Tuesday 20 February 2018

Swollen ankles and irritated skin folds

Ask the GP...

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

Advice from our GP on swollen ankles and irrtation in skinfold.

Question: I have noticed that my ankles swell a lot lately. They seem to be okay in the morning, but as the day goes on, they become more swollen so that by the evening, I can't really see my ankles at all. 

Dr Nina replies: Oedema is a condition where fluid gathers outside the normal blood vessels of the body. It is most obvious when it occurs in the ankles and legs but it can occur in other areas of the body. Oedema may reflect total body fluid overload. It is quite significant if associated with whole body weight gain.

It is important to differentiate oedema from ankle swelling due to subcutaneous fat. If fluid is present there will be an indent left behind if you apply pressure to the skin. This slowly reduces versus the simple bounce back that occurs after pressing on fatty tissue. There are many causes of oedema.

A simple injury can lead to quite dramatic oedema which often occurs quite quickly. There may be pain, bruising and redness of the area too. An ankle sprain is a common cause of this kind of swelling. This is isolated to the area of injury and goes away as healing occurs. Applying ice and elevating the limb may help reduce this.

A clot in the lower leg may also cause swelling of one leg or ankle. This may be more common after surgery or prolonged periods of rest, such as long journeys or illness. There may be pain on the affected side, along with tenderness, redness and firmness of the calf concerned. This warrants urgent medical review as a clot in the leg can travel to the lung causing a life-threatening pulmonary embolus.

An infected bite or cut may also lead to swelling on the affected side. The skin may be red, tender and there may be a slight pimple or cut nearby. Antibiotic tablets may be required and steroid creams may reduce swelling and irritation.

Inflammation, a cyst or growth occurring in the pelvis can be an easily missed cause of lower leg swelling. If your clothes feel tighter or you have abdominal pain or constipation, an ultrasound or further assessment is required.

Varicose veins are a common cause of lower leg swelling. This may affect one or both legs, depending on the extent of the veins involved. Ankle swelling may disappear at night, but during the day, gravity plays its role and fluid gathers towards the ankles as the day goes on. There are many effective surgical options for varicose veins, or for those for whom surgery isn't an option, support socks and tights applied first thing in the morning may help.

Swelling of both legs together points to a more central cause. Heart failure can lead to fluid retention and ankle swelling may be a sign of this. If your ankle swelling is associated with fatigue, lack of appetite, shortness of breath, chest pain or palpitations, you should seek medical advice.

Diseases of the kidney, liver and thyroid may also lead to ankle swelling which can be quite dramatic.

Finally, many medications can cause ankle swelling. These include anti-inflammatory painkillers, hormonal medication, such as the contraceptive pill, certain blood pressure or heart medications, some antidepressants, steroids and diabetic medication.

Question: I have a rash in my groin area that keeps coming back. It can be very itchy and uncomfortable. I thought it was perhaps the underwear I was wearing so I changed the type, but it hasn't helped. What is causing this and what can I do?

Dr Nina replies: Intertrigo is the term used to describe a rash that occurs in a skinfold. Common areas include the groin, buttock crease, neck, arm pits, under the breasts or in folds of protruding skin. It occurs most commonly in those who are overweight, who have diabetes, who sweat a lot, or it can be related to poor skin hygiene.

The skin is initially red and inflamed and may be itchy, stinging or burning. As inflammation progresses, the skin can become boggy and macerated and may fissure and ooze. This inflamed skin provides the perfect environment for infection to set in.

Intertrigo occurs for a number of reasons. The skin in skinfolds has a relatively higher surface temperature than other areas. Sweat cannot evaporate from skin folds.

Friction of skin in these areas causes chafing and irritation.

There are three main causes of infected intertrigo. Thrush causes skin that is red and inflamed with whitish patches. It tends to come on quickly and the skin may feel itchy and wet. Erythrasma causes pale brownish patches that may not cause any symptoms at all. Tinea is a fungal infection that comes on gradually over weeks or months. They may have a plaque-like appearance and there may be scaling and peeling.

It is worth visiting your GP with this. Prescription antibiotic, anti-fungal or steroid creams may help.

In order to prevent intertrigo reoccurring, keep the skin folds, clean, cool and dry. Wear loose cotton clothes. Apply a gentle antiperspirant to reduce sweating and consider changing clothes frequently to keep skin dry.

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