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Help With Unidentified Skin Condition

Discussion in 'General Issues and Discussion Forum' started by X5_452, Sep 4, 2010.

  1. X5_452

    X5_452 Member


    Members do not see these Ads. Sign Up.
    I have been seeing this client for several months and he presents with unusual lesions on his left calcaneal area. The lesions are also present on both legs however they are not as severe as the ones on the calc. I have attached photos pre and post debridement.
    As you can see it looks like HK however when you debride the area there is a marked periphery that appears to be HK going into the foot (sorry have trouble describing it).
    Things to note:
    The client has had them for close to a decade.
    The lesion never changes size
    There is pain on direct compression of the area pre and post debridement
    He has not treated it as both his GP and dermatologist have turned him away as they’ve “never come across this before”.

    I think it looks like a psoriatic plaque however I’m sure a GP and/or a dermatologist would have diagnosed this. Any thoughts? Help with this case would be GREATLY appreciated.
     

    Attached Files:

  2. Lizzy1so

    Lizzy1so Active Member

    Great pictures. No great ideas on what it might be, although i did initially think it might be residual scarring from Vpedis, looking at the shapes and location. Also any fungal or parasitic history?
     
  3. footsiegirl

    footsiegirl Active Member

    Although the OP stated that there were similar plaques on the legs...

    I would be interested to see the lesions on the legs
     
  4. anDRe

    anDRe Active Member

    Why not take a biopsy of the lesion and send it for analysis?
     
  5. cornmerchant

    cornmerchant Well-Known Member

    X5-452

    I have a couple of patients with identical lesions and they are psoriatic plaques. Unlike your patient's, they are not painful so I tend to leave alone. I am interested to see that you debride but say they are painful both before and after debriedment, therefore is it worth debriding? Do you find it easy to get a haem when you are debriding?

    Cornmerchant
     
  6. Catfoot

    Catfoot Well-Known Member

    X5-452,
    I was also wondering about the efficacy of debridement, as it doesn't seem to relieve the symptoms.
    I wonder if offloading the lesion would be more effective approach?

    regards
    CF
     
  7. toughspiders

    toughspiders Active Member

    Stab in the dark...ringworm??

    Has anyone taken a sample for culture?

    What is the patients social history?
     
  8. X5_452

    X5_452 Member

    Cornmerchant - Debridement provides him with some relief as the amount of pain before is around a 7/10 but after it is a 1/10. I think the pain is just the tenderness from post debridement as he is used to the area being hard.

    Catfoot - I applied some swanfoam inside his shoe and he has had great relief.

    Toughspiders - I thought that too but I didn't think ringworm had the callousy appearance and I thought the area would be more red and inflammed if it was ringworm.

    Also F.Y.I photos were taken with an iPhone 4.
     
  9. footsiegirl

    footsiegirl Active Member

    And ringworm itches like bilio
     
  10. blinda

    blinda MVP

    Hi All,

    From the post debridement pic the oval ring looks much like scar tissue, which on a weight bearing site such as this, would produce callus. This could explain the static appearance of the lesion, ie `The lesion never changes size`. But then again, the pt would recall a previous lesion that had been treated with electrocautery, electrosurger, acids, cryo or anything else that could cause scarring :confused:

    How old is the pt? Have you considered granuloma annulare? I also once saw a similar ring of HK on resolved pityriasis lesions, but they were much smaller and rash like on the legs only.

    Would be interested in the culture result.

    Cheers,
    Bel
     
  11. footinmouth

    footinmouth Member

    Hi,

    Can you give any information with regard to the following:

    Is patient's skin generally dry? Are the lower limbs dry? Skin flaky (shins, for example)? Scaly? Does the patient have particularly linear palms (many more lines than -say - you)?

    I've got an idea kicking around in what passes as my brain .... your answers may help it along.

    cheers, footinmouth
     
  12. Graham

    Graham RIP

    Does this Pt have diabetes?
     
  13. X5_452

    X5_452 Member

    No the client doesn't have diabetes
     
  14. footinmouth

    footinmouth Member

    Hi

    Am still curious, so is patient's skin generally dry? Are the lower limbs dry? Skin flaky (shins, for example)? Scaly? Does the patient have particularly linear palms (many more lines than -say - you)?
    Also amid any general dryness etc., does patient have any small similar lesions (although may not be 'flattened') anywhere else on body?

    cheers
    footinmouth
     
  15. Deborah Ferguson

    Deborah Ferguson Active Member

    Hi
    Maybe a dermatology opinion may be useful. Has he ever been referred ?
    Regards
    Deborah
     
  16. Abel

    Abel Active Member

    looklike a scar postquirurgical
     
  17. blinda

    blinda MVP

  18. Mr.T

    Mr.T Member

    Many thanks blinda, I do believe that's the first RHCP reference I have seen on podiatry arena!!

    Are they involved in any other reasearch??:good:

    For my 2 cents worth while posting, I concur it most certainly looks as though it is long standing scar tissue...
     
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