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Have A Red Rimmed Lesion On Back Of Neck. Not Cured By Steroid Ointment. What To Do?

Posted on Thu, 6 Dec 2012

Question: I have a red rimmed lesion on the left side back of my neck with a depressed center that weeps and crusts. This is the second one in the same location in the last 6 months or so. The first one lasted several months and this one is lasting longer. The old one left a scar. I have used antibiotic, anti fungal and steroid ointments and nothing has worked and some have made it worse. My nose weeps clear liquid on the same side also. I had sarcoidosis some years ago but doctor cannot determine what these lesions are.

Answered by Dr. Sudarshan (1 hour later)

Hi XXXXXXX,
Thanks for writing in.
The condition you are suffering from can be vasculitic condition,scrofuloderma,infected lymph node ,leishmaniasis etc.
History of CREST and Sarcoid goes in favour of vasculitic ulcer.Also it can be infected lymph node with sinus formation .Scrofuloderma is a type of skin Tuberculosis that starts in neck region with discharging sinus and underlying lymph node breaking on the skin.

Also I would like to know-
Do you have fever or any other systemic complaints?
Do you have underlying lymph node in the neck which are palpable?
Are you on any medication like steroids?
You had any lesions of sarcoidosis on the skin?
You have any other skin lesions at present?at other sites?

Can you upload the photographs of the affected area?Photos can help a lot in predicting the condition.

Upload the photographs and we can continue the discussion here.
I will be available for follow up.
Hope this helps.

Regards.
Dr Sudarshan
MD dermatologist.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudarshan (23 hours later)

Please review my answers to your questions along with the photos I uploaded. Thank you. XXXXXXX Klum

Answered by Dr. Sudarshan (10 hours later)

HI again,
Thanks for the details and the photos.
After going through your reply it appears to be lesions of sarcoidosis .

Sarcoidosis can cause this type of lesions in scalp.
The ideal treatment for it would be oral steroids.As per your history you cannot take steroids.In this case the treatment can be antibiotics like minocycline for few weeks(3-5 weeks).Also steroid sparing agents like azathioprine,cyclosporine ,cyclophosphamide can be given.

Over the counter preparations of steroids can be tried for hand and scalp lesions.
Also intralesional steroids can be given in scalp if you cannot be started on oral steroids.Also good quality moisturizer containing urea and lactic acid can be helpful.

hope this helps.
I will be available for further follow up.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudarshan (3 hours later)

Thank you, Dr. Sudarshan! I was pretty certain it was related to my Sarcoid even though a biopsy taken by my present dermatologist was inconclusive. However, she took the punch from a dormant area of the lesion rather than the area I pointed out as active. At present, I am getting some relief using an old prescription ointment called betamethasone. The treatment my dermatologist recommended of covering it with a skin-type material after using antibacterial ointment just irritated it more and the lesion was pussy and sore for 2 days. Clobetasol ointment that was prescribed also irritates it. It can be pretty sore if irritated. I am going to leave this discussion open for a couple of weeks to see how this goes and in case I have further questions. Thank you, again.

Answered by Dr. Sudarshan (10 hours later)

Hi again,

The betamethasone is also a steroid ointment .It is a correct treatment for sarcoidosis.You can continue using it once a day .Also you can apply a good moisturizer with aloe and XXXXXXX butter it will help a lot.

I will be available for follow up.

Regards
DrSudarshan

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar