Boils?

[fisherdvm]

Pernio? I guess the first thing I'd do is stop smoking, if you are smoking. I'd usually do some blood test just to make sure you don't have a collagen vascular disease (lupus, scleroderma, etc), vasculitis (inflammation of blood vessels), or coagulopathy (clotting dz). Medicine isn't exact science, and there is always room for doubts and more testing when it recurs.

Usually with pernio, I'd see bluish discoloration of the tip of the toes or fingers. It is usually very tender and painful on touch. I am not sure I see it as you described. Could it be the first episode (palm of the hand, and top of the finger), is different than the second episode (little toe and big toe). Perhaps two different causes with each of the episodes.

If you can upload photos the next time, it would be more useful. But no one ever seems to upload photos....

 

[fisherdvm]

Without further facing sarcasms from my colleages, another thing to think of is cryoglobulinemia. Usually, rheumatoid factor will be elevated. I had suggested working up coagulopathy in my last post. The RF is usually elevated, and occasionally some of the cryogens will be high. Ain't got time to search more on the matter, and I'll let the peanut gallery take over.

I saw a wonderful case of small vessel vasculitis last week. This women's finger tips were covered with small blisters. At first, I thought it was herpes. But then, she showed me a big blue round patch on her left thight. It was then we realized that she has suffered from a fixed drug eruption (common with tetracycline antibiotics), and also suffered from small vessel vasculitis from the same drug. Turns out, she was taking tetracycline off and on for her acne. She loved the tetracycline, as it did wonder for her zits.... And regretted having to stop it.

I would do a good drug review to make sure no recent drugs were introduced. A drug could have triggered the lesions, and the cold water might have just aggravated it more.

 

[Cacia]

wow
interesting.
JB's sister just has MRSA infection after doing tri swims in some pond.
Is this patient diabetic?
This thread caught my eye because I just had an unhappy situation cycling, nuff said.

 

[fisherdvm]

I had a case like this of a woman attorney. It looked like a contact dermatitis with vesicles. But the culture came back as MRSA.

On hindsight, it probably was still a contact dermatitis to poison ivy or some other caustic irritant stuff. MRSA was a red herring ... but still needed to be treated.

 

[Cacia]

Surfers always report weird stuff in Indo.

They say it is from raw sewage, I don't know if that is true, but that is what they say.