Cutaneous ulcers

Signs and Symptoms Symptoms include pain in the lower-right abdominal area resembling appendicitis, as well as fever, headache, pharyngitis, anorexia, vomiting, and possibly watery diarrhea. May also produce arthritis, inflammation of the iris (iritis), cutaneous ulceration. Infection may also produce abscesses in the liver, bone infection (osteomyelitis), and septicemia. Carriers may be asymptomatic. May also cause infections of other sites such as wounds, joints, and the urinary tract. 

Finlay, I.G., Bowszyc, J., Ramlau, C. and Gwiezdzinski,Z. (1996) The effect of topical 0.75% metronidazole gel on malodorous cutaneous ulcers. J. Pain Symptom Manag. 11, 158-162. 

Tolazoline hydrochloride Indolent cutaneous ulcers Increases local blood flow and tissue healing by inhibiting vascular smooth muscle contraction 2% aqueous solution or ointment from positive pole ... 

As with interferon alfa, pegylated interferon alfa has been associated with injection site skin necrosis (285). Severe local reactions after subcutaneous injections mostly consist of ulceration and skin necrosis, but a variety of reactions have been described. Prominent suppuration and granulomatous dermatitis at the injection sites of interferon alfa have been reported in two patients (286). Three patients who had severe rashes while receiving pegylated interferon alfa-2a or 2b had positive intracutaneous tests to both pegylated forms of interferon alfa but not to standard interferon alfa-2a or 2b (287). One of these patients subsequently tolerated standard interferon alfa. Cutaneous ulcers have also been reported in patients treated with peginterferon alfa-2b (288,289). In the latter case, the lesions healed under local therapy and the same dose of interferon was maintained. 

Heinzerling L, Dummer R, Wildberger H, Burg G. Cutaneous ulceration after injection of polyethylene-gly-col-modified interferon alpha associated with visual disturbances in a melanoma patient. Dermatology 2000 201(2) 154-7. 

Injection-site reactions are common after subcutaneous injection of interferon beta-lb, and are more frequent than with any other available interferons. In a multicenter placebo-controUed trial, 65% of patients receiving interferon beta-lb had reactions at the injection site compared with 6% in the placebo group (2). In contrast, only 5% of those who received interferon beta-la had injection site reactions (3). The clinical features of injection site reactions to interferon beta-lb mostly consist of benign inflammatory reactions, but they can sometimes be more severe, with sclerotic dermal plaques, painful erythematous nodules, and deep cutaneous ulcers with skin necrosis (SEDA-21,... 

Webster GF, Knobler RL, Lublin FD, Kramer EM, Hochman LR. Cutaneous ulcerations and pustular psoriasis flare caused by recombinant interferon beta injections in patients with multiple sclerosis. J Am Acad Dermatol 1996 34(2 Pt 2) 365-7. 

Greaves, M. W., "Zinc in Cutaneous Ulceration Due to Vascular InsuflB-... 

The disease can range from cutaneous ulcers to the mucocutaneous form affecting the nose, oral cavity, and pharynx. The highest incidence usually is seen in the summer months, especially in subjects working near forested areas. Visceral leishmaniasis may be ac-... 

The aminoglycosides are highly polar and, thus, poorly absorbed from the gastrointestinal (GI) tract. Instillation of these drugs into body cavities with serosal surfaces may result in rapid absorption and unexpected toxicity (e.g., neuromuscular blockade). Toxic levels also may result from sustained topical application to large wounds, bums, or cutaneous ulcers, particularly with renal insufficiency. Long-term oral or rectal administration of aminoglycosides may result in accumulation to toxic concentrations in patients with renal impairment. 

A Gilgore. The use of povidone-iodine in the treatment of infected cutaneous ulcers. Curr Ther Res 24 843-848, 1978. 

A cutaneous ulcer occurs in approximately 60% of patients and is the most common sign of tularemia. Ulcers are generally single lesions of 0.4 to 3.0 cm in diameter, with heaped-up edges (Figure 24-1). Lesions associated with infection acquired from mammalian vectors are usually located on the upper extremities, whereas lesions associated with infection acquired from arthropod vectors are usually located on the lower extremities. Ulcerative lesions are almost always accompanied by regional lymphadenopathy.13... 

Fig. 24-1. Cutaneous ulcer of tularemia. Photograph Courtesy of William Beisel, M.D., Colonel, Medical Corps, US Army (Ret).

Cutaneous ulceration occurred after treatment with leflunomide 20 mg/day for 1 month in two patients with psoriasis [45, 46 ], including a 31-year-old woman with psoriatic arthropathy who took leflunomide 20 mg/day for 1 month. 

Di Nuzzo S, Zanni M, De Panfilis G. Cutaneous ulceration induced by leflunomide in a psoriatic patient. Int J Dermatol 2009 48(6) 666-8. 

PhiUips, T.J., Chronic cutaneous ulcers etiology and epidemiology, /. Invest. Dermatol, 102,38S, 1994. 

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