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Dr. Andrew Rynne

Family Physician

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What causes chronic sores on the arms and legs?

Answered by
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8021 Questions

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Posted on Fri, 18 May 2018 in Skin Hair and Nails
Question: My wife has had sores on her arms and legs for about 1 year. They're not painful unless she picks at them. When she does pick at them, there's a small, hard, round ball that comes off. Attached is a photo. Any ideas what this could be?
doctor
Answered by Dr. Kakkar S. 56 minutes later
Brief Answer:
Upload more images

Detailed Answer:
Hello. Thank you.
I am Dr kakkar (Dermatologist and Venereologist). I have noted your concern and I have viewed the image.
Perhaps she has a perforating disorder.
I request you to kindly upload a few more good quality images of the various affected areas so that I am able to get a better understanding of the skin condition and guide you better.

Regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Kakkar S. 1 hour later
Per your request, attached are a few more images. I should also mention she's concerned that she may have contracted syphilis about 5 years ago. She had 2 separate tests (RPR screen and FT-ABS screen) but both of them came back negative. The tests were done in early 2015 before these sores appeared. Could these sores be the result of syphilis?
doctor
Answered by Dr. Kakkar S. 3 hours later
Brief Answer:
Either prurigo or dermatitis artefacta

Detailed Answer:
Thank you.
I have viewed the images.

I don't think that these sores are due to syphilis. I can see a few raw/denuded sores, a few crusted lesions and a few dark spots that probably represent healed sores.
Going through the morphology and distribution on accessible sites I would keep a possibility of either prurigo or dermatitis artefacta rather than a perforating disorder as previously suggested.
I would like to know if she complains of any symptoms like itching?burning? etc.
Is there any underlying emotional or psychological issues/mental stress?

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Kakkar S. 3 hours later
No, she's not under any stress. The sores don't itch or burn. I also have similar sores, but mine are extremely itchy at times. We've read that syphilis is known as the "great imitator" and mimics a lot of other ailments. Are you confident that we can rule out syphilis? If it's not syphilis, are there any topical ointments or creams that you can recommend to heal the sores?
doctor
Answered by Dr. Kakkar S. 7 hours later
Brief Answer:
Not syphilis

Detailed Answer:
Hello.

Open/necrotic sores on the body are extremely rare in syphilis and are mainly seen in immunosuppressed individuals e.g HIV /AIDS patients. Moreover, they don't look like gummatous lesions of tertiary syphilis as those are usually chronic and associated with scarring. Also her tests for syphilis (FTA ABS is a very sensitive and specific test) came as negative. So I rule out syphilis as a possibility.
One more possible cause that I would like to consider is that of bed bugs or perhaps scabies, specially since you also complain of itchy sores.
I suggest a Tab. Ivermectin 12mg single dose for both of you. Topically I would suggest application of a combination cream /ointment containing a steroid and topical antibiotic e.g either clobetasol propionate 0.05 %+fusidic acid 2 % cream Or mometasone furoate 0.1 %+fusidic acid 2 %cream Or fluticasone propionate 0.05 %+mupirocin 2% ointment. In addition I would suggest you to take a tablet of levocetrizine 5mg for symptomatic relief from itching.

Regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Kakkar S. 7 hours later
My wife is still questioning the reliability of the tests she's received for syphilis. She read that the FT-ABS is most accurate in the middle stage but not as accurate in the later stage as she would be in, given the time line of when she may have been exposed. Is there any test that will give definitive proof that she does not have syphilis?

Did I reach my limit on follow-up questions or are you still working on my last reply?
doctor
Answered by Dr. Kakkar S. 8 hours later
Brief Answer:
She may take TPHA test

Detailed Answer:
Hi.

Apology for delay.

She may take a TPHA test. It's a confirmatory test for syphilis. TPHA is a sensitive and specific test through all stages of syphilis. Though I strongly feel that this is not syphilis.

Regards
Above answer was peer-reviewed by : Dr. Raju A.T
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