Long-term Red Dots on Legs — Exploring Causes and Solutions
**Patient Profile:** - **Age & Gender:** 43-year-old Male - **Weight:** 82 kg - **Ethnicity:** Caucasian - **Location:** Norway **Main Concern:** I have developed persistent red, non-itchy dots and patches on my legs, which seem to resemble swimmer’s itch, but I have been assured it's not that condition. This issue has progressively worsened over a span of eight years, with increasing redness observed around my groin. **Duration of Symptoms:** Surging for over eight years, initially starting gradually and now extending more broadly. **Health Background:** - Suffering from chronic pancreatic insufficiency and currently taking Creon 25000. - Extremely low vitamin D levels (genetically suspected, as supplements have not helped). - Lower than normal white blood cell counts. - Possibly experiencing histamine intolerance, having attempted various dietary changes. **Medications Currently Used:** - **Creon 25000:** One [X capsules] with meals, prescribed following CT scans indicating fat malabsorption issues. - **Vitamin D supplements:** [Dosage, e.g., 5000 IU/day], which have not shown effectiveness. - **Bentacort (betamethasone):** Applied topically, but caused increased redness. - Other treatments tried include Fungoral shampoo, Canoderm, and Optima pH balm, all lacking positive results. **Lifestyle Choices:** - I do not smoke. - Alcohol consumption: [e.g., occasional/never]. - No use of recreational drugs. **Dietary Habits:** I avoid gluten, dairy, eggs, yeast, avocado, and meat broth while integrating dark chocolate, tomatoes, oats, grilled chicken, beef, fish, berries, onions, and garlic into my meals. **Inquiries:** 1. Is it plausible that **Creon 25000** (the pancreatic enzyme replacement) could be responsible for the rash I’ve been experiencing for the last eight years? 2. What could be alternative diagnostic considerations? A dermatologist suggested eczema, but the use of steroids has exacerbated the condition. Could it be psoriasis instead? 3. Is there a potential relationship between my low vitamin D and white blood cell counts? There is a family history of similar problems. 4. What advice can I receive regarding my diet? Am I overlooking any possible triggers? **Additional Information:** - There is no sensation of itching with the rash. - A skin biopsy identified "eczema," but lacking any detailed information. - I have tried a strict low-histamine diet with only partial improvement. I appreciate any guidance or insights you might have!
Answers (1)
3/21/2025, 8:10:46 PM
OpenHealth AI
Thank you for sharing your detailed concerns regarding the persistent red dots on your legs. It sounds like you have been through a lot in managing your health, and it's understandable to seek clarity and relief regarding this issue.
Summary of Main Points:
- Possible causes of the rash include eczema or psoriasis; however, the prolonged duration and lack of response to standard treatments suggest further investigation is needed.
- Dietary factors and your health conditions may interact to exacerbate the skin issues and vitamin D deficiency.
- Creon 25000 is unlikely to be the direct cause of the rash, but the relationship between your medications and skin symptoms deserves exploration.
Detailed Explanation:
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Creon 25000 and the Rash: Creon, as a pancreatic enzyme replacement, usually doesn’t cause skin reactions directly. However, you might be experiencing side effects or allergic responses to something else in your treatment or diet. It’s always good to monitor any changes you notice when adjusting medications or introducing new foods.
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Diagnostic Considerations: Since a biopsy indicated eczema without detailing further, it may be wise to consider other conditions such as psoriasis or even an allergic dermatitis, which may not be apparent without thorough evaluation. Given the lack of improvement with steroids, it's essential to explore other treatment options or consult a dermatologist for a focused examination—consider patch testing for potential allergies.
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Vitamin D and White Blood Cell Counts: Low vitamin D levels can impact immune function and potentially explain your lower white blood cell counts. Since your vitamin D supplementation has not improved your levels, you may want to consult with a healthcare provider specializing in nutrition or endocrinology to explore alternative fat-soluble forms (like emulsified vitamin D) or injections that could be more effective for absorption.
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Dietary Advice: Although you're avoiding common high-histamine foods, consider keeping a food diary to track any potential triggers of your skin condition. Introduce foods gradually and monitor reactions. Also, while your current regimen appears healthy, ensure you’re getting a varied intake of nutrients to support skin health (like omega-3 fatty acids), and consider consulting with a registered dietitian who can suggest specific additions tailored to your needs.
Next Steps:
- Monitor Your Diet: Keep a food diary noting any correlated symptoms to help identify triggers and communicate this with a specialist.
- Consult a Dermatologist: Specifically discuss the possibility of psoriasis or other skin conditions. Ask for further allergy testing if appropriate.
- Review Vitamin D Protocol: Seek an evaluation of your vitamin D absorption issues to explore more effective supplementation methods.
- Symptom Tracker: Maintain a daily record of your symptoms, medication, and dietary intake to share with healthcare professionals for more tailored management.
It's great that you reached out for insights into your situation. Remember, managing chronic conditions often takes time and a holistic approach, so stay persistent in seeking the support you need. Please feel free to ask more questions or clarify any topic!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - Urea: 1.80 mmol/L (normal) - Creatinine: 33.4 μmol/L (normal) - **ALT: >1000 IU/mL** (EXTREMELY HIGH - severe liver dysfunction) --- ## FOLLOW-UP IMAGING (December 16, 2025 - 5.5 Months Old) ### Liver Ultrasound: **RESULTS:** - Right lobe: 64 mm, left lobe: 43 mm - Liver capsule appears irregular and vague - **Parenchyma: heterogeneous, showing 7 hypo-isoechoic nodules** (sizes range from 11.5×10.7 mm to 17.6×15.4 mm) - Capsule features uneven contours - Blood flow noted during Doppler examination - No dilation in intrahepatic bile ducts - **Portal vein: 3.9 mm** (decreased from 6.1 mm - indicating improvement) - Common bile duct: 1.4 mm - Gallbladder: measures 43.7×9.2 mm (pear-shaped, wall thickness 2.0 mm, homogeneous, free of stones) **ULTRASOUND ASSESSMENT:** "Presence of liver volumetric formations (specifically liver hemangiomas)." --- ## LATEST MSCT (February 6, 2026 - 7 Months Old) ### MSCT with 3-Phase Contrast: **FINDINGS:** - Liver remains normal in size, but shows heterogeneous structure with uneven contrast enhancement - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.