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Leg ulcer needs second opinion
By Dr. Peter Gott | Columnist
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Published: 12/28/2009 12:04 AM

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Q. I'm in a desperate situation at age 82 and need someone to tell me what to do.

For more than a year, I have been seeing a dermatologist who says that I have an ulcer on my left leg that won't heal. I go twice a week for so-called "treatment." All they do is observe the wound drainage, scrub it aggressively with soap and a washcloth, and then pick the dead skin off. Then comes the most puzzling part: The nurse applies a cream to the wound, which is intended for jock itch, and several medicated gauze pads are applied to protect the area from bacteria. My leg is then wrapped from just below the knee to the end of my toes with an elastic bandage, which is wrapped tightly in a couple of layers. The wrap is so tight that it feels as if it is cutting off my circulation and is extremely painful.

I see the doctor every four days, and the same procedure is repeated. Between visits, I must cut the bandage in several places to relieve the unbearable pain.

The doctor says the wound is healing, and the sores are better; however, the bandage rubs my skin so badly that it creates new sores. It surprises me that he has never used a medication specified for my particular condition. At one time, I had an infection on a finger that rubs another finger owing to my severe arthritis. My primary-care doctor applied an antibiotic cream medication and gave me some to use. It cleared the sore within a week.

When I returned to the dermatologist for my leg treatment, I told him about this cream and how well it worked on another sore. He wrote it down, but he has never used it, doesn't mention it or any other medication that might work, and continues to use the same old treatment. It seems to me that I will have to go through this for the rest of my life.

If you have any suggestions, they would be greatly appreciated, as it seems that I'm stuck at a dead end.

A. You need to get a second opinion from another dermatologist. I don't believe you are receiving appropriate care.

I have never heard of using jock-itch cream to treat a chronic leg ulcer, but that doesn't mean that it isn't beneficial. Antibiotic creams are much more commonly used.

Pressure wraps are common for treating nonhealing wounds, but if they are creating sores of their own, then something is wrong. These wraps should be snug to reduce fluid buildup in the area of the ulcer, but not painful.

You don't say whether you have diabetes or peripheral neuropathy, so I am unsure how the lesion developed in the first place. If you have diabetes, it may be a sign that the wound is not being managed properly. Peripheral neuropathy is the result of nerve damage and may cause pain, tingling or numbness of the affected area. If you have lost feeling in part of your leg, an ulcer may develop owing to constant rubbing caused by ill-fitting clothing or shoes.

Don't forget to talk to a second dermatologist. Tell him or her everything you can about what treatments have been used, how long the ulcer has been present, and, if possible, bring your medical records pertaining to the ulcer from the previous physician. Perhaps something was missed or could have been tried but hasn't. Also, there are now wound-care centers in many hospitals that use the most up-to-date treatment methods.

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