What causes chronic sores on the arms and legs?
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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.
Either prurigo or dermatitis artefacta
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?
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.
Did I reach my limit on follow-up questions or are you still working on my last reply?
She may take TPHA test
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.
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