--there could be a vascular component to it; are there any positional differences in the onset or severity of symptoms?

Neuropathy of the small autonomic fibers can cause trophic changes along these lines; people with small fiber neuropathy often have autonomic symptoms that can include disturbances in blood flow, blood pressure, sweat response, and the like.

Also, a number of the vascular/connective tissue autoimmune conditions associated with anti-nuclear antibodies can produce such discolorations, and they also often produce neuropathy:

http://neuromuscular.wustl.edu/antib...html#vascassoc

I would think you'd need a more thorough work-up at a major center or teaching hospital

I agree, I just can't figure out how to find the right doctor here, and what type? .... heck, I live 5 blocks from UAB in Birmingham Al.

I'm up for a vacation since I decided not to go to Puerta Vallarta so if someone could suggest some really good hospitals (in some fun cities maybe) to look at that would be great!

if I find a teaching hospital, what type of contact do i look for at the hospital if my problem concerns PN, Skin Dissorder, Pain?

Do i need to go through this entire, each doctor at a time? or should i start with like the skin, and move on ...

at 50..... this is where I want my momma to do all the work!