What Causes Dark Marks on the Back of My Hands and Arms? – Answers to Your Health Questions

DRY eyes might be bothering you more this season, thanks to the summer heat, dry air and air conditioning.

It happens when the tear film breaks down and can get very uncomfortable, but it rarely requires a hospital trip.

Dr Zoe gives you health advice This week a reader is concerned about dark markings on the back of their hands Credit: Unknown

Data shows there are around 780,000 visits to A&E each year for conditions like dry eyes and conjunctivitis.

But almost half could be avoided if everyone had equal access to high street optometrists.

While a postcode lottery leaves many stuck, I would advise anyone to try and see a high-street optician, who can diagnose and treat you.

If cost is a barrier, check if you can get free eye tests – under-16s, over-60s and people with are among those who are eligible.

You only need an eye test every two years, the NHS says, unless you need to visit for symptoms.

Pharmacists can advise on over-the-counter eye drops or gels.

Here’s a selection of readers’ questions this week . . . 

Q) WHY do I get very dark markings on the back of my hands and up my arms?

Some purplish blemishes are starting to appear on my legs as well. My skin tears easily on my hands and also bleeds badly.

A) Thank you for sending the photo, from which I can see the marks are very visible.

You don’t say your age, but one likely explanation for purple marks on the backs of the hands and arms is actinic purpura, sometimes called senile purpura.

It is a common condition, especially with age and long-term sun exposure.

Over time, the skin on the hands and forearms becomes thinner and more fragile.

The tiny blood vessels underneath can break after minor knocks – sometimes so minor that you don’t even remember them.

This can lead to dark purple bruising, fragile skin and tears that can be painful, take longer to heal and be hard to manage.

It often affects the backs of the hands and arms first, but similar bruising can appear on the legs, too.

However, because you say the marks are spreading and your skin bleeds for ages, I would advise booking in for a review.

Your doctor might want to check your medication list – especially aspirin, clopidogrel, warfarin, apixaban, rivaroxaban, steroid tablets or steroid creams, as these can make bruising or skin thinning worse.

They may also consider carrying out blood tests, including a full blood count, platelets, liver function and clotting tests, particularly if the bruising is increasing or appearing without injury.

To protect the skin, moisturise regularly, wear gloves for or housework, consider tops with long sleeves and treat skin tears promptly with gentle cleaning and a non-stick dressing.

Seek urgent medical advice if you start developing nosebleeds, blood in your urine or poo, black stools, widespread tiny red or purple spots, very large unexplained bruises or bleeding that will not stop.

Actinic purpura itself is not usually dangerous, but new or worsening bruising should always be checked by a medical professional.

IRON TABLETS ARE MAKING MY WIFE ILL

One reader wants to know if there is an alternative to iron tablets Credit: Olga Pankova

MY wife has been put on iron tablets (ferrous fumarate 210mg) because she is anaemic, but they make her sick.

Is there an alternative, or a supplement she could take? She is a type 2 diabetic, for which she injects Trulicity weekly.

At the hospital, she had a capsule camera put in her body to look for bleeds, but they found none.

It is completely reasonable to ask about alternatives if the tablets make her feel sick. The priority is always to understand why someone is anaemic.

It sounds as though she has already had some bowel investigations, including a capsule camera, which is reassuring.

But if anaemia keeps returning, her GP may still want to review other causes, including diet, absorption problems such as coeliac disease, inflammation, kidney disease and whether any medicines could contribute.

Ferrous fumarate 210mg is a commonly prescribed iron tablet, but nausea, stomach pain, constipation, diarrhoea and vomiting can happen.

Taking it with food may make it easier to tolerate – although slightly less iron may be absorbed into the body.

Some people do better with a lower dose, taking iron on alternate days, or switching to a different preparation such as ferrous gluconate or liquid iron, so it is worth asking a pharmacist or your GP which option best fits her blood results.

Over-the-counter “gentle iron” supplements or iron sprays may be easier to tolerate, but they may not be strong enough to correct significant anaemia.

Diabetes and Trulicity are also relevant because GLP-1 medicines can cause nausea or upset stomachs.

If she cannot tolerate any oral iron, there are other options – including iron given by infusion – but this would usually be considered further down the line.

She shouldn’t simply struggle with feeling sick, though. Ask your GP to review the cause, dose and formulation.

CANCER RISK CONCERN

Young women considered at risk of breast cancer are not being detected by the NHS Credit: Guillermo Spelucin

UP to 95 per cent of young women considered at risk of are not being detected by the NHS, analysis suggests.

In England, women at a higher risk of the disease are referred by their GP for further assessment.

This is based on family history, and criteria set by the National Institute for Health and Care Excellence (NICE).

But, University of Cambridge researchers who analysed data from 1,258 women under 50, found that NICE criteria is missing up to 95 per cent of at-risk women who go on to develop the disease within ten years.

The experts used a new tool, called Boadicea, which identified eight times as many women.

It led to 26.5 per cent being classed as high-risk and referred for assessment, including almost 35 per cent of women under 50 who develop it within a decade.

Meanwhile, the current NICE criteria would result in 1.4 per cent women being referred for tests, including 4.4 per cent who go on to develop breast cancer.

Researcher Dr Juliet Usher-Smith said: “We need to get better at identifying women at the highest risk of breast cancer so that we can intervene early, when there are more options for preventing their disease.

“It’s time to look again at these criteria in the light of our findings.”

But NICE said “current evidence does not warrant a change to our existing familial breast cancer guideline at this time”.

In the UK, breast cancer is one of the leading causes of death in women under the age of 50.