The first photo is a close-up of red, inflamed skin, on the breast of a woman who was scratched by her cat. Dr. Batra explains this is a rare condition called pyoderma gangrenosum. This occurs when there is an injury to the skin and all of these inflammatory cells rush to try and heel the injury but they get stuck. There is then an overabundance of cells called neutrophils. Dr. Batra equates it to when there is a car accident and all of the bystanders block the way of the first responders. Similarly, the wound healing is blocked so it becomes this horrible, painful, non-healing ulcer.
Dr. Batra adds this is very challenging to diagnose because there are so many other reasons that need to be ruled out and also, it can only be diagnosed by having a biopsy. It is much more common in people with anti-inflammatory disorders and the treatment involves long-course anti-inflammatories which can take months or even years. Even after it heals, unfortunately, there is significant scarring.
The next photo of a giant ulcer on a man’s foot is a much more common occurrence. ER physician expert Dr. Travis Stork explains the man in this photo weighs 370 pounds and smokes one and a half packs of cigarettes each day. He had gastric bypass and lost 130 pounds, and then developed this wound on his foot.
Dr. Batra says this is a photo of a diabetic foot ulcer and it occurs in about 10% of people who are diabetic. Dr. Batra says diabetics’ elevated blood sugar levels dramatically slow down the body’s ability to heal wounds and people with uncontrolled diabetes often have nerve damage or neuropathy in their feet.
The challenge with ulcers like this is that they can be horrifically deep, straight to the bone, and seated with bacteria. They can be very difficult to seal up.
Dr. Travis notes this is a classic example of how prevention is so much better than treatment. The Doctors always tell people with diabetes to get their feet checked out. You can develop this and not even feel it! Even if you are not diabetic, Dr. Travis says to take a look at your feet tonight!
The last image is of a woman’s leg after she got scratched by a rusty nail. This condition is called necrotizing fasciitis. Dr. Batra explains necrotizing means the death of the tissue. Fascia is the sheath overlying the muscle.
Dr. Batra says this condition is caused by a number of different bacteria but in this case, it was black mold that was found in this woman’s bloodstream. This is a very aggressive infectious agent that can spread quickly. People with it can develop fevers and become very sick, even septic, says Dr. Batra. The treatment is surgical because the dead tissue needs to be removed.
Dr. Travis points out the surface appearance of a wound can be misleading; while this last image is the least gruesome, it’s actually quite serious. If you see a wound and you don’t remember how you got it, Dr. Travis advises getting to the ER right away.