Polyneuropathy (feet, legs, fingertips, hips, abdomen) and Small Red Dots
 

I'm posting this on behalf of someone I know who's been complaining about neuropathy symptoms for about a year. There seems to be neuropathy at various places: toes, feet, legs, thighs, hips, abdomen, etc. Also, there seem to be very tiny red dots that appear on his feet (there often disappear and reappear). Also, his feet are often cold and feel stinging type of pain (small fiber neuropathy?).

He works in a factory and stands most of the time. Before the symptoms appeared, he worked 10+ hours and his legs often became tired. He's not working such long hours anymore, though. He's 23 and not diabetic (FBG of 80) and tested ANA negative, so apparently no autoimmune diseases that could cause neuropathy. But he does have some inflammation (ESR=6, high tryglycerides) and his WBCs and platelets, though normal, are in the low-normal range you typically see among those who suffer from autoimmunity like lupus, RA, hashimoto's, etc.

Related to Vitamin B deficiency perhaps? I don't think it's petechia since that tends to be a lot worse than the red dots he has. No itching or pain at all. The small red dots appear on both feet. See enclosed. Any ideas?

Thanks for the photo... I'll have to think about this. Give me a day or two?

Does this itch? Burn? Are these spots only on the feet?
How long do they last? Has he been to a foot doctor?

Do they go away when he lies down? Do they go up the leg at all?

Does he smoke?

My first impression is that these are bites of some kind.

Does he have a dog? Flea bites on humans are often small, and don't always itch. Fleas will jump up from the floor, and perhaps bite only the foot area and ankles. If a dog sleeps in the bed, it may leave fleas also.

I'll continue to search... but in the meantime I'd put some Hydrocortisone cream on them, and see if they fade. If they do
then that is an inflammatory reaction.

Some people use too much soap in the wash, and socks may have a residue left after rinsing. When worn on the feet, the moisture from perspiration will dissolve the residue and leave little burns. Using a milder soap like Tide unscented in the white bottle, and doing a second rinse, may help.

The cluster of spots along the side of the foot resembles insect bites like fleas ...they will move along and bite again and again, but animal fleas don't like people so they don't feed a long time or make big bites.

There is also a condition called scabies...tiny bites like this.
But they tend to itch like mad. Not all scabies mite bites get inflamed. Some people are more allergic than others in this regard.
Chiggers are another possibility...
http://www.google.com/search?q=flea+...%3B2403%3B1899

But as a rule they itch alot. You can pick up chiggers on the legs and ankles, and they move to where the skin is softest to bite.
Walking thru leaves, or getting sand in shoes may bring them.
People vary in response to chigger bites....some get big welts and others not. They fade within a week or so.

No, they don't itch or burn at all. Only on the feet and not above ankles usually; they sometimes disappear and reappear. He believes they are connected to his neuropathy. No dog. He's been to a rheumy who's stumped. To a regular doctor who said he hasn't seen anything similar. His main concern is not so much the spots but neuropathy: the electric sensation and sometimes stinging SFN type of painful sensation at various places. I told him to check HbA1c but his doc only ran FBG and it's 80. No to a foot doctor. So I suppose it's not diabetes-related.

Some men wear tube socks that bind the leg with time.
Standing, and some swelling is expectable.

My son had lots of trouble with his socks. They left deep ridges in his legs at the end of the day. He looked around and found relaxed fit ones, or slightly larger ones, and now he has no trouble. He had alot of PN type pain, from the binding in the lower leg. He was not overweight or have big legs either.

Some of those spots appeared to be at the hair follicles and
others not. When the follicles are red, that is called folliculitis, and is a sign of poor skin integrity. Often using flax oil and fish oil will clear it up, as the skin gets better and resists bacteria which tend to enter the tiny cracks that open when nutrients are poor.

When diagnosis is elusive testing with various ointments and watching the response may be helpful. I'd start with HC cream and see if they clear faster. Next I'd try an antifungal like Lamisil. Sometimes sweat glands get blocked and they can turn skin red too. Whatever it is, doesn't look menacing yet.

Red Spots
 

These could be SENILE PURPURA (I love the name).I have them but usually larger, and on my arms mostly. But small ones can appear also. They come and go but are unsightly on arms if they are large like a dime. There is no cure so far.

Hi, I assume they tested him for thyroid disease. His sed rate is low but WNL I believe but it has been a while for me. I hate to even ask this but is he a heavy drinker? Sometimes that can cause PN but I'm assuming you would have told us that.

Suggest he go back to the doctor and ask for a A1C. I can't hurt to make the request. I also have idiopathic and have been told by my doctors you can test negative ANA and still it can be autoimmune. My GP told me the antibodies they do have testing for are only the tip of the iceberg.

He is so young, I hate to hear he has PN. It sounds like you are a good support system for him. Good Luck!

The first thought I had on the red dots was flea bites but they would itch. My mother in law had bites like that once and I think she was told the were mite bites.

A number of the vasculitic/connective tissue autoimmunities--
 

--can have petechiae (small red blood dots) among their symptoms.

A more extensive autoimmune work-up is necessary, probably along the lines of the Latov/Quest article on serological tests for neuropathy:

http://www.questdiagnostics.com/test...ripheralNeurop

http://www.primehealthchannel.com/pe...-petechia.html

His spots are not typical of most petechia IMO. They are not dark enough. Petechiae go thru stages when they fade. If his do not do that, they are probably something else. The pale pink spots are mostly confined to the skin.

I think it is something in his environment doing it. Perhaps his shoes? Are they too tight? I knew a young man who had terrible pain in his feet, from his job. He was a pole climber and wore those spiked shoes, climbing utility poles.

23 is awfully young for PN pain. Unless it is hereditary.

Looking at that photo of this young man's foot, there is a cluster
of angry red spots near the ankle bone. They look similar to chigger bites. If petechiae, that spot might be a compression spot from shoes.
I'd suggest he get more comfortable shoes.