How can a 94-year-old woman get rid of the persistent swelling, discoloration, and blisters on her legs?

Hello,

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I have reviewed the history and images provided (attachments removed to protect the patient's identity). They appear as stasis dermatitis. It is an inflammatory condition caused due to multiple factors including gravitational edema where fluid pooling on the lower limbs, especially around ankles and feet, is due to underlying venous insufficiency. In addition, the venous blood meant to be moving upwards from the lower limbs is incompetent and unable to move up, thereby leading to pooling around the leg. It can also be due to lipodermatosclerosis wherein the layer underneath the skin becomes thick due to venous problems resulting in hyperpigmentation. Sometimes, underlying medical conditions caus pedal edema or fluid accumulation around the legs due to liver, kidney or cardiac issues.

They usually present with hyperpigmentation or discolouration of the skin. Sometimes, there may also be noticeable ulcerations on the skin especially around the ankles and secretions.

I suggest you do the following:

1. Blood tests, D-dimer test, ECG (electrocardiogram), urine analysis may be done to rule out any underlying medical condition.
2. Ultrasound of leg is always advised to check for veins and arteries. Unfortunately, this may require to consult a doctor in person. However, you may check with laboratories to see if they have alternative options to be done at home.
3. Conservative management is the main approach as the aim is to reduce the skin peeling and thickening as much as possible.
4. Novasoft (Liquid Paraffin and White soft Paraffin) cream to be applied thrice daily (morning , afternoon, and evening) on the affected area to keep the area hydrated and soft.
5. Lukewarm saltwater cleaning and soaking once daily for five minutes to prevent secondary bacterial infection and reduce inflammation may be helpful.
6. Elevation of legs also helps with reducing the chances of swelling.
7. Compression stockings help reduce the swelling as well. However, if they may cause discomfort to your grandmother, kindly avoid them.
8. In case of secretions, they may be given for swab testing, which may be done at home by a lab technician to rule out the presence of bacteria via culture and sensitivity. Then, depending on the reports , antibiotics may be started.
9. Mupirocin 2 % cream twice daily may also be applied in case of blistering or secretions on the affected area.

Consult a specialist doctor, discuss with them, and take medications with their consent.

I would like to mention that stasis dermatitis may not be completely cured. Still, they may be reduced and managed by finding the root cause of the same and considering the above conservative treatment modalities.