Abstract: 68 yo man with chronic dermatitis of left leg
History: The patient has had a chronic dermatitis of left leg for over ten years. He has been seen at the Wound Care Clinic for over three years. What worked best in the past was an Unna boot but these are not used as commonly anymore as we have newer, more high-tech types of bandages.
History: The patient has had a chronic dermatitis of left leg for over ten years. He has been seen at the Wound Care Clinic for over three years. What worked best in the past was an Unna boot but these are not used as commonly anymore as we have newer, more high-tech types of bandages.
O/E: He has chronic lymphedema of the left leg, which
periodically develops elephantiasis-like changes. The examination woody edema left leg, that is erythematous with crusted areas. It looks clean today and there is no evidence
of secondary infection.
Impression: Chronic
dermatitis of his left leg. It is most
likely a chronic stasis eczema.
Comments: He has been diligent about home care. For the time being, he will use wet dressings
with a dilute bleach (a half cup of Chlorox per 40 gallons of water in a
bathtub) and zinc oxide-like paste. He
will be seen back in two weeks. Consider
going back to an Unna boot.
What are your thoughts?
What are your thoughts?
from Noah Scheinfeld: i have a patient with crazy bad ulcers should I send your pictures of him. besides that i use the treatments I put in this chapter i wrote on Livedoid Vasculopathy http://emedicine.medscape.com/article/1082675-overview you pump up the anticoagulants and do pt ot and compression
ReplyDeleteBack to basics. This is most likely a long standing chronic stasis eczema. Will send swab for bacterial culture. Most worrying aspect is undiagnosed contact dermatitis to medicaments. Once patch test has excluded contact dermatitis, I will use plain wet compress with dil. KMNO4 with emulsifying ointment/soft paraffin wax. Low strength topical steroid ointments will be useful. I would avoid zinc oxide paste. My favourite is a 4-layer supportive stocking for at least 3 days interval. this will hasten recovery and healing. He will probably need such stocking for weeks to months!!
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