Hello, Thank you for posting your query at Doctorspring.com.
Firsty, I am extremely sorry for the delayed reply - it is an exception and generally replies are quicker.
I understand your concern.
From the picture that you have sent, it does look like its in the process of healing. I can see some granulation tissue. However, if it has been there for a long time and is not making any progress, then it is a point of concern.
I need some additional history :
1) Do you have any swelling in your leg?
2) Are you a chronic smoker ?
Once you answer both these questions I will get a clearer picture. We also need to get your sugar levels checked right away. If such lesions take 6 months to heal, it is definitely something to be concerned about. Normally delay in healing can be due to poor nutrition/ malnutrition, repeated infection, chronic smoking leading to circulation problems in the limbs ( PVD ), varicose veins, diabetes. We need to rule out all these causes. I will also recommend you get a doppler test done for both your lower limbs. It will give us an idea of the circulation in your leg.
For the time being, clean the wound with Betadine solution, and apply Soframycin(Framycetin) ointment 2-3 times daily. Make sure the area is open, and tight socks are not compressing the wound in any way.
Please get back to me with more details.
Regards.
Patient replied :
First of all thanks for the response, I am a bit afraid to further examine at hospital as I do not have medical care (which I am seriously considering on purchasing now) no one I know has medical issues at age 23.
To answer the questions:
1) No Swelling on the leg, apart from the wound itself somtimes might get inflammed. Usually after a long day at the office or after a shower.
2) I smoke cigarettes casually, around 3-5 a day. On weekends I might smoke 10-15 a day. I do have a high stress job and usually remedy by drinking which is maybe 3 times a week, then yes I do smoke more than usual.
I will organize the sugar test early next week. Can you remind me the procedure? Do I need to fast, if so how many hours. Doppler test, do I need to see a dermatologist or is there a specialised department?
Having a second look at the wound, I think the granulation tissue you refer to is due to the MEBO applications. Would you recommend Soframycin over this? Previously I could not see skin, just a dark, hard scab that looks like the other image I sent you (have you seen that before? where the wound doest not go beyond the scab level?).
Another Questions - Cleaning the wound, do I need to use pressure to move the dead skin cells or should I be gentle? I normally wash the wound with warm water and rub my hand over it so some dead skin falls out. From looking at the image, can you say its not infected? I am a bit worried after reading on what happens if a wound gets infected.
Another fact, I skip meals (mostly lunch) but not sure if this has any correlation. Would immune boosters or vitamins help the process along?
Hello
Thanks for all the information that you have provided. I greatly appreciate it.
I reviewed the way your wound looks. As you mentioned, it's present since 6 months, we are dealing with more than just an infection.
I have four possibilities that it could be:-
1. Pyoderma gangrenosum
2. Deep fungal infection
3. TB of the skin.
4. Arterial or venous ulcers
It's important to come to a proper diagnosis following which an appropriate treatment can be started by your doctor. For this a biopsy would be essential to confirm the diagnosis.
The treatment for all three would vary and hence the importance of diagnosing it properly.
To answer your queries-
Immune boosters may help speed up the healing but it would not help to resolve the wound.
It's not looking infected, however a course of oral antibiotics would definitely be given to eliminate any secondary bacterial infection.
Doppler test requires you to go to a radiologist who can do the tests for you.
It would be worthwhile to rule out any arterial or venous ulcers.
Skipping lunch has no correlation.
You can apply mupirocin cream over it to help in the healing.
Hope this helps, Please let me know if you have any queries.
Take care
Patient replied :
Hello Doctor,
Sorry for the late reply. For the past few days I have cleaned the area with betadine solution and applied MEBO after. Mebo is keeping the area wet and it looks like the skin in very moist with a whitish appearance. As soon as I clean again with betadine it looks more normal.
So far I think its healing, no more bleeding and there is hair growth. I checked diabetes with a home machine. After dinner around 1 hour later the reading was 149. Then I fasted through the night around 9-10 hours and then got a reading of 79. Is that normal?
I have a theory and I refer to the photo with the dark scab. Maybe that is eczema, as my GP prescribed betnotave back then. Is it possible that I may have over-used betnovate on the wound area that has weakened the skin and causing dealyed healing? It is very possible that I may have used betnovate for over 2 months.
I will give the area till the end of this month then seek proper diagnosis if required.
Thank you again for all your help with my condition.
Hello
Thanks for your reply.
Betnovate can delay wound healing. However, it would be best to consult a dermatologist who can physically examine the condition n opine.
It's normal for the blood sugar to be raised after the meal and it to come down after fasting.
Take care