Q. I have recurring ulcers on my neck, shoulder blade, chin, and side of the mouth. Please help.

Answered by
Dr. Shanza Ikram
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 31, 2020

Hi doctor,

I have these recurring ulcers on my neck, shoulder blade, arm, chin, and the side of the mouth. Not all that painful and sometimes not painful at all. They appear to be tracking along with the lymphatic system. Ulcers generally start as a tiny red dot. If bumped, scratched, etc., they develop into necrotizing ulcers up to 1.5 cm within a week and take around four to eight weeks to heal eventually. I had really bad dandruff and what felt like fine sand sprinkling out of my hair and running down my back the day before. I have gradually had more lesions start, and some track along lymph such as my lower neck has tracked 8 cm, and one on hand has tracked across my hand, and half circumference, One on the arm has tracked approximately 10 cm. Usually, as soon as it heals in one spot, it will open up again on the edge of the opened side or very close to it. I have tried most topical ointments, and makes no difference. I have been attempting to cover it from the onset. This seems to make them develop the worst; keeping uncovered and spraying with White vinegar appears to be the only topical treatment that works along with debridement with alcohol sanitizer once a week. If debrided at the onset daily and sprayed with vinegar, they do not develop larger than a few millimeters before healing within days.

The blood tests are done, which came back with Pseudomonas species, Citrobacter Freundii, and some skin flora. My concern was with the skin flora as I have recently purchased a microscope and look at some of the material that has form these lesions. They show a lot of branched hyphae and tube rod-shaped structures. The doctor has not mentioned this as an issue, but there seems to be quite a lot. I want your opinion on what type this may be and if this is normal to have this amount and type in my skin. The lesions look like I started with one last year and got up to 25 simultaneously the previous month, including one in the center of my palm before starting on antibiotics, which have stopped it from getting worse but hardly improved. Should I be concerned with this amount of fungal hyphae, and if so, what should I ask my GP to assess. My condition is still to have a confirmed diagnosis and would appreciate your opinion. I am currently taking Statins for hypercholesteremia and NASH, Aspirin for arteriosclerosis, and Resprim Forte to treat lesion bacteria.



Welcome to icliniq.com.

I have gone through the case. I have been to get access to your laboratory reports (attachment removed to protect patient identity) only, and you have not uploaded any picture of your skin lesion for evaluation. Now, based upon your history and lab report, my diagnosis is a secondarily infected wound. Apart form pseudomonas and citrobacter growth, there is also squamous hyperplasia and stroma degeneration. It shows that due to a rating, your small lesion gets infected secondarily. In my opinion, you should not try to scratch the lesion. Let it take its course. See whether scratching is making it worse. If you get an irresistible desire to itch, then take some anti allergies like Cetirizine at night. Now your questions regarding the growth of hyphae. Well, as I have described to you that whatever your primary illness is, now your wound is getting emotional, secondarily infected either with bacteria of fungus. Mixed skin means gram-positive or harmful bacteria.

Thank you, doctor, for your reply.

I have sent you some pictures of the fungi hyphae. I understand the bacteria are secondary infections, but the question was more around the quantity of flora (fungi hyphae) contained within the blood and samples I have taken and analyzed under my microscope that have not been identified on the laboratory reports.

Thank you.

Kind regards.



Welcome back to icliniq.com.

I have gone through the files (attachment removed to protect patient identity). Yes, these are the pictures of fungus hyphae. Your report might not have shown the fungus because there may be the possibility that there might be no growth when you send the sample, so it is not mentioned in your report.

Take care.

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