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What Causes Recurring Purpural Painless Rash?

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Posted on Wed, 28 May 2014
Question: I am a 65 yr old female with a number of health issues (although you'd never know it because I'm a perfect weight, look at least 10 yrs younger than I am and the only physical limitation I have is weakness in my legs and occassionally my knees act up). I have a number of controlled medical problems. I have had 6 heart attacks over the past 15 yrs due to CAD (it runs in the family), have 2 medicated stents in my circumflex artery and my keft coronary is 100% blocked but it grew small peripherals so I have no heart muscle damage and of course am on 75mg of asa daily along with 75mg of plavix. I also lost my left kidney and renal artery a few years ago but the nephrologist doesn't know why and attributes it to an unknown acute metabolic occurrence. Because of my age I am now experiencing CKD but my gfr and other numbers are pretty good and my nephrologist is not concerned. I have testing done twice a year. A little over a year ago I was diagnosed with elevated IGM (also in my bone marrow) but have no outward sumptoms. My oncologist says it will definately turn into Waldenstroms at some point and have bloodwork done every 3 months to monitor it. Now that you know my medical backround I will get on to my question, which I have also asked my IM dr, my nephrologist, my cardiologist, and am planning on asking my oncologist about today. I get the same answer from all of them, it's either "don't worry about it " or I really don't know". Being a retired nurse I find my condition puzzling and also worriesome. I keep getting purpura for no apparent reason. The part that concerns me is it's ALWAYS on my left hand and forearm. They are usually the size of a dime or smaller and there are always at least 3-4 of them. They take a few weeks to fade and when they are almost gone I wake up in the am with 2-3 more. They do not itch or hurt (they are just ugly and sometime bleed). My concern is they are always on my left hand and forearm, NEVER ANYWHERE ELSE . This has been going on now for over a year. I realize I am on plavix and asa daily but from everything I read purpura from these medications appear regularly but not in the same exact location everytime. I am not bumping or injuring my arm. Is this a symptom of some underlying condition? I am so frustrated I can't even think of the right questions to ask anymore. My protien level is a little restricted due to the kidney problem but my blookwrok is good. I am not anemic or deficient in protien.
thanks,
Marianne
doctor
Answered by Dr. Chakravarthy Mazumdar (18 hours later)
Brief Answer:
Blood pressure measurement

Detailed Answer:
Hi,

It is an interesting question to answer. However purpural painless rash that rarely bleeds and recurs at the same location is something clueless even for your Nephrologist. Did you ever thought of meeting Dermatologist if the local tissues under the skin are thin and the blood is extravasating through the thin tissues to appear as purpura.

Next thing is if you measure blood pressure in the left arm (being a CKD, your are regularly monitored), the high pressure built in the vessels in the left fore arm while measuring BP would cause extravasation of blood.

While I talk to some of the other experts please check the two views I gave you.

Wish you Good health.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Chakravarthy Mazumdar

General & Family Physician

Practicing since :2004

Answered : 2087 Questions

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What Causes Recurring Purpural Painless Rash?

Brief Answer: Blood pressure measurement Detailed Answer: Hi, It is an interesting question to answer. However purpural painless rash that rarely bleeds and recurs at the same location is something clueless even for your Nephrologist. Did you ever thought of meeting Dermatologist if the local tissues under the skin are thin and the blood is extravasating through the thin tissues to appear as purpura. Next thing is if you measure blood pressure in the left arm (being a CKD, your are regularly monitored), the high pressure built in the vessels in the left fore arm while measuring BP would cause extravasation of blood. While I talk to some of the other experts please check the two views I gave you. Wish you Good health.