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Diabetic amputee,dialysis,heart attack,holes in groin,black,bleeding,small cysts

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General & Family Physician
Practicing since : 2003
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I care for my father who is a diabetic amputee. He has had numerous medical problems the last year including a perirectal abscess, a fempop bypass, complications from the bypass: CHF, the need for dialysis for three days, mild heart attack, breathing trouble, and an injured back. He has recovered fine but is pretty much immobile due to his back injury and weight gain. While bathing him tonight I noticed 7 holes in his groin area. All are black and bleed easily, they are about 1/4in" XXXXXXX and around. They look to be due to his hairiness and don't seem to be infected at all. I'm thinking they are small cysts that have developed due to his immobility. I cleaned them with antieptic spray and inserted medical packing into them. I know he needs to see the doctor for a proper diagnosis and antibiotic treatment of course, but am I on the right track here?
Posted Tue, 1 May 2012 in Men's Health
Answered by Dr. Deepak Anvekar 16 minutes later
Hello and thanks for the query,

From the description of the lesions, your father seems to have infected ulcers in the groin.

The other possible causes could be stress ulcers or decubitus ulcers ( due to the sleeping posture).

For any condition to be treated, a proper diagnosis is essential, and for this a visual examination of the lesion would be helpful. Hence it would be very helpful to me, to guide you accordingly if you can provide me images illustrating your father's condition.

You can upload images of the lesions in the right side of the query box, which after going through would help me in suggesting you better.

You can also email it to me at YYYY@YYYY with the instruction ATTN: Dr. ANVEKAR in the subject line.

Please do confirm by writing here about the uploading of the photo as to suggest you at the earliest.

I would like to provide you with specific suggestions after going through the photo.

Waiting for your response.

Dr Anvekar.
Above answer was peer-reviewed by
Follow-up: Diabetic amputee,dialysis,heart attack,holes in groin,black,bleeding,small cysts 30 minutes later
I sent an email of a picture to that address with a little more detail.
Answered by Dr. Deepak Anvekar 59 minutes later

Thanks for the images and the additional description which have helped me to arrive at a proper conclusion.

The ulcers described are most probably due to Pseudomonas bacterial infection induced Ecthyma gangrenosum lesions.

Ecthyma gangrenosum (EG) is a well-recognized but uncommon cutaneous infection that usually occurs in diabetic patients who are critically ill, malnourished and immunocompromised and is almost always a sign of pseudomonal sepsis. The characteristic lesions of EG are hemorrhagic pustules or infracted-appearing areas with surrounding erythema that evolve into necrotic ulcers surrounded by erythema.

This condition needs prompt diagnosis and treatment with appropriately selected antibiotics for pseudomonal bacteria. If the lesion fails to respond to antimicrobials, surgical debridement of the spreading, necrotic lesion may be required.

I would suggest you to consult his treating doctors at the earliest and initiate the necessary treatment at the earliest.

I hope this helps to answer your questions effectively.

Wishing a speedy recovery for your father,

Dr Anvekar.

Above answer was peer-reviewed by
Follow-up: Diabetic amputee,dialysis,heart attack,holes in groin,black,bleeding,small cysts 5 hours later
I thought those lesions were 1-15 cm in diameter with a red circle around the legion? I looked up images and the only images that look like them are under "pilonidal sinus" and since they come in twos I thought sinuses came in twos?
Answered by Dr. Deepak Anvekar 40 minutes later
Hello again,

Thanks for the follow up query,

Pilonidal sinuses can arise in the intergluteal cleft (Between the two cheeks of the buttocks). But they are chronic lesions and do not appear within a short period of time. In addition they do not occur in the pubic region, and the side of the scrotum or also they do not present in the form of multiple bleeding ulcers.

In case you are referring to the size of the lesions of Ecthyma gangrenosum being larger, the size does not matter, but the clinical presentation (presence of 7 XXXXXXX ulcer like lesions in the groin), the critical status of a patient and presence of risk factors including diabetes are indicators of them being due to pseudomonal infection and Ecthyma Gangrenosum.

I hope this clears the doubts that you have.


Dr. Anvekar.

Above answer was peer-reviewed by
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