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Dermatological Query - Heel Lumps?

Discussion in 'General Issues and Discussion Forum' started by Mark Egan, Sep 29, 2005.

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  1. Mark Egan

    Mark Egan Active Member


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    Dermatological Query Heel Lumps?

    Dear All,

    Trust these images get through as I am a little stumped with what these are.

    This patient first presented with a sore hard spot on her heel (see attachment listed as jpg) following the Hx and assessment I felt it was a wart. My Rx involved education on what is a wart and options for Rx the patient liked the sound of duct tape and bannana therapy (which has worked for me before) she then went off for a month. Medical Hx unremarkable GHG no previous wart or dermatological issues before. Although husband had something on his heel and another podiatrist burnt it off, although she was not sure if it is the same thing on her foot.

    She has recently return with more discomfort in the heel - swelling and redness. I decided to debribed the area to discover 4 circular lesions which have the appearance of a subdermal blister. I attempted to denucleate to see if there was a foreign object in the site and or fluid, neither of which I found, the bleeding occured as I went into her dermis layer. I asked her GP to do a biopsy but he did not want to instead he has prescribed a topical corticosteriod and asked her to return in 1 month if still a problem.

    DDx welcomed - lipomas, fat pad rupture etc
    Rx options also welcomed.

    Regards
     

    Attached Files:

  2. Felicity Prentice

    Felicity Prentice Active Member

    Weird indeed. The original lesion looks very much like it did initially, and the new lesions look to be of very different pathology.

    How long did she use the banana and duct tape treatment? Given the presence of swelling/pain/erythema, is it possible that she has had an allergic reaction to this? I know that very few people have digestive reactions to bananas, but that does not mean that an epidermatogical reaaction is out of the question.

    It would consider adding an (oral) anti-histamine to the picture, just to see if there is an immunologically dervied reaction going on.

    cheers,

    Felicity the baffled
     
  3. footdoctor

    footdoctor Active Member

    Keep bananas for the fruit bowl

    Hi Mark,

    Any of my patients that have used banana skins taped to there foot have developed blister like,burnt patches on there foot.I guess from this that they are toxic.
    Possibly a reaction to that?

    Personally i have given up on sal acid and co.

    Thuja really works for me!

    Thanks

    scott
     
  4. pgcarter

    pgcarter Well-Known Member

    The second one looks more like an HPV to me....plug away with tx of choice.....make sure you don't do any serious damage....you can always do nothing later...but it appears that the outcome of that is already known. There are people out there whos immune systems just don't seem to react to HPV....tough to win those ones.
    Regards Phill
     
  5. Mark Egan

    Mark Egan Active Member

    Thanks for the replies

    I have been thinking it may have been an allergic reaction to the bannana skin which she used for 2 weeks as such the anti histamine Rx is something I will discuss with her (thanks Felicity).

    Scott you mentioned Thuja I remember reading about this inprevious postings - is it purley for HPV ? If it is would you use it on something which you are not sure is a HPV lesion?

    Regards
     
  6. Mark Egan

    Mark Egan Active Member

    Thanks for the replies

    I have been thinking it may have been an allergic reaction to the bannana skin which she used for 2 weeks as such the anti histamine Rx is something I will discuss with her (thanks Felicity).

    Scott you mentioned Thuja I remember reading about this inprevious postings - is it purley for HPV ? If it is would you use it on something which you are not sure is a HPV lesion?

    Regards
     
  7. pgcarter

    pgcarter Well-Known Member

    I believe thuja is an extract of red cedar?...I am sure some one else will be able to be more sure of this.....
    Regards Phill Carter
     
  8. Felicity Prentice

    Felicity Prentice Active Member

    I believe that Thuja can be applied directly to VP's as a tincture, and there are those who recommend it as a homeopathic remedy (swallowed, not applied). I would imagine you could get it from Naturopath suppliers. It is not a caustic as such, but is supposed to stimulate the body's own immune reaction to the HPV.

    cheers,

    Felicity
     
  9. Don ESWT

    Don ESWT Active Member

    Mark,
    They look like HPV. with several Satelite units. Depth will probably 1cm into P/S.

    Duct Tape - What is the chemical make up of the adhesive and how long to remove the wart.

    Banana Skin - Humans and primates hate the taste of the skin of the banana so that would lead us to to think that it might be slightly acidic - again how long to remove the wart.

    Mono and Sal - known acid treatment for HPV Time for treatment is 1 Tx - 5 days Apply Mon Remove Fri final dressing and discharge Mon Total 7 days.

    Don Scott
     
  10. Mark Egan

    Mark Egan Active Member

    Don and others,

    Firstly thank you for advice in this case.

    I have hopefully attached not only repeat photos but also new ones. For your referrence of the presenting complaint see Rima Heath.jpg as seen in my rooms on the 08/08/05 which I felt was a wart. My Rx involved advice on using duct tape (generic brand bought from a hardware store) used with bananna skin to be kept on the area for 4-7 days then remove tissues using a pumice stone and reapply over 1 month period I also added deflective padding to her exercise shoes so she could maintain normal activity. Reviews in the preceding weeks indicated improvment - reduction of size of wart and reduced pain (phone review so wart was not sighted).

    A review in my rooms see photo Rima Heath 007 Jpg taken on the 15/09/05 revealed something that I had not seen before. The CC had appeared to have returned with a vengence and brought friends the photo is following debridedment of the superficial HK while the bleeding area is following my attempt to denucleate one of the lesions. The patient had stopped using the duct tape and bannana skins for 2 weeks.

    The remaining photos were taken on the 03/10/05 (sorry for the quality) and show a further increase in the number of these subdermal lesions. I do not think they are warts and would be reluctant to start using acid therapy on multiple lesions of unknown pathology, they have the appearance of pitzogenic papules but are hard and painful to press on and develop a superficial HK covering. the patient is currently using a topical cortico-steriod cream as prescribed by her GP (who also wanted her to get an x-ray as they felt is was a spur). I am trying to get a dermatologist to have a look at the photos and have advised the patient to try some anti-histamine as suggested by Felicity. I am completely baffled by this one, as apposed to being mildly unsure with everything else

    Regards
     

    Attached Files:

  11. Don ESWT

    Don ESWT Active Member

    Does this person work with pestacides?
    Cyanide base?
    What is their Nationality (Mediaterrian Origin's)?
    Are there any leisons on their hands?

    Don Scott
     
  12. Don ESWT

    Don ESWT Active Member

    Mark,
    The pumice stone may actually spread the viral particles causing a Kobner like Effect. Where the skin is abraded the virus will restart to multiply. You clear up one site and they regrow in another.
    On Rima Health 007 image it looked like about 15 units were present?

    Good Luck

    Don Scott
     
  13. Mark Egan

    Mark Egan Active Member

    Don

    In answer to your questions -
    No to cyanide or pesticides
    Yes to mediterranian - Lebanon
    No to lesions on the hand

    With regards to the kobner effect I question the patient today and she commented that she did not use the pumice stone.

    I have e-mailed a dermatologist who feels they are warts but has suggested a shave biobsy. For me to do this it will cost the patient $124 with no refund from medicare as such I have advised her to see her GP or to bite the $ bullet and let me do it.

    Regards
     
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