What could cause a red spot, blister, and ulcer near the ankle of my left leg?

Question

Hi doctor,

I have a skin problem (ulcer development) on my lower leg near the left ankle. I did not have any ulcers in my legs so far. I think it was an insect bite. Initially, there was a spot where the sting might have happened. Gradually the spot developed, hardened, was red locally, then a blister with watery content appeared, broke, and the ulcer developed further. Now, a few spots feel hard and have small blisters with lymph fluid content. There is no red line to be spotted along lymphatic vessels, and I have pain typically from stretched tissue (swelling). During the morning, the swelling usually is less, and I had a lot of stress on the leg from walking, driving, and being up and active during the day. I had a dressing on top of the affected area, and I removed it yesterday as the itching was heavy. I applied the anti-histamine gel over the affected area for itching. Could this be an allergic reaction against the dressing? What would be your best advice? What could have happened, and what needs to be done?

Answer 1

Hello,

Welcome to iclinic.com.

As per the history and images provided (attachments removed to protect the patient's identity), there are two possible diagnoses for the same. Insect bite reactions - As you mentioned insect bite may be one of the possibilities. Most typical symptoms of insect bite are appearances of hives, raised papules, itching, swelling, and sometimes fluid-filled blisters on your leg. Depending on the insect type, it can develop, and it may be painful and red, and the areas around the blisters may also become swollen. Other symptoms include itching, discoloration of the bite site, tenderness while touching, and a burning sensation. The blister may eventually turn into ulcers which may take time to heal. In such circumstances, cold compression, and frequent dressing with antibiotics after removing any retained parts of the insect are done, and oral antihistamines with oral antibiotics are suggested. Venous leg ulcers - Most common diagnosis for ankle ulcers with pain, redness, swelling, and itching, and it takes time to heal. Venous ulcers of the ankles would be my diagnosis for you. It is usually formed due to venous insufficiency on your legs due to the veins that carry blood upwards towards the heart have become insufficient and cannot carry out their functions well. It results in stagnation of blood, swelling, itching, pain, and discoloration, eventually leading to ulcerations that may get infected if left untreated or in the case of underlying diabetes. It requires frequent dressing with paraffin gauze, oral antibiotics, pain killers or analgesics, and treatment by surgery or sclerotherapy. Exercise, leg elevation, compression bandages, or stockings also help reduce the symptoms. Most commonly, the symptoms reduce after a walk or exercise and may worsen with sitting or standing for long hours. I suggest you kindly consult a surgeon in person for further investigations and management as it requires intervention in person for faster healing. It will help the doctor to suggest you the right medications depending on the severity of the ulcer. In case of superinfections (secondary bacterial infections), the doctor might take a swab test from the affected area for culture to detect the sensitivity of the bacteria to the antibiotic, which would help reduce the wound infection and help heal better. I hope I can be of help. Stay happy, healthy, and safe.

Answer 2

Hello,

Welcome back to icliniq.com.

I am glad to hear that. I hope you get well soon. I suggest you take proper rest and kindly follow the doctor's advice. Thank you so much for the positive feedback from your end. Stay happy, healthy, and safe. Take care.