The skin of the lower leg region is very susceptible to various inflammatory conditions due to poor vascularization and very fragile innervation. Different metabolic, infectious, and hypersensitivity reactions often affect this region. Here are some of the most common inflammatory skin changes on the lower legs, along with a short explanation of each of them.
Scabies is an infection, or more precisely, an infestation, caused by a mite called Sarcoptes scabiei. It can be recognized by lots of small, red, very itchy dots on the surface of the skin, often covered by scratch marks. Scabies most commonly affects the intertriginous regions (areas with increased moisture, like between the fingers and toes), but the infection can spread to any part of the skin.
In general, scabies is treated very easily, as there are both topical and systemic drugs which are very efficient. However, some patients report recurrent scabies, despite aggressive and repeated treatment, but the most common cause of this phenomenon is autoinfection. Scabies can remain alive in the clothes and sheets up to three days, so all the fabric needs to be either washed, or put away for that period.
Diabetes mellitus contributes to a condition called peripheral neuropathy, which causes autonomic and vegetative disorders, usually appearing on the lower legs first. These changes include thin and inflamed skin with reduced muscle mass (atrophy) and gradual loss of sensibility. These changes are usually not painful. If left untreated, diabetes can cause severe damage to many different organs, such as the kidneys, eyes, and blood vessels in the entire body.
Allergic reactions to food ingredients, drugs, fabric, or any other substance can cause skin inflammation on the lower legs. These inflamed areas usually appear very shortly after making contact with the antigen and their duration depends on the presence of the antigen and proper treatment. They are very itchy and sometimes joined with swelling. The treatment includes removing the antigen first, and antihistamine drugs if necessary. Corticosteroid drugs are prescribed only if the swelling is present or the inflammation is very pronounced.
There are several different types of vasculitis, and one of the most common is Henoch-Schonlein Purpura. It is a disorder of the small blood vessels, causing frequent blood effusion. Although this disorder affects joints, kidneys, and other organs, the changes are also visible on the surface of the skin of the lower legs. They are usually in the form of wide, reddish plaques. This vasculitis can affect persons of all ages, but it is most commonly seen in children. Luckily, this disorder disappears by adolescence in most cases.
The skin of the lower legs can be affected by local and systemic infections. Local infections of the skin are usually caused by bacteria (Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeruginosa), and fungi (Candida albicans). In any case, poor hygiene or microinjuries of the skin are responsible for these infections. Systemic infection by meningococcus are not very common, but they are very serious and can be recognized by skin changes on lower legs. They are usually expressed in the form of red plaques similar to those in vasculitis, and sometimes joined with bleeding. A systemic meningococcal infection requires intensive antibiotic and supportive treatment.
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