold (via Health.com)

What is Dactylitis?

Psoriatic arthritis (PsA) often begins in the distal joints, those farthest away from the core of the body, such as the interphalangeal joints in the fingers and toes. The disease can cause significant swelling in the fingers and toes, creating a sausage-like appearance, called dactylitis.1

Psoriatic arthritis in fingers and toes

Dactylitis is a painful swelling of the entire digit and is often asymmetric, occurring only on one side of the body. For example, all the joints in one finger on the left hand may be affected while the same finger on the right hand is unaffected. However, PsA can also be symmetrical, with joints affected on both sides of the body.2 Studies show that dactylitis occurs more frequently in the toes than the fingers, with 78% of patients experiencing the swelling in the toes and 42% experiencing swelling in the fingers.1

Dactylitis is a combination of swelling in the joint, as well as inflammation at the attachment points of ligaments and tendons. This type of inflammation is called enthesitis.1 Dactylitis occurs in up to 50% of patients with PsA and is a marker for disease progression.2 Dactylitis is a hallmark feature of PsA, although it occasionally occurs in other conditions, such as spondyloarthropathies, gout, or some infections.1

Dactylitis can be acute or chronic. Acute dactylitis is defined by the painful swelling of the digit. Chronic dactylitis is characterized by persistent swelling with an absence of pain. Tender inflammatory dactylitis is associated with disease that erodes the joints, often leading to deformity and loss of function.1

Fingers & toes swelling progression

PsA is a chronic disease that can fluctuate and change over time. Some patients present with asymmetrical disease affecting only a few joints (oligoarthritis) at diagnosis and evolve to having symmetrical disease affecting many joints (polyarthritis). Others find that with effective treatment, the disease might go from polyarticular to oligoarticular.1

Arthritis mutilans, the most severe form of the disease, occurs in approximately 5% of patients with PsA. The shortening of digits, deformity, and loss of function characterize arthritis mutilans.1

How is psoriatic arthritis in the fingers and toes diagnosed?

PsA is often diagnosed with the use of imaging techniques, including x-ray, MRI (magnetic resonance imaging), and ultrasound. Ultrasound and MRI have been shown to be more sensitive than x-ray to detect inflammatory changes in patients with PsA. Ultrasound is useful for assessing structural changes and detecting abnormal blood flow. MRI allows visualization of soft tissue as well as bony changes.1,3

How is psoriatic arthritis in the fingers and toes treated?

Minor pain and stiffness of mild PsA can be alleviated with non-steroidal anti-inflammatory drugs (NSAIDs). In addition, injections of corticosteroids may be used.4

For moderate to severe disease, treatments that target joint disease in PsA can reduce symptoms and prevent disease progression. Recommended treatments include disease-modifying anti-rheumatic drugs (known as DMARDs). The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor (TNF), a chemical that produces a wide range of inflammation in PsA. Examples of TNF blockers include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi), and certolizumab pegol (Cimzia). Other DMARDs that have proven effective in clinical trials include ustekinumab (Stelara), brodalumab (which is awaiting FDA approval), and secukinumab (Cosentyx). 1 The FDA has also recently approved Inflectra (infliximab-dyyb), a biosimilar to infliximab, for the treatment of PsA.6

Physical and occupational therapy, involving exercises, stretching, heat, cold, and possible vocational readjustments, can be critical treatment approaches to protect the involved joints and maintain function.4,5

Patients may be referred for possible surgery to alleviate severe pain or damage. However, high rates of recurrent joint damage have been noted after surgery for PsA, particularly in the hand.5

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *