A 76-year-old woman with type 2 diabetes of 10 years' duration was referred to the diabetic foot clinic by casualty. She had an erythematous right 2nd toe with fusiform swelling (sausage toe) and a sloughy ulcer with a draining sinus which probed to bone (Fig. 5.21). Cellulitis extended onto the dorsum of the foot. She had been aware of redness and swelling of the toe for 3 days and the foot had begun to throb over the previous 24 h.
Pedal pulses were absent. She was sent for X-ray (unremarkable), and for vascular assessment which showed monophasic pulsatile waveforms and elevated indices due to arterial calcification. A deep swab was sent for culture and grew Staphylococcus aureus. The ulcer was debrided and dressed with a foam dressing. Quadruple antibiotics were prescribed initially: oral amoxicillin 500 mg tds, flucloxacillin 500 mg qds, metronidazole 400 mg tds and ciprofloxacin 500 mg bd; and then narrowed down to fucidin 500 mg tds and flucloxacillin 500 mg qds. Although repeat X-ray after 2 weeks showed lucency of the terminal phalanx compatible with osteomyelitis, the ulcer healed
in 3 weeks. The fusiform swelling remained but the erythema resolved after 3 months.
' Fusiform swelling (sausage toe) and erythema are frequently associated with osteomyelitis and X-rays are needed to confirm the extent of the infection in the bone and monitor progress
• Erythema may take several weeks to settle if infection was severe
• 'Sausage toe' may resolve with antibiotics: surgery is not always necessary for osteomyelitis
• In some centres osteomyelitis is treated by definitive bone resection followed by 4-6 weeks of parenteral or equivalent therapy.
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.