Strange Lesion

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I have a patient with this strange lesion on the plantar surface of her foot. The skin is peeling and there are dark marks like blood but it does not rub off. I would appreciate some suggestions as to its possible cause. It is not painful or itchy and the patient is only botheres when it catches on the carpet as she walks.
I am trying to attach a photo.

 

Hi,
are there any other lesions/vesicles etc elsewhere on the foot, any history of blistering etc; or, has the pt any history of other skin conditions?
and, have you looked on www.dermnetnz.org - has a great collection of photos so can really help point you towards a diagnosis.

 

Thank you for the suggestion, I will look at the website you suggested.
No, there are no other vesicles on the foot and no history of skin problems or blistering.
She is not at all worried about it, only I am!!

 

After having just seen Dr. Bradley Bakotic speak about amelanotic melanoma I would biopsy a strange lesion like that.....just to be safe.

 

Hi,

A little more information would be helpful.

Medical history.

Activity.

When the lesion was first noted?

etc.....

Also as there is callus present does the patient walk barefoot either indoors or out?

Foreign object may be a likely cause (even in absence of pain).

Interested in your findings.

Kind regards,

Mandy.

 

Agree with Twirly - looks like foreign body or foreign body trauma and more info required. Is she neuropathic??

Id probably get my scapel to them.. but that just me all over.. pick it and see what happens

 

Agree with Twirls and my fellow picker....more info would be great. Whilst it`s good to have pics, I will always take med hx and get the pt to describe the duration, onset etc of the problem before I even look at any lesion. That reduces the redherrings affecting dx.

That said, looks like tinea to me but wouldnt like to say for sure....

cheers,
Bel

 

The patient has been attending my surgery for many years, has no medical problems of any sort, her nails are fine too, they just need cutting. She does walk about bare foot and has some callus on the soles, but this latest peeling appeared about 3 months ago and does not seem to change. It is at the side of the foot, not normally the site of callus. I have seen Tinea but I did not think this was. Nevertheless I am going to try an antifungal, just in case! There seems to be no foreign object there, I have looked at it under magnification. The skin is not very thick that is why I did not take my scalpel to it.

 

is there a history of psoriasis with this Px??

 

hi,

for my twopennies worth, i looked at the pics (good pics by the way!) and thought tinea...i also would just pick at the redish areas to see what happens...Hx seems to idicate the other suggested ddx of TP or foregin body. sometimes a look under a mag works but i would still have a pick. if you are still unsure...refer on!

good luck
poppet

 

No psoriasis. Thanks for all your suggestions, I shall take my scalpel to it at the next visit and let you know how I get on!

 

Hi,
If its a FB why a similar lesion on the posterior heel?
has your patient recently changed her shoes? or has she started any new physical activity? walking?gym?

the pattern of involvement, post heel and lateral foot suggests physical stimulus may be?? i could be wrong, assuming she has a supinated foot.

similar patterns at elbows? behind neck? have you ruled out atopic eczema? (may be not, as u said its not itchy)

try vasaline or any oil based cream over the areas to reduce shear forces.

In doubt send the skin scrappings for examination.

Regards

David

 

Looks like someone applied something, covered it, removed it and picked at it

 

Hi Zsuz !

Had a client with a very similar looking issue, and the outcome, no medhis issues or dermatological background......therefore she was sent off to the GP, it was a reaction to an insect bite picked up from the lawn. FucidinH prescribed and used, slight paring .... clients foot as good as new ..........

Edwina

 

What is it? Skin scrapings for exclusion of fungal infection, skin swab for exclusion of bacterial infection. Looks eczematous, but could be psoriatic - had a recent case with a similar appearance and the dermatologist Dx of psoriasis was a surprise - I didn't look in the patient's scalp as the dermatologist did to make the diagnosis.