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Dr. Andrew Rynne

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Suggest treatment for dry and itchy gangrene on palm and fingers

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Dr. Geetika Paul

Dermatologist

Practicing since :2008

Answered : 2609 Questions

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Posted on Tue, 12 Aug 2014 in Skin Hair and Nails
Question: Hi - my father (77 years, known COPD patient) is suffering from dry gangrene on his palm & fingers. While Fentanyl infusion is alleviating the pain, he is unable to tolerate the skin itch around the gangrene. Right now we are applying Neosporin ointment around that area, but that doesn't appear helpful. Or is Neosporin itself causing itching? Thankful if you could suggest a medicine/ointment to relieve this please, as my father is unable to even sleep peacefully.
doctor
Answered by Dr. Geetika Paul 55 minutes later
Brief Answer:
Kindly provide details and upload pictures

Detailed Answer:
Hi

I understand your concern regarding your skin problem and I hope I am able to help you in the same .
I need to know certain things from you before I can prescribe you the medicines .
Why did your father develop the gangrene? What was cause told to you? Was it due to some vascular problem or due to infection? Is the area infected at present?
If possible, please click some close up pictures of the skin condition so that I can assess and look for skin changes and cause of itching and signs of infection . Kindly upload the pictures here on this page .
Also please mention the place you belong to, so that I can prescribe the medicine accordingly .

Dr Geetika Paul
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Geetika Paul 45 hours later
Dear Dr., thanks for your reply. Just to provide you some quick background - my father has been in the hospital for 50 days now. Was admitted for Type 2 resp failure, and initially he also had infection in his lungs & was under antibiotics.

The cause of gangrene formation as per doctors here is infection. But we also suspect that it could be due to accidental puncturing of artery during the treatment/blood sample extraction that was done multiple times. We just don't know the exact cause.

The gangrene initially affected the middle finger on the right hand. Due to late action by the doctors (post which embolectomy was done to remove clots), it started spreading to the ring & little fingers, and then upto the wrist on one side of the hand. The vascular surgeon inspected it and said it would not spread any further. But we now notice that it is starting to spread even to the index finger. The surgeon is ruling out any treatment/surgery at this point given my father's age and the psychological impact any surgery would have. He wants to wait & watch.

Unfortunately I am unable to attach the image. Where I seek your advice is a) how do we control the infection & make sure it doesn't spread further & b) what can we do to alleviate the skin irritation (we are applying Moisturex - a moisturizing ointment at this point) around the affected area.

We are currently in XXXXXXX XXXXXXX

Thank you
doctor
Answered by Dr. Geetika Paul 59 minutes later
Brief Answer:
Use steroid antibiotic combination cream

Detailed Answer:
Hi again

Since your main concern at present is the eczema that is occurring around the region of dry gangrene, I would advise you to apply a steroid antibiotic combination cream over the affected areas twice a day. You can apply either flutibact cream or fucibet cream over the affected areas twice a day .
You can continue to use the moisturiser two to three times a day .
Avoid using neosporin since it itself has a potential to cause skin eczema and itching.


Dr Geetika Paul

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Geetika Paul 3 minutes later
Thanks much, Dr.! I will apply the steroid-antibiotic combo cream as suggested. Thank you!
doctor
Answered by Dr. Geetika Paul 5 minutes later
Brief Answer:
Best of health

Detailed Answer:
You are most welcome.

Wishing your father speedy recovery

You can always follow up with me with the pictures or with a local dermatologist in case of any problems.


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