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Dr. Andrew Rynne

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Suggest treatment for swollen arm after missing a Subutex injection

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Dr. Noble Zachariah

Internal Medicine Specialist

Practicing since :1974

Answered : 2250 Questions

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Posted on Fri, 31 Mar 2017 in Veins and Arteries
Question: Hi my friend missed a subutex injection probably a week to ten days ago. Later that day he noticed where he had missed on his left inner arm a few inches above the elbow was covered in red spots all around the spots took up about 4x3 inch space on his arm and was swollen. After a few days the swelling went down and the spots turned to a more faint red solid spot and then pink and got smaller but it's still pink and some skin in spots has returned to normal but some of it has gotten darker and looks to be dark blue or purple. And he said that yesterday he woke up and his right thigh was numb but went away by the end of the day but now instead of his thigh his forearm below the missed injection is numb and tingly. What should he do? Even though darker in spots and numb tingly it appears to slowly be going away but again spots are not and are dark in color
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Answered by Dr. Noble Zachariah 3 hours later
Brief Answer:
Purpura to be investigated if first time.

Detailed Answer:
Hello,

Welcome and thanks for your query.
Your friend has purpura ( bleeding into the skin).
If this is the first time, it is better to have it investigated with a complete blood count and coagulation studies. If all results turn out to be normal, it is likely to be autoerythrocyte sensitization (psychogenic purpura). If that is so it may be related to him missing the subutex.
Do get back to me if you have further queries.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Noble Zachariah 3 hours later
So he needs to go get a doctor and have a blood test? He doesnt want anyone finding out, but doesnt want to lose his arm either. Where should he go?
doctor
Answered by Dr. Noble Zachariah 17 hours later
Brief Answer:
See below

Detailed Answer:
These tests can be done in a clinical laboratory.
Check with the lab whether they require a request from a doctor. If a request is required a GP, internist or hematologist would be able to give one.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Noble Zachariah 15 hours later
Okay. He said it is still numb now, and woke up this morning and he's having like a burning kind of sensation scale of 1-10 pain is probably a 1 or 2 but it's there. Does this change anything? I read that he may need a chorticosteroid to help the circulation and nerves to rebuild
doctor
Answered by Dr. Noble Zachariah 5 hours later
Brief Answer:
Let me know the test results

Detailed Answer:
Thank you for your input.
Let's not put the cart before the horse.
Treatment comes only after confirming the diagnosis.
Corticosteroids are indicated only if there is a vasculitis like in HS purpura which is less likely. Even in HS purpura, it is controversial.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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