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Suggest Treatment For Enlarging Wound On Hand

Posted on Tue, 21 Jul 2015

Question: Have a wound on arm that will not heal, it's been there for about 8 months and slowly enlarging. Been to see family doctor and referred to dermatologist and had culture taken, negative for anything obvious (fungal/bacterial), biopsy was negative and most recent lab work (March) was normal. There are several draining sinuses within wound (vertical). Have been wearing an occlusive dressing but no sign of infection, although wound seeps continuously and is moist. Change dressing twice a day. Wound is not painful, not sensitive. Need answers, please help. Thank you.

Answered by Dr. Shahid Hassan (36 minutes later)

Brief Answer:
Upload photograph

Detailed Answer:
Hi, Welcome to healthcaremagic,

It seems to be deep fungal infection as per your description, as draining sinuses are seen in mycetoma (it may be bacterial) or in sporotrichosis.

Please upload a good quality photograph for evaluation.

There is a feature to upload the image by yourself on the right side of this query page. You may utilize that. Alternatively, you can mail it to YYYY@YYYY with subject line as "ATTN: Dr. Shahid Hassan". I will review the photograph and get back to you.

Regards

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

Follow up: Dr. Shahid Hassan (25 minutes later)

Photo uploaded. This picture is approximately a week old, since then the redness around the wound has increased

Answered by Dr. Shahid Hassan (8 minutes later)

Brief Answer:
Lichen planus Vs FDE

Detailed Answer:
Hi, welcome again,

From clinical photograph it looks liken erosive lichen planus.
Biopsy is conclusive for this. as your earlier report is normal i will advise you to go for Repeat Biopsy.
The other differential is fixed drug eruption.
Are you taking any medicine regularly for pain, loose motion, psychiatric medicine or any other medicine.
Fixed drug reaction, It is a type of allergic reaction to a medicine, they recur at the same site with each exposure to a particular medication.

There is no sign of deep fungal infection from the photograph.

Hope this will help you.
Thanks

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

Follow up: Dr. Shahid Hassan (43 minutes later)

Thank you for your timely response. No regular medicines being taken, wound started off small (8 months ago), easily covered by a bandaid. No itchiness or pain present at all. No mouth sores present (Looking up diagnoses in medical book). Wound weeps blood-tinged fluid into dressing continually, if pinched, blood comes to surface of 'sinuses', when pinching ceases, bleeding stops immediately, and wound reverts back to weeping.

Answered by Dr. Shahid Hassan (8 hours later)

Brief Answer:
repeat biopsy

Detailed Answer:
Hi, welcome again,

Go for repeat biopsy for diagnosis.
Come back to us with report.

Regards

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

Follow up: Dr. Shahid Hassan (2 hours later)

The biopsy will be repeated. One last thing, there was a Benz XXXXXXX test in which the result was only slightly elevated, does this have any relevance to this diagnoses?

Answered by Dr. Shahid Hassan (13 minutes later)

Brief Answer:
Nothing relevent

Detailed Answer:
Hi, welcome again,

Bence-jones test is for abnormal protein in urine.
It has nothing to do with diagnosis of lesion.
Thanks

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

Follow up: Dr. Shahid Hassan (23 hours later)

Biopsy has been scheduled. Just out of curiosity, is there any possibility this is due to a bug or spider bite (brown recluse?)

Thank you for your time and patience.

Answered by Dr. Shahid Hassan (42 minutes later)

Brief Answer:
least chances

Detailed Answer:
Hi, welcome again,

Least chances,

Bug bite will not remain such localizes and will subside soon, will not persist for such a long duration.

Thanks

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