Persistent Red Spots on Skin: Causes and Treatments - Dermatology

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Understanding persistent red spots on the skin can be quite challenging, especially when they manifest in a way that is not typical of common skin conditions. Based on your description, it seems you are experiencing small, flat red spots on your hands that resemble tiny ink dots. These spots are not acne, keratosis pilaris, or heat rash, and they have a tendency to resolve on their own after some time. However, the recurrence and the recent development of pain upon touching these spots suggest that further investigation is warranted.


Possible Causes
1. Eczema (Dermatitis): Your previous diagnosis of eczema could still be relevant. Eczema can present as small red spots, especially if there is an underlying irritation or allergic reaction. It is characterized by inflammation and can sometimes lead to the formation of small, flat lesions.

2. Cherry Angiomas: These are benign growths of small blood vessels that can appear as red spots on the skin. They are common and usually harmless, but they can sometimes become raised or bleed if irritated.

3. Petechiae: These are tiny red or purple spots that occur when small blood vessels bleed into the skin. They can be a sign of various underlying conditions, including infections or clotting disorders, and should be evaluated by a healthcare professional if they persist.

4. Seborrheic Keratosis: While typically more raised, these benign growths can sometimes appear flat and red, especially in their early stages. They are common in older adults and usually do not require treatment unless they become bothersome.

5. Vascular Lesions: The mention of "blood vessels rising" suggests that you might be dealing with a vascular lesion, such as a hemangioma or a similar condition. These can sometimes be treated with procedures like cryotherapy, as you have experienced.


Treatment Options
Given the persistence of your symptoms and the pain associated with the spots, it is advisable to consult a dermatologist for a thorough evaluation. Here are some potential treatment options that may be considered:
1. Topical Treatments: If the spots are indeed eczema-related, topical corticosteroids or calcineurin inhibitors may help reduce inflammation and alleviate symptoms.

2. Cryotherapy: As you have already undergone this treatment, it can be effective for certain types of vascular lesions. However, if the pain persists or the spots do not resolve, further evaluation may be necessary.

3. Laser Therapy: For vascular lesions or cherry angiomas, laser treatments can effectively reduce or eliminate the appearance of these spots without significant downtime.

4. Observation: If the spots are not causing significant discomfort and are not changing in appearance, a watchful waiting approach may be appropriate, especially if they have previously resolved on their own.

5. Biopsy: If there is uncertainty regarding the diagnosis, a skin biopsy may be performed to obtain a definitive diagnosis and guide treatment.


Conclusion
Persistent red spots on the skin can arise from various causes, and understanding the underlying condition is crucial for effective treatment. Given your history and the recent changes in your symptoms, I recommend seeking a consultation with a dermatologist who can provide a comprehensive assessment and tailored treatment plan. It is essential to address any concerns about pain or changes in the lesions, as these could indicate a need for more immediate intervention. Remember, early diagnosis and treatment can often lead to better outcomes and peace of mind.