Q. I have white spots secreting pus with cellulitis in my leg thumb region. Kindly help me.

Answered by
Dr. Dhepe Snehal Laul
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 26, 2021

Hi doctor,

I am a 21-year-old male of height 5'10" and weight 92 kg. My left leg thumb region has cellulitis with white spots secreting pus. On the first day, there was only itching, but the second day it started to pain and hotness over the region. Today is the fourth day since the problem started. I have no medical history.

Please suggest medication.



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Is there a loss of nail cuticle? Are you diabetic? Is there any history of injury or microtrauma? Do you have a fever? Is there any oozing? What is your occupation? Was there any prolonged contact with water?

Please answer the questions and attach a clinical picture of the lesion so I can guide you accordingly.

Hi doctor,

Thank you

I think it is because my legs were wet due to soaked in the rain for a long time. Please see the images of the infection attached. There is a lot of tiredness, not feverish. Kindly give your opinion.



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It is mixed pattern onychomycosis with secondary bacterial infection (attachments removed to protect the patient's identity). Risk Factors include nail trauma, diabetes, autoimmune disorder, advanced age, family history, environmental factors (hot, humid regions, barefoot walking, occlusive footwear), peripheral vascular disorder, etc.

Differential diagnosis include paronychia, bacterial infection, nail dystrophy, nail changes due to systemic illness, nail atopic dermatosis, nail bed tumor, etc.

Nail clipping is needed to confirm the diagnosis (one sample for direct microscopy and one for culture). Other diagnostic modalities are KOH (potassium hydroxide) mount, special stains, HPE (Holoprosencephaly), nail dermoscopy.

I suggest applying 5% Amorolfine Nail lacquer one to two times a week for 12 weeks or Ciclopirox 8% is another alternative and Mupirocin ointment (T-Bact ointment) twice daily in the morning and evening for ten days. Wear loose shoes. Keep nail short. Avoid barefoot walking.

Is it painful?

I hope this was helpful.

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