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Jump to Key Points This week in medical subreddits: A rash with crusts that moved, a young runner whose leg goes numb at the 20-minute mark, and a wave of perimenopause patients requesting transdermal estrogen.
A Rash, or Something More?
r/FamilyMedicine · u/FieldsAButta · September 28, 2026
An intensely itchy rash of papules and vesicles that began on the feet and ankles and kept spreading upward, with new lesions appearing daily, brought a patient into their family medicine clinic. The patient had assumed the spots were mosquito bites after time outdoors. On closer inspection, a clinician found that what looked like hemorrhagic crusts “appeared to be moving.” Lifting several off with tape and examining them under a microscope revealed dozens of larval ticks, which the clinician suspected were lone star ticks. The clinician posted that larval tick bites are unlikely to transmit disease, with the exception of alpha-gal syndrome, but can cause hypersensitivity reactions and are often mistaken for chigger bites.
The poster asked, “Has anyone else run into this in practice?” Their literature searches turned up little, and they found nothing on UpToDate.
- Larval tick bites can cause intense pruritic papules/vesicles; often mistaken for chigger bites.
- Tape removal + microscopy can reveal larvae when crusts seem “moving.”
- Larval ticks unlikely to transmit disease; alpha-gal syndrome remains exception.
- Species ID before nymphal stage is difficult; parasitology input may change identification.
- Reproducible exertional unilateral numbness/weakness has vascular, neurogenic, and compartment differentials.
Some commenters expressed horror, like u/Go-outside1 who wrote, “A tick bomb that made it into the clinic…on your patient.” Commenter u/SueBeee, who identified as a parasitologist, offered a different identification. They thought the ticks were probably brown dog tick (Rhipicephalus species) larvae rather than lone star ticks, writing, “The mouthparts don’t match lone star tick.”
The exchange illustrates a reference gap the poster raised: Few sources help identify ticks before the nymphal stage, and a commenter with parasitology expertise reached a different species call from the same photo.
Join the Conversation ▸ Interesting Case
A Runner’s Leg Goes Numb at the 20-Minute Mark
r/FamilyMedicine · u/Flipflops1999 · October 3, 2026
A clinician described a 27-year-old man with no significant medical history who reliably develops numbness in the left leg below the knee, followed by progressive weakness, about 20 minutes into a run. At its worst, the patient described it as essentially complete paralysis of the lower leg, as if his “knee is slipping.” The episodes are painless, resolve within 5-7 minutes of rest, and have not occurred in the right leg or at rest. The poster asked, “Would you approach this primarily as a vascular, neurologic, or musculoskeletal/compartment-related issue?”
Commenter u/rolltideandstuff suggested checking ankle-brachial indexes (ABIs) for completeness but wrote that “this patient needs exertional compartment pressure testing.” Commenter u/MRapp86, who identified as an orthopedist and former distance runner, leaned toward a sciatic cause, recalling that a tight piriformis once caused foot drop late in their own runs. They reasoned that “Without pain it isn’t compartment syndrome or any sort of vascular occlusion,” doubted that electromyography would show anything given the exertion-only pattern, and suggested starting with physical therapy for the low back and piriformis stretching.
The two answers split on whether the absence of pain rules out a compartment or vascular cause. Other comments suggested potential diagnoses of peroneal artery entrapment syndrome and neurogenic claudication from lumbar pathology. The thread underscores how one reproducible symptom can support several competing explanations.
Join the Conversation ▸ 27M with reproducible unilateral leg numbness and weakness after ~20 minutes of running — thoughts?
Perimenopause Patients Are Asking for Transdermal Estrogen
r/FamilyMedicine · u/BS_54_ · September 29, 2026
A clinician reported seeing more and more women in their forties requesting transdermal estrogen with oral progesterone for perimenopause symptoms. The poster asked whether the regimen is reasonable for a 43-year-old with fatigue, hot flashes, itchy ears, and low libido, and whether it provides contraception at low doses. Several of these patients had tried combined oral contraceptives and stopped. The poster wanted to “gauge the room and see what y’all were doing.”
Commenter u/Born_Tale_2337, who described being in healthcare and in their late forties with perimenopause symptoms, attributed part of the surge to women no longer putting up with symptoms and to the recent removal of the boxed warning on hormone replacement therapy (HRT), noting ongoing estrogen patch shortages. They advised ferritin, vitamin B12, and vitamin D checks and cautioned against routine hormone-level testing, writing, “Work with these women. Walk them through the process of ruling other causes out.”
Commenter u/AmazingArugula4441 confirmed that HRT does not provide birth control and recommended a levonorgestrel intrauterine device plus transdermal estrogen for patients who still have periods, while acknowledging that insertion can be painful. They urged clinicians to rule out sleep apnea and thyroid issues, as well. They wrote that there is “a lot more that goes into deciding to start HRT” and recommended The Curbsiders’ menopause episodes as a useful refresher.
The replies converged on treating the request as a prompt for a workup rather than a yes-or-no prescribing decision, with contraception and endometrial protection settled separately from symptom relief.
Join the Conversation ▸ Transdermal estrogen
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
