This 55 yo woman has has a one week history of a painful necrotic lesion on her left temple. She suffers from chronic pain and depression but is on no new meds. Her health is otherwise good. Her hemogram is unremarkable. Two days ago, she developed a similar lesion on her left shoulder. At present, it is just an erythematous papule with a surface erosion. He internist started her on cephalexin 500 mg bid before I saw her.
Both lesions, by history, began with a vesicle superimposed on an erythematous papule. She feels well otherwise and has had no fever.
In the differential disgnosis I am considering:
Ecthyma
Ecthyma gangrenosum (normal hemogram is against this)
Brown Recluse Spider bite - but these are usually not so symmetrical
A bacterial culture was done but may not be helpful since she was on cephalexin.
I doubt biopsy will help; but will be done if she continues to develop new lesions.
Wednesday, June 01, 2005
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The picture is more in favour of insect bite ,most probably spider bite.It is a common problem in iraq.The bite often present as a single red indurated plaque with a central black necrotic area that ends in ulcer.The commonest sites affected are thighs.It continues to enlarge for days and take few weeks to heal leaving a central scar. Management by giving oral steroid to stop the progresion of lesion,together with oral antibiotic.Topical use of antibiotic mixed up with honey is also helpful.Also antihistamine and analgesia might be needed.
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