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What causes recurring painful lesion extending from wrist to underarm?

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Posted on Fri, 11 Jul 2014
Question: My child had a blister on her hand that became red, a red line traved up her wrist to her underarm. She was treated with anti-biotics. Soon as the the anti-botics were finished the line reappeared. The blister is grown over with normal skin leaving a red mark still underneath, the line appeared again with pain in hand and wrist. I took her to hospital where she had 1 dose of IV anti-biotics and topical & oral anti-biotics. When the oral anti-biotics finished it came back again. I then took her to the doctor and she has now finish 2x scripts of anti-biotics off him, and the line is back again. She has an appointment for ultra-sound for her hand in two days. I'm concerned with the facts of all the pain she's having in her hand and wrist might damage ligaments/tendons longterm. Also it seems the anti-biotics are not completely resolving the issue. Should you have any suggestions? Thank-you, I will await an answer :)
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Answered by Dr. Johny Chacko (40 minutes later)
Brief Answer:
? Acute lymphangitis / ? Cutaneous larva migrans

Detailed Answer:
Hello,
Welcome to healthcare magic.

I understand from your query that your child has been having a recurring painful lesion extending from her wrist to her underarm.

From your history and description, the possibilities I can think of are Acute Lymphangitis , Thrombophlebitis and Cutaneous larva migrans.

Lymphangitis is an infection of the lymph ducts in the skin an underlying soft tissue.

Thrombophlebitis is inflammation of the veins.

Cutaneous larva migrans occurs due to the entry of the nematode larva ( after contact with dirty water like puddles/ playing in a sandpit, etc) which travels and creeps under the skin.

Lymphangitis and thrombophlebitis tend to respond well to antibiotics. However, in your child's case, it seems to recurring after the course of antibiotic is over. This could occur
1. If the underlying bacteria is resistant or not completely responsive to the antibiotic administered.
A swab from the blister or aspiration from the inflammed edge of the red line may help to identify the organism and find out its sensitivity pattern. Since the blister has already dried up, an aspiration might help.

2. If your child has any underlying immunosuppression - Does your child have any other medical issues like diabetes or is she on any drugs like steroids?

The 3 rd possibility I would consider is Cutaneous larva migrans. This is generally painless but can become painful if the lesions gets secondarily infected by a bacteria. This requires treatment with an anti -larval like oral Ivermectol.

You have a feature to upload the images by yourself at the right side of the query page, please utilize that so that I can answer your query better. You can also send the image as attachment to YYYY@YYYY , with the subject as 'Attn: Dr. Johny Chacko'.

I understand that your child is due for an ultrasound in 2 days. In the meantime, you could try the following measures to give her symptomatic relief.

1. Keep the limb elevated.
2. Do not move the affected area too much. Try to keep it immobile.
3. Hot, moist compresses will help to provide relief from pain.
4. Anti- inflammatory and analgesics like Acetaminophen and Ibuprofen can be given for pain relief.

It would be good if you could send me the clinical picture.

Hope this helps you to provide some relief to your daughter.

Take care.

Regards,
Dr. Johny Chacko
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Johny Chacko

Dermatologist

Practicing since :2005

Answered : 1916 Questions

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What causes recurring painful lesion extending from wrist to underarm?

Brief Answer: ? Acute lymphangitis / ? Cutaneous larva migrans Detailed Answer: Hello, Welcome to healthcare magic. I understand from your query that your child has been having a recurring painful lesion extending from her wrist to her underarm. From your history and description, the possibilities I can think of are Acute Lymphangitis , Thrombophlebitis and Cutaneous larva migrans. Lymphangitis is an infection of the lymph ducts in the skin an underlying soft tissue. Thrombophlebitis is inflammation of the veins. Cutaneous larva migrans occurs due to the entry of the nematode larva ( after contact with dirty water like puddles/ playing in a sandpit, etc) which travels and creeps under the skin. Lymphangitis and thrombophlebitis tend to respond well to antibiotics. However, in your child's case, it seems to recurring after the course of antibiotic is over. This could occur 1. If the underlying bacteria is resistant or not completely responsive to the antibiotic administered. A swab from the blister or aspiration from the inflammed edge of the red line may help to identify the organism and find out its sensitivity pattern. Since the blister has already dried up, an aspiration might help. 2. If your child has any underlying immunosuppression - Does your child have any other medical issues like diabetes or is she on any drugs like steroids? The 3 rd possibility I would consider is Cutaneous larva migrans. This is generally painless but can become painful if the lesions gets secondarily infected by a bacteria. This requires treatment with an anti -larval like oral Ivermectol. You have a feature to upload the images by yourself at the right side of the query page, please utilize that so that I can answer your query better. You can also send the image as attachment to YYYY@YYYY , with the subject as 'Attn: Dr. Johny Chacko'. I understand that your child is due for an ultrasound in 2 days. In the meantime, you could try the following measures to give her symptomatic relief. 1. Keep the limb elevated. 2. Do not move the affected area too much. Try to keep it immobile. 3. Hot, moist compresses will help to provide relief from pain. 4. Anti- inflammatory and analgesics like Acetaminophen and Ibuprofen can be given for pain relief. It would be good if you could send me the clinical picture. Hope this helps you to provide some relief to your daughter. Take care. Regards, Dr. Johny Chacko