What could be causing the persistent round red rash around the right ankle despite taking medicines?

Question

Hello doctor,

I am a 36-year-old female teacher having this problem. It started as a round red color rash with red dots around the right ankle and it was burning. After two weeks I consulted the first skin specialist he told me it can be a vascular ulcer and he gave me medication that did not work even after consulting twice, meanwhile I was taking medication for vitiligo also (prescriptions are uploaded for reference). The second skin specialist told me it is an infection and he gave medications (Lynx 200 mg) and he also said it may be a poisonous insect bite. The third skin specialist gave me Zempred-16 and I uploaded all prescriptions for reference. Lastly, I went to a cardiothoracic surgeon to rule out if it is varicose veins, it was none and he also did not understand but prescribed medications for one month (Daflon 1000 mg) which initially was a relief but now it is the same situation, no relief and there is a pain in the right ankle. I am confused as to whom to consult, so I am making an approach to orthopedic since I am suspecting it may be bone related.

Kindly clear my doubts and provide medication for the same.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and the images provided here (attachment removed to protect the patient's identity). Although the lesion is in the area of a varicose ulcer there are no dilated veins visible in the images provided here. So as of now, we can keep that later for discussion, in case you provide images showing dilated veins we can discuss it further.

For this lesion to be caused by the bone-related issue, I need to know a few more things about your condition.

Did you have an injury or trauma to incite the event?

Do you have a fever, malaise, or decreased appetite?

Any episode of similar wounds in the past?

Do you have any X-rays of the region? if not then I would like to see it for any changes in the underlying bone.

Any similar lesion elsewhere on the body?

The lesion can be due to osteomyelitis (infection of the underlying bone) or it can be attributed to dermatological causes as suggested by your skin specialist.

Answer 2

Hi,

Welcome back to icliniq.com.

Doppler only shows the blood flow (attachment removed to protect the patient's identity). It is not of any use to determine if the infection is coming from the bone or not. If the issue has started after the injury, then it is either a nonhealing ulcer for which a general surgeon or orthopedic surgeon does the management or it can be osteomyelitis. X-ray is the minimal investigation which is a must in this case. In case the X-ray is normal and there is a high suspicion of osteomyelitis then MRI (magnetic resonance imaging) or other scans might be required. Since there is no positive history of injury or infection-related history or venous malformation. My recommendation is to get a basic test first.

What could be causing the persistent round red rash around the right ankle despite taking medicines?

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