Case report: That long?

Patients who come to our walk-in clinic have a wide variety of problems—and an equally diverse amount of time having elapsed since their concern began. The duration of issues can vary from minutes—such as following an injury, burn or cut—to hours elapsed since a child developed a cough—and occasionally much longer. A recent patient fit the last group definitively.Many reasons account for wait times following a concern. Pain, lack of knowledge about basic physiology, anxiety about anything related to a child—and perhaps unconcern or failure to successfully employ remedies suggested by relatives or friends, can all contribute to a delayRead: Case report: And the stitch?A 77-year-old man, with a scattering of medical issues under care and adequate treatment, presented with a rash on his left leg (see picture). The rash had been much smaller when it began two years earlier following a scrape from a wooden board in his garage. The only therapy used in the interim, was his wife’s moisturizer—which had no effect—and the itchy area progressively enlarged, oozed at times and was a bit sore recently. The patient had no allergies, but was taking appropriate medications for diabetes, hypertension and prophylaxis for gout. His diabetes was under good control—morning sugars around 6 —and blood pressure excellent. His rash was raised, scaling, inflamed, excoriated and confined to the anterior aspect of his lower left leg, above his socks and mostly below his pants. He admitted to scratching and occasionally wore compression socks (visible edema) to help the rash. This didn’t work eitherWaiting two years seemed to be his (or somebody’s) limit. Multiple factors were contributing to persistence. I suggested avoiding scratching, and prescribed a short course of Clavulin and topical Fucidin cream. Anti-itch CeraVe cream was to be used to treat the dryness and pruritus. He might require a steroid cream, once the inflammation settles. It will be interesting to see how long it takes to improve. Certainly one of the longest delays for treatment, that I have encountered.Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: That long?

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