Leg and foot ulcers. An epidemiological survey

Medical records for leg and foot ulcer patients have been investigated, 1377 patients were found. The median age for women was 76 years and for men 70 years. Totally there was a majority of women, 61%. The age specific frequencies for leg and foot ulcer patients did however not differ between men and women. Thirty percent of all patients had ulcers on the feet only. The ratio between men and women for feet ulcers was 1:1. Men got their feet ulcers 5-10 years earlier than women. Seventeen percent of all patients had ulcers on the medial side of the calf only. Seventy percent of these patients were women. A rough estimate of the prevalence of leg and foot ulcer patients was made to between 0.2-0.4% of the whole population. The involvement of different medical disciplines in the care of leg and foot ulcer patients in Gothenburg is reported.     

Eczema en los pies en una consulta de alergia cutánea: estudio retrospectivo de 13 años

IntroductionFoot eczema is a common complaint encountered by skin allergists.ObjectiveTo study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved.Material and methodsCross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema.ResultsOf the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients > 18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%).ConclusionPatch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement.     

Foot Ulcer Due to Arteriovenous Malformation: Report of a Case

A 41-year-old woman had erosive eruptions surrounded by irregularly shaped pigmentation on the lateral aspect of her right foot, where she had noted gradually increasing warmth and pain for 10 years. The eruptions waxed and waned without complete healing, and an ulcer which had formed one year previously did not respond to topical treatments. Arteriography performed on the right lower extremity disclosed multiple diffuse arteriovenous malformations in the right lower leg and foot. The ulcer was treated by bed rest, surgical debridement, and topical application of bucladesine sodium ointment. After three months, the ulcer healed, leaving a shallow scar and pigmentation.     

The effects of foot disease on quality of life: results of the Achilles Project

BACKGROUND: Foot diseases have a high prevalence in the general population, but their impact on quality of life has not been assessed in large-scale studies. The Achilles Project surveyed foot disease in patients visiting their primary care physician or dermatologist. METHODS: A total of 43 593 patients were asked about the impact of their condition on their quality of life: pain, discomfort in walking, limitations in daily activities, and embarrassment. RESULTS: Overall, 52.5% of patients had some aspect of their quality of life affected by their foot disease. More specifically, 30.7% of patients experienced pain, 40.3% had discomfort in walking, 19.6% had their daily activities limited, and 27.3% were embarrassed. The survey indicated a larger impact of foot disease on the quality of life of women vs. men in all categories, except for daily activities. Similarly, the elderly (> or = 65 years) were more affected by their foot disease, although they suffered no more embarrassment than other age groups. Participation in sports seemed to lower the proportion of patients who had their quality of life adversely affected. Non-fungal foot diseases, particularly ulcer and gangrene, are more likely to cause pain, discomfort in walking and limit daily activities, than fungal diseases. CONCLUSIONS: In general, non-fungal foot diseases caused pain, discomfort in walking and limitations in daily activities in more patients than fungal foot diseases, but a higher proportion of patients with fungal foot diseases were embarrassed by their condition than patients with non-fungal foot diseases. The study found that the impact of foot disease on quality of life may be greater than previously suggested. Given that effective treatments are available, routine examination of patients' feet by dermatologists and primary care physicians may help to reduce the burden of these foot conditions.     

Milia-like Idiopathic Calcinosis Cutis Occurring in a Toddler Born as a Premature Baby

Milia-like idiopathic calcinosis cutis (MICC) is characterized by smooth, firm, whitish papules resembling milia. Histologically, it appears as a well-defined, round, basophilic nodule within the upper dermis. Although the etiology and treatment remain unclear, it may resolve spontaneously. Some cases have been associated with Down syndrome, and the mean age of MICC patients was 9.9 years old. Herein, we report a rare case of MICC that was not associated with Down syndrome. Noticeably, the patient, a toddler, was born as a premature baby and had an ischemic injury on the right foot at birth. However, the lesions appeared on both feet, including the non-injured left foot. Otherwise he was healthy. After a 21-month follow-up period, the lesions had almost disappeared without any treatment.     

Acquired fibrokeratoma. A long standing case with a peculiar shape

An acquired fibrokeratoma which had developed on the sole of the right foot of a woman over the past 37 years was removed surgically at the age of 55. It was shaped like a fleshy leaf. Histologically, it was characterized by a protrusion of the sole devoid of skin appendages.     

表现为多发性斑块的软骨样汗管瘤

报告1例罕见的多发性软骨样汗管瘤。患者男,36岁。右跖部褐色斑块2年,手部褐色斑块1年,均伴有局部疼痛。经组织病理检查诊断为软骨样汗管瘤。采用雷公藤多苷治疗有效。     

Superficial spreading capillary hemangioma. A peculiar type of capillary hemangioma

A 57-year-old Japanese woman had a history of several years of a slowly growing, dark red plaque on the sole of her foot without any subjective symptoms. Histopathologically, the lesion was a capillary hemangioma which showed a lobular structure composed of newly formed capillaries. Each lobule was separated by thin elongated rete ridges. The lesions was definitely circumscribed in papillary and subpapillary layers and appeared to extend laterally.     

Treatment of EARLY‐ONSET Gorham Syndrome with 8‐Year Follow‐Up

Abstract: A case of Gorham disease with several years of follow‐up is reported. At birth he had a mass in the thigh which was had pathology demonstrating a lymphangioma. By age 3 years, he had lymphedema of the ipsilateral foot and discrepant leg lengths. Radiography revealed heterogenous dystrophy of the bones and osteolysis of the hallux. At age 6, a spontaneous fracture of the right tibia was treated with surgery. Histopathology of a bone sample demonstrated bone remodelling, fibrous tissue, and large vascular lacunas within bone tissue, bordered by cells expressing the lymphaticmarker D2–40. At 8 years old, lymphedema of the right inferior leg had increased, leg lengths still differed, but other clinical signs were absent.     

Does the proximity of an amputation, length of time between foot ulcer development and amputation, or glycemic control at the time of amputation affect the mortality rate of people with diabetes who undergo an amputation?

OBJECTIVES: The main purpose of the authors' research was to compare the 3- and 5-year mortality rates of diabetic patients who have undergone a lower-extremity amputation, evaluating the proximity of the amputation in 3 groups (toe and foot amputation, BKA, and AKA), the timing of the amputation (within or after 2 years of the onset of the foot ulcer), and the effect of glycemic control at the time of amputation, regardless of the level of amputation. METHODS AND DESIGN: The subjects were 80 male inpatients at Illiana Veterans Health Care System who had diabetes, diabetic neuropathy, peripheral vascular disease, and a diabetic foot ulcer that resulted in an amputation. Of the 80 patients, 29 had a toe amputation, 30 had a BKA, and 21 had an AKA. The mean age in all 3 groups was 68.5 years+/-7.2 years. The authors used the hemoglobin A1C (Hgb A1C) level to assess glycemic control. MAIN OUTCOME MEASURES: Several chi tests were used to compare the 3- and 5-year mortality rates among the amputation groups. An Hgb A1C level of 8% or less defined good glycemic control; an Hgb A1C level of more than 8% defined poor glycemic control. A chi test was used to compare glycemic control, the level of amputation, and the mortality rate. A chi test was also used to evaluate the length of time between ulcer formation and amputation, the level of amputation, and the mortality. All statistics were done using SPSS 10.0 student version. CONCLUSIONS: The research revealed a statistically significant difference in mortality among the 3 groups at 3 and 5 years. No statistically significant difference in mortality in patients with good glycemic control and patients with bad glycemic control was found. At 3 years, a statistically significant difference in mortality existed between patients who had an amputation within 2 years of ulcer formation and those who had an amputation after 2 years. At 5 years, no statistically significant difference existed between these 2 groups.     

Primary Cutaneous Nocardiosis

A 35-year-old male presented with multiple discharging sinuses and fluctuant swelling on right side of face which started after a vehicular accident three year back. The lesions did not respond to routine antibiotics treatment but went on increasing. Gram smear showed typical acid fast branching filaments suggestive of nocardiosis, which was confirmed by culture. Patient received co-trimoxazole for three and a half month. When seen again after three years, all the lesions had healed with puckered scarring. Patient had received co-trimoxazole for three and a half months with dramatic improvement.     

Severe allergy to sorbolene cream

A 40-year-old male developed a constant hand and foot dermatitis in 1980 while using sorbolene cream as a barrier cream at work. He was forced to leave his trade as a motor mechanic because of his hand dermatitis. It was not until 16 years later that he was diagnosed as having an allergic contact dermatitis to chlorocresol secondary to an endogenous hand and foot dermatitis. Chlorocresol is the preservative used in sorbolene cream as well as many corticosteroid creams. Patch testing carried out in 1983 was negative but had omitted testing with chlorocresol or sorbolene cream.     

Shoe dermatitis

Chronic foot dermatitis can be disabling and footwear allergy is not always excluded as a partly because patch testing to shoes and their components can he daunting. Once the diagnosis of shoe allergy is made, the difficult problem of finding suitable footwear remains. There is a lack of literature regarding the follow-up of these patients. We analysed the data on 55 patients with allergic contact dermatitis from their shoes and followed them up to see whether knowledge of the allergen had enabled them to find suitable footwear and to improve their dermatitis. The files of 55 patients with shoe allergy were analysed, and 4K were followed up. Rubber was the commonest allergen, followed by chromate. P -tertiary-butylphenol-formaldehyde resin and colophony. All parts of the feet were affected, except the interdigital areas. The majority of patients suffered from hyperhidrosis, 43% were atopics, who had a super-added shoe allergy. The mean duration of the foot dermatitis before patch testing was 4 years 8 months. Follow-up of 48 cases showed that 87.5% had either improved or resolved completely. Most of our patients were successful in finding suitable footwear and many differing strategies were used. All patients with foot dermatitis which does not respond to treatment should be patch tested to exclude shoe allergy.     

肢端无色素性黑素瘤

报告1例肢端无色素性黑素瘤。患者女,51岁。因右足第2趾背水疱、糜烂1年余就诊。皮肤科检查见右足第2趾背有一浸润性斑块。皮损组织病理学检查示:真皮内可见一浸润性肿瘤团块,免疫组化染色示S-100蛋白( ),gp100及melanoma(pan)均(±)。诊断为无色素性黑素瘤。     

Stepease™ diabetic socks: An answer to efficacious indoor foot pressure relief- A prospective study

BackgroundDiabetic foot ulcer is commonly seen in people with diabetes mellitus. Inadequate plantar pressure offloading has been identified as a contributing factor to development of diabetic foot ulcers. Various pressure off-loading footwear are widely available in the market but poor compliance has been reported especially for indoor usage. StepEase™ diabetic socks have been designed using Ethylene Vinyl Acetate (EVA) microspheres for better redistribution of plantar pressure. The objective of this study was to determine the efficacy of StepEase™ in redistributing the foot plantar pressure and to assess patients’ satisfaction on the usage of the socks.MethodsThis was a prospective non randomized clinical trial conducted on 31 patients with diabetes mellitus with high risk foot (King's classification stage II) over a 12 weeks period. Dynamic foot plantar pressure reading was recorded at day 0, 6 weeks and 12 weeks intervals, both barefoot and with StepEase™, using Novel Pedar-X system (Novel GmbH, Munich, Germany). Patients' satisfaction and usage practice were assessed by a questionnaire.ResultsThe mean age of subjects was 57.9 years with mean body mass index (BMI) of 26 kg/m². The mean duration of diagnosis with diabetes mellitus was 10.2 years. The mean peak plantar pressure was found to be highest at the right forefoot and left heel region, 267.6 kPa (SD113.5 kPa) and 266.3 kPa (SD 94.6 kPa) respectively. There was a statistically significant reduction of mean peak pressure (P < 0.0001 to P = 0.024) in all masked regions except the left toe region ranging from 22.3 to 47.5% (53.2–117.4 kPa). The highest reduction was seen in the right toe region (47.5%). The reduction of peak pressure was still significant (P < 0.0001 to P = 0.034) at 6 weeks ranging from 24.7% to 46.8% (46.1–100.6 kPa) and at 12 weeks, which was 22.2–49.2% (40.6–91.9 kPa). Mean usage of the socks was 4.39 days per week (SD 1.82), with the mode of 4–6 h per day. Most of the subjects were satisfied or very satisfied with the StepEase™ socks (77.4%) while 87.1% agreed to continue using the socks. None had any new ulcer development or fall during the study period.ConclusionStepEase™ was significantly effective as an indoor foot pressure relieving footwear. It resulted in significant peak plantar pressure reduction by up to 49.2% and the effect was maintained for at least 12 weeks duration.     

Cutaneous Plexiform Schwannomas in a Patient with Neurofibromatosis Type 2

Plexiform schwannoma is a rare benign neoplasm of the neural sheath characterized by a multinodular plexiform growth pattern. The tumor usually occurs as an isolated finding, although rare cases have been reported in association with neurofibromatosis type 2 (NF2). A 25-year-old man was admitted for foot drop. He had an asymptomatic skin-colored nodule on his neck that had been present for 10 years. His medical history included local excision of a plexiform schwannoma on his left leg in our dermatology clinic 6 years prior. A histopathological examination of the skin-colored nodule also showed the typical microscopic features of a plexiform schwannoma, including the characteristic Antoni type A areas showing frequent nuclear palisading and Verocay bodies. Magnetic resonance imaging revealed a meningioma and a vestibular schwannoma in the cranium and multiple neurofibromas on the spinal cord. Herein we report a rare case of cutaneous plexiform schwannomas in a patient with NF2.     

Health status and plasma dioxin levels in chloracne cases 20 years after the Seveso, Italy accident

BACKGROUND: The Seveso, Italy accident of 1976 exposed a large population to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD or simply dioxin). The accident resulted, mostly among children, in one of the largest ever-reported outbreaks of chloracne, the typical skin disorder due to halogenated-hydrocarbon compounds. OBJECTIVES: Approximately 20 years after the accident, we conducted an epidemiological study in Seveso to investigate (a) the health status of chloracne cases; (b) TCDD-chloracne exposure-response relationship; and (c) factors modifying TCDD toxicity. METHODS: From 1993 to 1998, we recruited 101 chloracne cases and 211 controls. Trained interviewers administered a structured questionnaire assessing, among other epidemiological variables, information on an extensive list of diseases. During the interview, individual pigmentary characteristics were determined. We measured plasma TCDD levels using high-resolution gas chromatography/mass spectrometry. RESULTS: Plasma TCDD was still elevated (> 10 ppt) in 78 (26.6%) of the 293 subjects with adequate plasma samples, particularly in females, in subjects who had eaten home-grown animals, and in individuals with older age, higher body mass index and residence near the accident site. After 20 years, health conditions of chloracne cases were similar to those of controls from the Seveso area. Elevated plasma TCDD was associated with chloracne [odds ratio (OR) = 3.7, 95% confidence interval (CI) 1.6-8.8, adjusted for age, sex and residence]. Chloracne risk was higher in subjects younger than 8 years at the accident (OR = 7.4, 95% CI 1.8-30.3) and, contrary to previous hypotheses, did not increase at puberty onset or in teenage years. Subjects with elevated TCDD levels and light hair colour had higher relative odds of chloracne (OR = 9.2, 95% CI 2.6-32.5). CONCLUSIONS: Dioxin toxicity in chloracne cases was confined to the acute dermatotoxic effects. Chloracne occurrence appeared related to younger age and light hair colour. Age-related dioxin elimination or dilution must be taken into account in interpreting these results.     

Delayed reaction to suture material simulating melanoma.

A twenty-one-year-old woman who had been involved in an accident sustained severe trauma to the left side of her face and scalp. Because of deterioration in her neurologic condition, a number of exploratory burr holes were drilled in her skull. Fifteen years later, a 6 mm black tender nodule was noted on the left temple, close to one of the burr holes. Nodular melanoma was suspected, but results of microscopic examination proved the lesion to be a granuloma with transepidermal elimination of exogenous filamentous material. The relationship between foreign bodies and cutaneous neoplasia, genuine or simulated, is noted briefly.     

The impact of foot complications on health-related quality of life in patients with diabetes

BACKGROUND: The concept of health-related quality of life (HRQoL) has been the focus of much debate in recent years. However, within diabetes the focus has centred on the behavioural adaptation to a chronic disease state. The impact of foot complications is witnessed regularly in the clinical setting; amputation in this group is usually preceded by ulceration and a worsening cycle of foot problems. OBJECTIVE: This review sets out to investigate the literature on foot complications in those with diabetes, to assess the cost to the individual in terms of impact on everyday living. CONCLUSION: The literature on the specific impact of foot complications is limited, but indicates a situation in which those with diabetic foot ulceration may have an even poorer HRQoL than those who have experienced an amputation related to diabetes. In order to assess the full impact of new treatments or therapeutic interventions, it is vital that further research is conducted in this area.