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Dr. Skinner
Dr. Skinner, Dermatologist
Category: Dermatology
Satisfied Customers: 1555
Experience:  MD , DNB ( D &V), FAAD
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I have round raised edge sores on my arms with center scabs, non healing for app

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I have round raised edge sores on my arms with center scabs, non healing for approx 2 months, center turns soft and whitish in shower, not itchy, they weep clear yellowish drainage if I cover them, I have traveled to Puerto Rico end of April 2010, The sores grossly resemble leishmaniasis when I searched the web, not a listed location for this sand fly but wow it looks the same. I live in Wisconsin, have been on bactrim ds for a uti and thought maybe would clear it if was secondary infection, but nothing helps. have tried hydrocortisone and atb oint, the spots seem to follow the same progression at diff intervals, a small approx 2mm raised red bump, then looks like a red scab, then becomes a raised dark pink border with a crater like center about 7 mm around that will not heal, 3 on rt arm and 1 on lt arm, 3 small ones on lt forearm that stay little raised pink dots but have not progressed like the others, please advise

Since it is there for more than 3 months and have already tried quite a few medicines without relief, it is ideal to investigate this case.Suggest pus for culture and sensitivity, slit skin smear for LD bodies,skin biopsy from the lesion, Complete blood count with ESR, Xray Chest.The conditions to be considered include cutaneous leishmaniasis, atypical mycobacteria infection , blastomycosis, blastomycosis like pyoderma, pyoderma gangrenosum, ecthyma gangrenosum.

Customer: replied 6 years ago.
Would i need a Specialty MD or just general family MD? What tests would you do if my insurance will not cover and would like to keep costs low? does skin cancer occur in groups of lesions with sun exposure, my arms are tan but skin is fair and freckled? I did have a normal CBC lab about 1 month ago. wouldn't fungal infection itch? leisions are raised only at outer border with a sunken center, sore to touch but not painful otherwise, only drain if covered with bandaid, otherwise dry center scab. Also will be difficult to get an appointment with a Dermatologist, will take at least 1 month, is this too long to wait, would you just go to family md and ask for tests?
It is best to meet a dermatologist.if insurance cover is not there I would at least do a skin biopsy.itching is only a subjective sensation and fungal infection need not necessarily itch.Nummular eczema is another differential diagnosis.unlikely to be malignancy.A photograph may help for better diagnosis.
Customer: replied 6 years ago.
too deep to be eczema, i will need to see dermatologist as no way to send you a picture, it looks like pictures of the cutan. leishmaniasis on internet, but i'm unsure where i would have gotten this in US / Wisconsin. Was in Puerto Rico in late April but did'nt notice bites till June. started like a chigger bite and ended larger with a halo of erythemia and center crater sunken slightly w yellowish dry scab. did swim in a pond prior to bites and we do have biting flies like horse and deer flies with neighbors that have horses.
I just never had bites last this long. Thank you for your time!
The biopsy will certainly solve this mystery and guide us towards appropriate treatment.Thanks.
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