Hard-to-heal wounds are a major cause of morbidity and/or mortality. Multiple aetiologies can be identified and wounds can be treated according to their aetiology and macroscopic appearance. However, evidence behind the wide range of locally applied treatments is weak, without clear guidelines available to treat a variety of wound aetiologies. We present the case of a 63-year-old male with hard-to-heal wounds not responding to standard topical treatment. No clear underlying aetiology could be found. Extensive contact allergies were diagnosed after multiple topical and systemic treatments had been applied. A full recovery was observed after stopping topical agents and treating the wounds with an alternative treatment based on epicutaneous test results.
Dermatitis, Allergic Contact , Immersion Foot , Administration, Topical , Dermatitis, Allergic Contact/diagnosis , Diagnosis, Differential , Humans , Immersion Foot/diagnosis , Male , Middle Aged , Wound Healing , Wounds and Injuries/drug therapy , Wounds and Injuries/physiopathology
Treating skin disorders in wilderness settings is often challenging. In this report we describe common skin conditions affecting the feet of river runners on the Colorado River in Grand Canyon National Park. These conditions are frequently referred to by river runners with a catchall term, "tolio." Several skin disorders have been identified as components of tolio, with the most prevalent currently being pitted keratolysis. We present a case of pitted keratolysis in a river guide occurring during a multiday river trip, where treatment can be difficult. Prevention is often more important.
Athletic Injuries/diagnosis , Athletic Injuries/therapy , Foot Rot/diagnosis , Foot Rot/therapy , Immersion Foot/therapy , Water Sports , Animals , Arizona , Athletic Injuries/etiology , Foot Rot/etiology , Humans , Immersion Foot/diagnosis , Immersion Foot/etiology , Male , Middle Aged , Treatment Outcome
A 6-year-old boy was admittted because of dark discoloured and painful finger tips of both hands, which had developed 2 weeks after playing with bare hands in a ditch with cold water still containing parts of ice. Trench foot of the hands was diagnosed.
Amlodipine/therapeutic use , Hand/pathology , Immersion Foot/diagnosis , Vasodilator Agents/therapeutic use , Child , Diagnosis, Differential , Humans , Immersion Foot/drug therapy , Male , Treatment Outcome
Dermatitis/diagnosis , Military Personnel , Tropical Climate , Dermatitis/etiology , Dermatomycoses/complications , Dermatomycoses/diagnosis , Diagnosis, Differential , Humans , Immersion Foot/complications , Immersion Foot/diagnosis , Insect Bites and Stings/complications , Insect Bites and Stings/diagnosis , Miliaria/complications , Miliaria/diagnosis , Vietnam
The syndrome of immersion foot is being seen with increasing frequency among the homeless population. It represents the effects of injury by water absorption in the stratum corneum of the skin of the feet. The taxonomy of this disorder is confusing and the many colorful pseudonyms should probably be dropped in favor of a simple classification based on the temperature of the water and the duration of exposure. When uncomplicated by infection or ischemic injury, immersion foot will quickly resolve with conservative measures only. More complicated cases may require antibiotics and surgical treatment. This syndrome may be exacerbated by disturbances of cognition, peripheral neuropathy, peripheral vascular disease, or the use of tobacco or vasoconstrictor drugs such as cocaine. A major contributing factor seems to be lack of shelter in the homeless population. Attention to foot care problems among the homeless and education concerning preventive measures are incumbent on physicians who care for the indigent.
Ill-Housed Persons , Immersion Foot/epidemiology , Adult , Aged , Female , Georgia/epidemiology , Humans , Immersion Foot/diagnosis , Immersion Foot/therapy , Male , Medical Indigency
Se realizó este estudio para evaluar el significado del componente vascular en el pie de trinchera, por medio de la medición de la temperatura superficial durante el enfriamiento y el recalentamiento del miembro afectado, mediante el empleo de la termografía infrarroja de tiempo real. Se compararon 2 grupos de 8 individuos, uno de enfermos y otro de controles. Por medio del método Anova multifactorial el nivel de significación obtenido indicó que no era necesario extender el análisis a una mayor cantidad de casos. Se observó que las curvas de recalentamiento fueron más lentas en los enfermos que en los controles, en forma muy significativa; pero algunos individuos presuntamente sanos también presentaron trastornos de recalentamiento. No es posible conocer aún si la dificultad para el recalentamiento es una condición previa a la instalación del pie de trinchera o una secuela del mismo. Si fuera cierta la primera hipótesis sería posible detectar los individuos más susceptibles y discriminarlos cuando deban concurrir a una zona de riesgo. (AU)
Humans , Male , Immersion Foot/diagnosis , Thermography/statistics & numerical data
Se realizó este estudio para evaluar el significado del componente vascular en el pie de trinchera, por medio de la medición de la temperatura superficial durante el enfriamiento y el recalentamiento del miembro afectado, mediante el empleo de la termografía infrarroja de tiempo real. Se compararon 2 grupos de 8 individuos, uno de enfermos y otro de controles. Por medio del método Anova multifactorial el nivel de significación obtenido indicó que no era necesario extender el análisis a una mayor cantidad de casos. Se observó que las curvas de recalentamiento fueron más lentas en los enfermos que en los controles, en forma muy significativa; pero algunos individuos presuntamente sanos también presentaron trastornos de recalentamiento. No es posible conocer aún si la dificultad para el recalentamiento es una condición previa a la instalación del pie de trinchera o una secuela del mismo. Si fuera cierta la primera hipótesis sería posible detectar los individuos más susceptibles y discriminarlos cuando deban concurrir a una zona de riesgo.
Humans , Male , Immersion Foot/diagnosis , Thermography/statistics & numerical data
Passive rewarming of a cold-water stressed foot was evaluated in 33 recovered trenchfoot (TF) patients and 15 uninjured men. Infrared images were recorded prior to immersion, immediately following, and at 1-min intervals for 20 min. Individual baseline temperature (IBT) recovery was used to separate subjects into three groups designated Good and Poor Rewarming Controls (GRC and PRC) and Injured Subjects (Inj Sub). IBTs were significantly less (p less than 0.01) for Inj Sub compared to both GRC and PRC while no difference existed between GRC and PRC. This relationship changed when slopes of and areas under the mean rewarming curves were compared. Both these criteria were significantly greater (p less than 0.01) for GRC than for PRC and Inj Sub, while no difference was noted between PRC and Inj Sub. It could not be determined if the poor response of Inj Sub was inherent or a result of injury. We conclude that previously injured subjects and nearly 60% of a normal population may be at significant risk for cold injury.
Foot/blood supply , Immersion Foot/diagnosis , Infrared Rays , Military Personnel , Thermography , Argentina , Blood Circulation , Humans , Immersion Foot/physiopathology , Male
Immersion Foot/etiology , Tropical Climate , Biopsy , Dermatitis/etiology , Dermatitis/pathology , Environmental Exposure , Erythema/pathology , Foot Injuries , Humans , Immersion Foot/complications , Immersion Foot/diagnosis , Immersion Foot/pathology , Male , Military Medicine , Skin/injuries , Skin Temperature , Temperature , Tropical Medicine , Vascular Diseases/etiology , Vascular Diseases/pathology , Vietnam , Warfare , Water/adverse effects
