Recurring Red Spots on Ankles: Possible Causes and Insights

Red spots on the feet?

Hello Doctor: I have multiple sclerosis (MS), and for the past two months, I have been experiencing red spots on the inner sides of my ankles.
They are not painful or itchy, but they recur and tend to spread upward.
Sometimes, red spots also appear on the dorsum of my foot or the outer side of my ankle.
After applying medication prescribed by a dermatologist, the spots fade, but the frequency of outbreaks has increased from once every two weeks to approximately once a week.
I have had coagulation function tests and platelet counts that came back normal, and no allergic reactions were detected.
Recently, I tested positive for ANA at 1:160 and a rheumatoid factor of 32.8.
I would like to know what might be causing these symptoms.
Thank you!

Jessica, 20~29 year old female. Ask Date: 2021/06/20

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your message.
The small red spots on your skin may also be due to ruptured blood vessels or vasculitis.
A dermatologist should provide you with their preliminary suspected diagnosis.
As for the ANA of 160 and RF of 32.8, these are just initial screening indicators to assess for potential rheumatic diseases.
While these values are somewhat elevated, it is possible for normal individuals to have such results, but it may also indicate an underlying rheumatic condition, warranting further blood tests.
I recommend that you consult a nearby allergist or rheumatologist.
In addition to providing your test results, please inform them that you are also a patient with multiple sclerosis, and they will arrange for more detailed blood examinations.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is concerned about you.

Reply Date: 2021/06/20

More Info

Hello! Thank you for your question regarding the recurring red spots on your ankles. Given your medical history of multiple sclerosis (MS) and the recent developments with your skin, it’s important to consider a few potential causes and insights into your condition.

Firstly, the appearance of red spots on the skin, especially if they are not painful or itchy, can be attributed to several factors. Since you mentioned that these spots tend to appear on the inner sides of your ankles and can spread upwards, it could indicate a few possibilities:
1. Dermatitis: This is an inflammation of the skin that can manifest as red, itchy, or scaly patches. Contact dermatitis, for instance, could arise from exposure to irritants or allergens, even if you haven’t identified a specific allergen. Given that the spots respond to topical treatments, this could be a plausible explanation.

2. Vascular Issues: Given your MS diagnosis, it’s also worth considering that vascular changes could be contributing to the appearance of these spots. Conditions such as vasculitis, which involves inflammation of the blood vessels, can lead to red spots or rashes. While your coagulation studies and platelet counts are normal, it’s still important to monitor for any systemic symptoms that could suggest an underlying vascular issue.

3. Autoimmune Factors: The presence of an elevated ANA (antinuclear antibody) titer and RA factor could indicate an autoimmune process. While MS is primarily a neurological condition, it can be associated with other autoimmune phenomena. The red spots might be a manifestation of an underlying autoimmune condition that is not yet fully diagnosed.
4. Infection or Inflammatory Conditions: Certain infections or inflammatory conditions can also cause skin manifestations. For example, conditions like erythema nodosum, which is characterized by painful red nodules, can occur due to various triggers, including infections or systemic diseases.

5. Medication Reactions: If you are on any medications for MS or other conditions, it’s essential to consider that some medications can cause skin reactions. Reviewing your medication history with your healthcare provider could provide insights.

Given the frequency of the outbreaks has increased from every two weeks to weekly, it’s advisable to follow up with your dermatologist or a rheumatologist. They may suggest further investigations, such as a skin biopsy, to better understand the nature of the spots. Additionally, they might consider whether a referral to a specialist in autoimmune diseases is warranted, especially given your ANA and RA factor results.

In the meantime, maintaining a detailed diary of the occurrences, including any potential triggers (such as new products, activities, or changes in your environment), can be helpful for your healthcare provider in identifying patterns or correlations.

Lastly, while the red spots are currently not causing discomfort, it’s important to keep monitoring them. If you notice any changes in size, color, or if they begin to itch or become painful, seek medical attention promptly.
In summary, while the exact cause of your recurring red spots may not be immediately clear, considering the interplay between your MS and potential autoimmune factors is crucial. Continued communication with your healthcare providers will be key in managing your symptoms effectively. Thank you for sharing your concerns, and I hope you find relief soon!

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