Spontaneous expanding painful ulcer

N is a young girl with a painful spontaneous ulcer on her leg which enlarged quickly to 2.5cm in diameter over 3 weeks.

Ulcers can develop for many reasons - external injury and pressure (obviously), failure to sense pain (hence suffering repeated injury - usually in diabetics), blood vessel disease (eg varicose veins, blood vessel inflammation and/or obstruction) etc. The spontaneously-occurring ulcer you see here, however, is different from these. It expands very quickly, has a boggy edge and is painful. It is important to see a dermatologist ASAP to evaluate the cause as it looks like either a blood vessel inflammatory disease (which can be either on its own or involve internal organs too), or an uncommon 'skin-eating' disease called pyoderma gangrenosum (which also can be either on its own or related to an internal disease). Concomitant infection with bacteria should also be excluded and treated.

Spontaneous Bruises in an Elderly

My friend's mum was shocked to see bruises appearing on her arm one day. She didn't recall any injury.

In old people, skin dryness is very common (it's so dry that wrinkles have formed; see picture). It causes itch which leads to scratching. Again in old people, there is poor collagen support for the blood vessels, hence these superficial vessels break easily with very minor trauma such as scratching. The bruises that form will go away on their own with time, so there is no need for alarm. This is why it is important for old people to moisturize their skins regularly!

Got a problem with your skin?

Hi folks

I am a dermatologist practising in a tertiary institution in Singapore, and I see the full range of cases - medical, surgical and cosmetic skin problems of all ages. I also do a great deal of teaching and research.

This blog serves the following purposes:
1. let people ask about their problem skins and we work out some solution
2. let others learn from your problem skin and how it was dealt with

So, what are you waiting for? Post me your problem at theproblemskin@gmail.com (must come with pictures, okay!) and see if it may be eradicated DIY, or that you do need to see a doc! Don't be shy... what have you got to lose??

Dr Skin Solution

PS. By mailing me your picture, you automatically consent to your picture being used as any form of teaching and publicity material.