How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • Go back-and-forth until satisfied
    Rate the answer you receive.
Ask Dr. Mark Your Own Question
Dr. Mark
Dr. Mark, Doctor (other than dermatologist)
Category: Dermatology
Satisfied Customers: 7893
Experience:  30 years of primary care medicine
19706630
Type Your Dermatology Question Here...
Dr. Mark is online now

I have darkness on my big toe knuckles and want to know if

Customer Question

I have darkness on my big toe knuckles and want to know if it is of concern.
JA: What are all your symptoms? Are you taking any medication?
Customer: The skin is thick and rough on both my big toes just over the joint No medicatins
JA: Got it. Have you seen a dermatologist about this?
Customer: No
JA: Thank you so much for your time. Finally, is there anything else in your medical history you think the Dermatologist should know?
Customer: I have swollen lymph nodes (which have been ultrasounded and come back normal) and a positive ANA titer of 1:360 with a homogenous pattern.
Submitted: 21 days ago.
Category: Dermatology
Expert:  Dr. Mark replied 21 days ago.
Hi. I’m Dr. Mark. I’m a board certified physician and happy to assist you. Can you take pictures of the toes and upload them? Any pain in the toes? How long have the toes been dark?
Expert:  Dr. Mark replied 21 days ago.
You might get a phone call request. Just ignore it as it’s sent out automatically.
Customer: replied 21 days ago.
Hello, I have no pain - it just feels like thick skin on the joints. They have been dark for at least a month or so.
Customer: replied 21 days ago.
File attached (2V44S2S)
Customer: replied 21 days ago.
When I bend my toe joint the coloration goes away, and when I push down on my toe, the discoloration is more noticeable and takes a while to go back to normal (feels like tight skin)
Customer: replied 21 days ago.
Please ignore the red second toe in one of the pictures, that was a separate injury
Customer: replied 21 days ago.
Please let me know if you would like other pictures - these aren't that good.
Expert:  Dr. Mark replied 21 days ago.
The discoloration doesn’t look that dark. There are a variety of conditions that cause pigmented skin. They are associated with autoimmune disease. Occasionally with diabetes or prediabetes. Have you had a recent blood sugar done?
Customer: replied 21 days ago.
my blood sugar is normal. What autoimmune diseases could they suggest? As I mentioned, I have anti-nucleated antibodies, with a homogenous pattern but was tested for lupus and was negative.
Customer: replied 21 days ago.
Please note I have no discoloration on my hands and the discoloration does not appear to vary with temperature change.
Customer: replied 21 days ago.
I have been concerned about Scleroderma, is that one of the autoimmune diseases you would consider?
Expert:  Dr. Mark replied 21 days ago.
A positive homogeneous ANA is not specific for any autoimmune disease. It can be positive in lupus and in scleroderma. I’m not concerned per se about the toe color. It’s not a vascular problem or vasculitis. It may indicate early autoimmune disease which requires monitoring. Have you seen a rheumatologist?
Customer: replied 21 days ago.
No I haven't. Would you recommend that at this stage?
Expert:  Dr. Mark replied 21 days ago.
I would recommend it. The elevated ANA is not specific nor diagnostic. Something may or may not develop. That’s why I’d get a rheumatologist to evaluate you.
Customer: replied 21 days ago.
Okay, thank you.
Customer: replied 21 days ago.
the toe thing could be a further sign warranting a rheumatologist's evaluation?
Expert:  Dr. Mark replied 21 days ago.
Skin discoloration is seen with autoimmune diseases. It’s also seen secondary to some medication. Are you in meds? Poly cystic ovarian syndrome also has some skin discoloration.
Customer: replied 21 days ago.
I take birth control (for several years) and recently started taking sertraline for health related anxiety
Expert:  Dr. Mark replied 21 days ago.
Estrogens as in bcp can cause this discoloration.
Customer: replied 21 days ago.
But I have been on it for many years, would it create this issue all of a sudden?
Expert:  Dr. Mark replied 21 days ago.
It’s possible. I found a nice review article on this topic for you.
Expert:  Dr. Mark replied 21 days ago.
https://www.healthline.com/health/symptom/what-causes-dark-knuckles-and-how-can-you-treat-them
Customer: replied 21 days ago.
Okay thank you.
Customer: replied 21 days ago.
If an autoimmune disease how quickly do these things tend to emerge? Should I seek immediate consultation with a rheumatologist?
Expert:  Dr. Mark replied 21 days ago.
There’s no urgency. Autoimmune diseases can develop very gradually as in many years.
Customer: replied 21 days ago.
Okay, thank you. I think that is all my questions.
Expert:  Dr. Mark replied 21 days ago.
You’re welcome. Take care.