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At the heart of general practice since 1960

A case of the post-Christmas blues

The last straggler on New Year's Eve was a middle-aged lady, a temporary resident with an unusual history.

She had caused alarm on Christmas Day with a strange cyanotic discolouration of her hands. Relatives had wanted to call a doctor but it gradually subsided. But she then noticed her legs had changed colour. Having a past history of DVT, she was concerned. Examination confirmed her upper legs to be cellulitic and bluish-grey in colour.

I discounted any circulatory problem, but was contemplating checking serum rhubarbs for something unusual… when my recently renewed Sherlock instinct (thank you Robert Downey Jr and Jude Law) kicked in.

‘Are those new trousers?'

I quizzed.

‘Yes,' bemused.

‘And have you been wearing them since Christmas Day?'

‘Yes,' sheepishly.

‘And have they been washed yet?'

‘No,' getting embarrassed.

‘Aha! My dear patient, you are suffering from a rare condition, Unlaunderus Trouseritis, or dye seepage, initially to the hands...' patient now anxiously rubbing thighs ‘... and then to the legs. I shall prove this hypothesis by screwing said material up into a ball and voila! Blue hand.'

My patient seemed a little less than grateful.

‘And why just my thighs, not buttocks, calves and so on?'

‘Elementary, my dear. Giant pants, big thighs, area of closest friction.'

And then, being the patient-centred GP that I am, and to deflect from any perceived judgment of personal hygiene, I disclosed my own story of red sandals that stained my feet for weeks no matter how many times I washed them. I promised to write this case up to help other patients in future, and we parted wishing each other a happy new year.

From Dr Vivien Knox, Westerham, Kent

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