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Atypical Heel Fissuring

Discussion in 'General Issues and Discussion Forum' started by SHudson, Feb 8, 2016.

  1. SHudson

    SHudson Member


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    Hi All,

    40 year old female, presented with atypical heel fissuring lateral right heel.
    First started 5 months ago, increasing in size and pain. Now covers 5 x 2.5cm
    She thought it was fungal in nature so tried a variety of canestan creams and has tried numerous emollients on this lesion without any improvements
    No itchying reported, painful to walk on. Nil pain with lateral compression only direct
    Unremarkable medical history nil diabetes, thyroid or other skin conditions.
    50:50 enclosed to open footwear as living in hot (dry) climate.
    Dermatologist only visiting x2/year as remote part of Australia.
    I know the photo is a little unclear but has anyone seen something similar to this before?
    I have suggested that she have a skin scraping/biopsy to start with due to increase in size and pain before anything further topically is added
    Thank you all for your suggestions.
    Susie
     

    Attached Files:

  2. blinda

    blinda MVP

    I agree, it does appear to be atypical. I also think your suggestion of skin scrapings and biopsy is spot on. Any new lesion which increases in size, has an irregular border and is manifesting more than one colour should be referred for further investigation.

    Please let us know the outcome.

    Cheers,
    Bel
     
  3. LeonW

    LeonW Active Member

    Is the lesion secondary to trauma?
     
  4. SHudson

    SHudson Member

    Hi Leon,

    No reported trauma or change of footwear etc reported
    First started as a small fissure, but she has had typical callous with fissuring previously so she didn't think anything different but it has just gradually increased in size and pain over the 5 months.
     
  5. SHudson

    SHudson Member

    Thank you for your reply Bel and will be sure to let you know the outcome of her biopsy and further treatment/management plan.
    Thanks again
     
  6. Paul Bowles

    Paul Bowles Well-Known Member

    Acral lentiginous melanoma possibly? referral and biopsy.
     
  7. LeonW

    LeonW Active Member

    Since her general health is unremarkable either there is something extrinsic to her causing trauma or some localized chronic pathology.
    DDx
    Melanoma
    Bacterial infection
    Viral infection
    Fungal infection
    Yeast infection
    Foreign body
    Idiopathic
    Immunological

    Thats all i can thinm of
     
  8. SHudson

    SHudson Member

    Hi All,

    Thank you for your help and suggestions it is much appreciated.
    Early reports from punch biopsy are suggestive of a spider bite, we are still awaiting further investigations from this.
    Strange since it has taken so long to become worse and also that she couldn't remember being bitten.
    Thanks again
    Susie
     
  9. Greg Fyfe

    Greg Fyfe Active Member

    Thanks for the feed back.

    I did a quick search and interestingly...

    "Initial bite is painless but symptoms develop about 2-8 hours later, area becomes painful and swollen "

    from http://www.dermnetnz.org/arthropods/spider-bites.html

    She may not have been aware of being bitten if she didn't see it happen.

    Although other articles suggest spider bites are a difficult diagnosis, unless you see it happen , and the effects are usually minor.

    http://www.williampoh.com/Documents/AFPSpiderBites1109.pdf

    I'm curious as to what the results of the other show investigations will show.

    Regards
    Greg
     
    Last edited: Feb 16, 2016
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