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Dr. David
Dr. David, Board Certified Physician
Category: Medical
Satisfied Customers: 46722
Experience:  Experienced Physician trained in New York City. I'm ready to help.
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I have a patient with a bruise like lesion on her outer

Customer Question

I have a patient with a bruise like lesion on her outer thighs and don't know what it is
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
Hello, this is Dr. David. I have read your question and I'm ready to help.
how old is the patient?
man or woman?
any history of trauma?
is the patient taking aspirin?
would the patient be willing to get a biospy of the area?
do you have a photo of the area you can upload?
Customer: replied 2 years ago.
25 yo female, no trauma and yes to picture where can I upload ? Healty woman that diet consists of mainly coffee and low carb food
Customer: replied 2 years ago.
No aspirin and would like to avoid biopsy and show u picture
Customer: replied 2 years ago.
Normal CBC and coagulation profile
Expert:  Dr. David replied 2 years ago.
here are instructions to upload a photo
type a word in the textbox and highlight it
then select the "chain" icon above the textbox or the paper clip icon to upload a jpg
this opens a window where you can click next to the text box to select the jpg or pdf file on your computer to upload into JustAnswer
http://ww2.justanswer.com/how-do-i-send-photo-or-file-expert
Customer: replied 2 years ago.
Photo
Customer: replied 2 years ago.
Worse on left leg and seems to be getting worse, are you a dermatologist ?
Expert:  Dr. David replied 2 years ago.
most likely a bruise from when she wasn't noticing it.
she could have been hit when she was sleeping
that part of the thigh in the front is often traumatized.
how long has it been there?
Customer: replied 2 years ago.
Bruises or marks on both sides for around 4 months. I do not think it is an actual bruise
Customer: replied 2 years ago.
She doesn't seem to bruise easily and have tried to find similar cases but think I need a dermatologist
Expert:  Dr. David replied 2 years ago.
both sides?
I think she needs to get a leg ultasound to check for proper blood flow
has she had a bilateral leg doppler ultasounds?
Customer: replied 2 years ago.
No Doppler, what kind of conditions would have poor blood flow ? I am sure I could get but what condition are we looking for ?
Expert:  Dr. David replied 2 years ago.
she needs to see a hematologist and get special blood testing to check for factor II, V, VII, X deficiencies which could be causing this.
von willibrand disease is rare, but can cause it as well.
have liver enzymes been tested yet?
Customer: replied 2 years ago.
Liver enzymes normal, specific factors not done. No bleeding disorders in family.
Customer: replied 2 years ago.
Is there a good dermatology atlas online ? Can I show this picture to a dermatologist
Customer: replied 2 years ago.
No easily bruising other places, just upper outer thighs dark marks
Expert:  Dr. David replied 2 years ago.
clotting factors should be checked.
and leg dopplers should be checked as well
if these are normal, she might need to get a skin biopsy to get more information
you said she is resistant to get a biospy done?
this is your patient?
are you a primary care doctor?
does she rest computers or anything else on her lap repeatedly?
Customer: replied 2 years ago.
I am a urologist and she is a nurse I work with. I have been trying to find out what this is for her but can't seem to help her. I am sure I can get her all this tests but wants some names of possible conditions I could research that only usually present like this.
Customer: replied 2 years ago.
Maybe idiopathic livedo reticularis ? I am trying to look through dermatology atlases
Expert:  Dr. David replied 2 years ago.
trauma would still be the most common condition
like if her thighs were hitting the desk or table daily in that position.
some bruises can take months to heal
parts of the medial parts of the discoloraztion is turning yellow and healing, just like bruises heal.
bruises can take 4-6 months or longer to heal
the body makes macrophages to take away extravasated red blood cells one at a time, so it can take a long time
she could have purpuric dermatosis as a possibility.
it could be a mild case of livedo reticularis