Chronic nonhealing ulcer on the hand

Abstract

A 12-year-old boy presented with a progressive chronic ulcer over the left hand of 6 yearsÕ duration. The lesion had started as a skin-coloured papule over the dorsum of the left hand. It later ulcerated and gradually extended over a number of years to the adjacent area at one end and healing with scarring at the other. This led to fusion of the middle three fingers of the left hand, causing difficulty with movement. The lesion was not preceded by any local trauma or bite. He was from poor socioeconomic background and his immunization was incomplete. There was a history of weight loss for past 2 years.On physical examination, the patient was found to have mild pallor and bilateral submandibular and posterior cervical lymphadenopathy, with no systemic abnormalities. There was atrophic, hypopigmented, Ôcigarette paperÕ-like scar involving the dorsum of the left hand merging with the ulcer. A large well-defined, irregularly bordered, painless ulcer with adhesion to the underlying bone was present, involving the dorsum of the left hand, and the index, middle and ring fingers, extending to the distal part of the palm. (Fig. 1a,b) The involved three fingers were fused with each other proximally due to extensive granulation tissue and necrotic slough, distorting the finger morphology. The patient also had pediculosis capitis and pyoderma over his face. Figure 1 Well-defined, irregularly bordered, painless ulcer involving the dorsum of the left hand and the index, middle and ring fingers. Note the hypopigmented atrophic scarred patch proximal to the ulcer.

Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

“…Plaque-type LV is considered a common form, while based on a study done in India, the ulcerative type was the least common clinical variant, accounting for 14.2% of cases [8]. Long-standing ulcerative LV may eventually lead to scarring and deformity in addition to the risk of squamous cell carcinoma [9]. Fortunately, our patient had no destruction or deformity in the underlying tissue.…”

Mycobacterial infections of the hand and wrist

“…Concomitant tuberculous infection of the spine was discovered after the patient's presentation with digital pain and swelling. 7 De et al 8 reported a 12-year-old boy with 6 years of chronic ulceration and tissue remodeling of the left hand causing fusion of the index, middle, and ring finger. The lesion was bordered on the dorsum of the hand with an atrophic, hypopigmented ''cigarette paper-like'' scar.…”

“…The patient was treated with isonizaide, rifampicin, ethambutol, and pyrazinamide and was markedly improved after 4 weeks. 8 Chrispal et al 9 reported a 40-year-old immunocompetent woman with fusiform swelling of the small finger of her left hand. The patient failed to improve after an initial debridement and course of antibiotics.…”