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Help wanted with dermatology problem

Discussion in 'General Issues and Discussion Forum' started by pknuts2, Nov 13, 2014.

  1. pknuts2

    pknuts2 Welcome New Poster

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    Hi all, have had pt attend clinic today with lesions on both medial/plantar heels- see attached pictures.

    Patient is generally healthy 92 year old female, non smoker, no previous significant dermatology problems. Right foot occurred first 5months as small blister and steadily progressed to as you can now see In photo. Left foot only began in last few weeks, pt has been attending g.p. and treatment room nurse for redressing. Topical antibiotics and corticosteroid have been tried but with little to no improvement. Pt reports no pain just a tingling sensation on right heel.
    Anyone any ideas¿ patient is awaiting referral to dermatologist.

    Thanks on advance

    Phil IMG_20141113_151114.jpg

  2. W J Liggins

    W J Liggins Well-Known Member

    Could be a number of conditions. Can you give a little more information on nature, course, aggravating factors, peripheral vascular status, neurological status, associated conditions, any other skin conditions such as BCC elsewhere?

    Bill Liggins

    JAYNES Active Member

    Has she been bed bound recently.?
    possible healing pressure sores?

  4. lrglover

    lrglover Welcome New Poster

    What is her footwear like?
  5. blinda

    blinda MVP

  6. Catfoot

    Catfoot Well-Known Member

    Thank you for the most useful link.

    However, it is my understanding that Basex Syndrome is found in men aged 60/70 whereas the patient under discussion is a 92 y.o. lady. :confused:

  7. blinda

    blinda MVP




    From the above; An Australian study showed that the incidence of BCC is higher in men, but the incidence in women has been steadily increasing. 3 Factors such as excessive, chronic sun exposure, indoor tanning, fair complexion, prior exposure to ionizing radiation, exposure to chemical cocarcinogens such as arsenic, and genetic determinants are significant risks factors.

    BCC/SCC aint gender preferential. Need more evidence in addition to the above 3 references? Can if you want... :rolleyes:

    Please note; I pointed out that ‘paraneoplastic acrokeratosis’ or ‘Bazex syndrome’ is a disorder to "watch out for". Without further medical history, diagnosis on a forum is nigh impossible.
  8. Catfoot

    Catfoot Well-Known Member

    I am puzzled.:confused:

    There is no mention that this lady has the symptoms of Basex's Syndrome which should be obvious. Basex's syndrome is an autosomally dominant inherited disorder. It is characterized by multiple BCCs of the face, follicular atrophoderma of the extremities, localized or generalized hypohidrosis, and hypotrichosis.

    And what relevence is a study from Oz ?


    I thought when one heard hoofbeats one looked out for horses not zebras?

    Looking at the lesions, which are almost mirror images of each other, my first thought would be "footwear". :rolleyes:
  9. blinda

    blinda MVP

    Let me help clear your confusion;

    It probably is trauma induced. As I said, Bazex syndrome is merely a differential diagnosis.
  10. Catfoot

    Catfoot Well-Known Member

    I am not confused at all However, I would suggest that you are making this unnecessarily complicated.

    So why should the OP "watch out for it" when there is no evidence of any associated pathologies?

    If people come to this forum seeking advice IMO it would be better to stick to the mundane unless indicated otherwise.

    I would be interested to hear the opinion of the Dermatologist on these lesions and I hope the OP will come back and let us know.
  11. blinda

    blinda MVP

    Glad you're not confusing 'Bazex-Dupre-Christol syndrome' with the differential diagnosis of ' Acrokeratosis Paraneoastica of Bazex'.

    Whilst the sound of hooves usually indicates horses, it's the zebras that sue.

    As you say, let's wait for the Dermatologist's opinion.
  12. jos

    jos Active Member

    Looks a bit inflammatory on the edges....did you debride the lesions ?
    Could be pressure from shoes, as both in roughly same area.....need more medical Hx/background.
    Looks a bit like Keratoderma, but in my experience, they have more than one lesion in various spots on the feet.

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