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What it means: __Dermatitis herpetiformis (DH) — clusters of small, ferociously itchy blisters that show up repeatedly in the forearms near the elbows, the knees, the buttocks, the back, or the face or scalp — are a hallmark of celiac disease, or an allergy to gluten. As many as one in four people with celiac disease have DH.
More clues: The rash appears on both sides of the body. Itching and burning are so intense you can hardly quit scratching. People with DH don’t usually have the digestive symptoms of celiac disease, but they’re intolerant of gluten just the same. DH often shows up between ages 30 and 40, and most often in people of northern European heritage.
What to do: Report the rashes to your regular doctor or a doctor who specializes in skin disorders to evaluate and rule out other causes. Blood tests and a biopsy of tissue from the small intestine are used to diagnose DH. A gluten-free diet for life is usually advised to keep symptoms at bay; this includes banishing foods, beverages, and medications that contain wheat, barley, rye, and sometimes oats. Drugs may help control the rashes.
Purpura: What Purple Splotches on Your Skin Might Mean
What it means: What looks a bit like a bruise, is often mistaken for a bruise, but tends to hang around longer because it’s not exactly a bruise? Purpura (from the Latin for “purple”), or leaking blood vessels under the skin. It has several possible causes, ranging from a bleeding disorder to scurvy (vitamin C deficiency). But in adults over age 65, in whom it’s common, the main explanation is thin skin, often made even more fragile by years of sun damage and weakened blood vessels. Then the condition is known by the unfortunate name of senile purpura.
“A substantial excessive intake of aspirin, nonsteroidal anti-inflammatories, vitamin E, or ginkgo biloba, which older adults often take to boost memory, can worsen the condition,” says dermatoligst Newburger. So can blood thinners, such as coumadin, alcohol, and steroids.
More clues: A classic bruise tends to turn black and blue following an injury. With purpura, in contrast, there doesn’t need to be any trauma; the discoloration starts as red and turns purple, persisting longer than a bruise before fading or remaining brownish. The purple skin doesn’t blanch (fade or lose color) when you press it. Purpura can cover large patches of skin or show up as small purple speckles called petechiae. No matter what the size, the purple areas are most common on the forearms, legs, and backs of the hands.
What to do: Extensive or persistent bruises should always be evaluated by a doctor, as should someone who seems to bruise easily. It’s important to rule out underlying causes such as a bleeding disorder.
Pruritis: What Itchiness Without Rash Might Mean
What it means: Feeling itchy in more than one specific spot can have many causes, but when there’s no accompanying visible skin change, it may be pruritis, one of the first symptoms of lymphoma (cancer of the lymph system). In fact, it’s known as the “Hodgkin itch” (the two main types of lymphoma being Hodgkin’s disease and non-Hodgkin’s lymphoma).
More clues: The itchiness is more intense than that caused by ordinary dry skin. It can be felt generally or, most commonly, in the lower legs. Less often, the skin also looks reddish and inflamed. Another common symptom of both Hodgkin’s disease and non-Hodgkin’s lymphoma is swelling of the lymph nodes in the neck, armpit, collarbone, or groin. (Note that lymph nodes can swell because of common infections as well.)
What to do: Report persistent, intense itching to your doctor.
Pallor: What Super-Pale Skin and Blue-Tinged Nails Might Mean
What it means: Severe anemia, a blood disorder, can show up as pasty, paler-than-usual skin on the face and palms. Anemia can be the result of iron deficiency, chronic blood loss from bowel disease, or ulcer disease, among other reasons. Iron-deficient anemia is sometimes seen in people over age 70, who may no longer prepare nutritious meals or have interest in eating them because of depression or other health problems.
More clues: Unlike merely having a pale complexion, the pallor of anemia tends to affect the usually-reddish tissues of the mouth, gums, and lips, too. Look for nail beds to be very pale, almost bluish. Other symptoms include being quick to tire, headaches, dizziness, and shortness of breath.
What to do: Consult a nutritionist or doctor. Over-the-counter or prescription iron supplements usually correct anemia caused by a nutritional deficiency. It helps to eat more iron-rich foods (red meat, egg yolks, dark leafy green vegetables, dried fruit), especially in tandem with vitamin C (as in orange juice) for best iron absorption. Cooking in an iron skillet adds iron, too.