### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have had cold hands all my life, and in general have been always on the cold side. I have had had back and sciatic related leg/foot pain issues for the last four years involving L4 region. I have been diagnosed with epilepsy 12 plus years ago - coinciding, time wise, with a stressful marital divorce. I question stress and or sleep apnea as a trigger, since the University of Cincinnati is studying a possible link to the apnea and epilepsy. I have been totally controlled for over 10 years with dilantin and Keppra (generic) and would love to get off medication, if not needed. Recently, I was diagnosed with mild sleep apnea and wear an oral appliance which is working very well. Now recently, I am experiencing an increase in numbness and tingling in my hands and feet. Also, about six/seven years ago, I started having a series of skin eruptions - small, itchy, and crusty - occurring anywhere on my body, mostly on my trunk. They are more intense initially then subside yet leaving a small, permanent and crusty eruption which may flare up on occasions. A dermatologist diagnosed this as Grover s disease. My last blood tests were mostly normal except for a high good cholesterol reading, which my M.D. stated out weighed the overall high cholesterol reading. First, what is your opinion on the skin eruptions, and secondly, how might my other issues be perceived. My blood sugar levels have been fine over the years, yet I do wonder about type two diabetes particularly with the tingling extremities. I also wonder about a possible thyroid involvement, since the blood tests have revealed a borderline reading. No history in the family of either issue. My back issue has improved recently - curiously, as the tingling became more apparent. Connection? With the present state of hurry-up office visits, my questions are superfluously addressed. - frustration. Thank you for your opinion!

### output:

Hello, Regarding the skin eruptions, the diagnosis of Grover disease is likely, it has the characteristics which you mention.  However, I am afraid that it is difficult to express a decisive opinion without being able to examine them or at least some photos of them. As for the tingling and numbness symptoms they can be a manifestation of peripheral neuropathy.  It is unlikely to be due to diabetes as diabetic peripheral neuropathy generally occurs when there is long-standing confirmed diabetes, not as an initial sign.  Thyroid disorders may cause it too, but with a borderline result its unlikely.  An electrolyte panel is advised if not already done as alterations in magnesium, calcium or potassium levels may also be a cause.  If no metabolic cause is found I would advise nerve conduction studies to check for nerve damage.  If all is normal then peripheral neuropathy is less likely and anxiety should be considered as a possible cause. Hope I have answered your query. Let me know if I can assist you further. Take care Chat Doctor. 