I've got a mystery disorder- Pin pricks, ashy skin! Help!
November 26, 2011 10:15 AM   Subscribe

YANAD, but my doctor is stumped. Symptoms: Painful prickly needles, ashy skin, angry red hives. Appears at times of stress. More inside!

So I've had this, uh, "disorder" twice in my life. The first was right after my grandfather died when I was about 15 and the second is right now, 12 years later. Both are times of enormous stress. I would also get these symptoms intermittently through the 12 years (Like, maybe once a month, briefly?), but lately it's been a daily occurrence.

Here's what happens: I end up in a situation where I might start sweating due to a social pressure (i.e., not exercise. Maybe an embarrassment or impatience) and all of a sudden I get a feeling like I'm being pricked by hundreds of tiny, hot needles. On the underside of my arms and chest I get dozens of tiny, angry red hives. I get shaky. If I sit down for a few and cool off (I often feel very hot during these episodes, enough so that if I'm at home I'll often strip down) the hives will subside, but I'm often left with patches of flaky, ashy, dry skin on my arms and hands. I also generally feel enormously relieved afterwards, like I just turned in a big paper or got some good news.

If I had to describe the sensation, it feels like I'm trying to sweat and I can't. I can also kind of "feel" it come on, it's like someone wraps me in a big blanket. Because of the enormous stress I've put myself under (I'm moving, changing careers, experiencing some relationship issues and trying to get into grad school. At the same time.), I originally assumed I'd simply worked myself into some kind of panic attack. But it seems like more physical than that? On the other hand, 95% of these episodes are triggered by emotional events- Distress, nervousness etc.

Anyhow, I don't have insurance and the doctor at the clinic seem stumped, so I figured I'd turn to the wisdom of the crowds and see if anyone else had a guess or a suggestion.
posted by GilloD to Health & Fitness (10 answers total) 3 users marked this as a favorite
I'm not an MD and I'm making a pretty wild guess here, but the combination of neuropathy and hives reminded me of Fabry's disease. However, I think the "hives" in Fabry's are small and red and well defined.

Another alternative is Stress hives.
posted by sciencegeek at 10:28 AM on November 26, 2011

This could be a wild guess, but I got something similar for years which turned out to be food triggered. In stressful situations I would get hives all over my torso and legs, swelling, and insane amounts of itching for hours on end. Tried everything my doctor could think of, including testing for allergies, etc. After three years of mystery, turns out it was a combination of stressful situations and a wheat/egg allergy. The stress triggered the existing allergy into something crazy in those kinds of situations, triggering the hives and itching. I've since cut wheat and eggs out of my diet (same stress levels as before) and its been night and day. I haven't seen any hives since I cut out the wheat. Maybe try investigating if its a food/environmental trigger?
posted by snowysoul at 10:57 AM on November 26, 2011

Weird, it seems like one of those mind and body interact with each other in different people in different ways kinds of things. You probably won't have much luck addressing it from the physical side, which an MD would have been able to help with, but from your description it sounds like there are predictable triggers and some consistent warning signs you can use to help you address it from the psychological side.

I get psychosomatic symptoms too whenever I get under stupid amounts of stress, I also made the poor life choice that is grad school. In me, when I get stressed enough to go to bed anxious, I'll wake up, take a shower, brush my teeth and then start coughing and burping. My father mentioned to me that it happens in him in exactly the same way when he saw me doing it, which is weird. It was entirely psychosomatic, which doesn't mean not real, but does mean addressable with work.

Since you have some warning, try changing the situation that is triggering it the moment you know it is coming on. Learning meditation techniques will also help you look inward enough to tackle it head on if this doesn't work consistently. Figuring out how to be mindful of your breathing and heartbeat is a non-trivially difficult thing to do but will help give you practice in finding the more subtle triggers for what is happening to you. Learning how to manipulate your heart rate up and down at will as well as your need for oxygen will also give you practice in controlling that mind-body interaction. It is also just really cool and mind opening in subtle ways. As I learned to be more self aware, and aware of my body, I was able to stop the coughing in its tracks. I still get stupidly stressed, and despite my best efforts still go to bed anxious occasionally, but have figured out how to defuse it.

As a first step, I'd get into comfortable clothes or naked, put on music that is relaxing but not distracting to you, sit on something comfy, assume a proper posture,* close your eyes and breathe. Focus on your breathing, be totally conscious about it, and just let your chest go up and down. Slowly try to breathe deeper and slower and more intentionally. Then when you can hear your heart rate, listen it, your body should be quiet enough that it reverberates through you, if it isn't then breathe some more and silence the muscles not actively breathing. Feel your heart beat as you breathe. Then try to imagine it beating slower than it is. Slow your mind, slow your breathing, silence the music from the inside, stop everything else, and breathe while listening.

When you can successfully slow your heart rate, which is hard and will take practice, I'll bet you will be in a better position to stop the hives. There isn't anything in the symptoms you describe that the brain isn't capable of producing on its own without damage or external stimuli. From your description of the triggers its sounds totally psychosomatic, though don't rule out other complicating factors that might help trigger you like food sensitivities/allergies or something else you haven't noticed yet.

*An easy shortcut to this is to simply straighten your spine as much as possible and then point your nipples at the sky, its weird but it works.
posted by Blasdelb at 11:05 AM on November 26, 2011

My vote is for cholinergic urticaria.
posted by candasartan at 11:13 AM on November 26, 2011

posted by candasartan at 11:17 AM on November 26, 2011

Prickly heat.

Symptoms of miliaria include small red rashes, called papules, which may itch or more often cause an intense 'pins-and-needles' prickling sensation.[citation needed] These may simultaneously occur at a number of areas on a sufferer's body, the most common including the face, neck, under the breasts and under the scrotum. Other areas include skin folds, areas of the body that may rub against clothing, such as the back, chest, and stomach, etc.
posted by the young rope-rider at 11:33 AM on November 26, 2011

(The thing that makes me think prickly heat is that you say you aren't sweating, but skin rashes are notoriously difficult to diagnose so...)
posted by the young rope-rider at 12:20 PM on November 26, 2011

Voting for allergies as well. Stress may be the trigger, but the allergen might be what makes you susceptible. Ask around in your family...does anyone else get this, does anyone else have food or other kinds of allergies?

Went through several years of weird allergy-caused illnesses w/ my husband...he turned out to have thyroid issues plus gluten, egg, dairy, and soy allergies. Life is much better for him now that he's cut those out of his life. Hopefully you will not have to make changes that drastic.
posted by emjaybee at 1:29 PM on November 26, 2011

I agree with both the young rope-rider and emjaybee. I used to get prickly heat quite a lot when I was a young kid and it felt exactly like that -- pure misery. And although I don't have any food allergies that I'm aware of, certain pollens and penicillin can make me break out in allergic hives. Investigate those triggers first if you can. You have my sympathies. Feel better soon.
posted by LuckySeven~ at 1:51 PM on November 26, 2011

I thought my doctor was being kind of vague and hand-wavy when he told me my skin rash was caused by stress. Then I read this blog post by a dermatologist which explains the causal mechanism involved:
Studies have shown that chronically elevated cortisol levels lead to a decrease in your skin’s natural lipid or fat barrier. These lipids are essential to keep your skin protected and to prevent it from drying out. Without a layer of lipids on your skin, it is no longer waterproof, and irritating soap and water from hand washing or bathing is able to penetrate the skin, causing inflammation. Without a protective lipid layer, the moisture in your skin evaporates easily, leaving the skin dehydrated. This dry, flaky skin is even more susceptible to damage or irritation.

Elevated cortisol also impairs your skin’s natural defense system. Your skin is constantly producing specialized protiens that act as bacterialcides, killing off unwanted intruders on your skin. Stress can lead to a drop in production of these first line defense proteins, leaving your skin vulnerable.

The consequences of this loss of lipids and decreased defenses is that rashes such as eczema and psoriasis can be triggered or can flare, turning a minor irritation into a full blown outbreak.
Okay, it's not exactly a peer-reviewed journal, but a cursory Google Scholar search seems to concur. At any rate, this explanation makes sense to me in a way that "oh, it's just stress" really didn't. And when my stress went away, so did the rash. Hope you feel better soon.
posted by embrangled at 4:01 AM on November 27, 2011

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