Reocurring sore on ankle

Doc:

Over the past 6 months, I have experienced 3 ulcer type sores in the exact same spot on the anterior side of my left ankle approximately one inch above the joint in the ankle.  I would really describe the sore as a raw skin ulcer.  It is flat, and it looks like the first few layers of skin are missing.  It does not have a pocket like a blister, but feels as though it has some sort of fluid on the surface.  I do not believe it is from rubbing, as I never wear shoes that go up that high.  Additionally, all three have popped up in the morning when i wake up, so I doubt it is from friction.  They are very slow to hear taking between 2-3 weeks.  I have taken pictures of it, but I am not sure how to post them in the message.  If you can instruct me how to do it, I will post in the follow up.  Any idea of what this could be?  Also why do they continue to show up in the exact same spot.  I know this is a long shot, but the only thing that shows up when I perform a Google search is atypical herpes.  I was tested no long ago (blood) and the test came back negative, but reading the data on the test, I know the sensitivity is around 95% leading to some margin for false positives.  Like I said, I know that is a long shot since all the stars would have to align, but I just wanted to get your thoughts on this as well.

Thanks for your time!

[Jasmina Jankicevic, MD, MSc, CCRP]

Hello, "Anklehelp"!

Pictures you attached indicate that ulcer is not deep, has steep edges and slightly wet bottom (possibly covered with some fibrin). The surrounding skin seems red and dry. You did not mention having any other health issues (systemic symptoms), but the ulcer has prolonged spontaneous healing action.  That, plus the fact it is reappearing in the same location, could indicate compromised circulation (tissue is not properly nourished).  In such a case, starting with evaluation of the arterial and venous circulation would be very appropriate (Color/Duplex Doppler Ultrasound technique).

In regards to atypical HSV infection you thought about, it does not seem to be your case (neither clinically nor based on the test results). However, to give you a wider view, many diseases/disorders are accompanied with leg ulcer and the differential diagnosis list is very long: vascular (arterial, venous, lymphatic), metabolic (Diabetes mellitus, Porphyria, etc.), infections (bacterial, fungal, viral, etc.), vasculitis (Hypersensitivity vasculitis, Polyarteritis, SLE, Wegener granulomatosis, Rheumatoid vasculitis, etc.), Lymphedema, drugs, hematologic abnormalities, tumors, traumas, insect bites, etc.

Your dermatologists will take a very detailed medical history and perform specific clinical examination before deciding what other diagnostic tool (blood tests, biopsy, etc.) is needed.



Wishing You Optimal Health and Happy Holidays,
Dr. Jasmina Jankicevic

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum!

Yes, good quality photographs of your lesion could be helpful. You can upload them if you go on your "profile" page and then "photos".

Thank you,
Dr Jasmina Jankicevic

[ankehelp]

Hi Dr. Jankicevic,

I have uploaded pictures, please let me know what yo think.

Thanks!