Discolored toe after possible bug bite

[JillibilliMom]

My 12 y.o. daughter has one toe that is very discolored and dry, almost wrinkly looking.  About 4 weeks ago she had what looked like 3 small white-ish bumps on her toe.  They became itchy, she took anti-histamines for a few days and the itchiness and bumpbs went away.  It was tender to the touch, a bit swollen, and the skin started to turn blotchy red/purple.  After a few more days it looked better, but then returned.  It almost looks like it's bruised, but there was no trauma.  Her Pediatrician had never seen anything like it, feels it's a deep bruising caused by possible bug/spider bites.  It did not feel warm to the touch, she had no fever, and there are no breaks in the skin, no sores or peeling skin for the doctor to biopsy.  She did feel there was a slight spot of fluid under the skin, and when the toe is pressed on the skin blanches but returns to the purple color.  It almost looks like it was hit by a hammer!  She suggested waiting a few days and getting an xray to look for possible infection in the bone.  It's been 10 days and it's not better, so I guess we'll get an xray.  I don't like to expose her to unnecessary radiation so we wanted to wait longer.  10 days after the doctor visit, her toe looks pretty much the same except now the skin is very dry and a bit wrinkled.  It's still a little tender to the touch but it no longer itches.  Because it doesn't hurt unless pressed on or affect her daily life, she and I tend to forget about it.  But it's been about a month and it's no better, and now I'm getting concerned.  Any suggestions would be helpful.  I created an album with 3 pictures but do not know how to post them here.  Thank you!

[Bhupinder Kaur, MD]

Hello,
Thanks for posting your query.

I can understand your concern for your daughter’s symptoms. I have checked the photographs in the profile and the symptoms are suggestive of a scar after some insect or spider bite.

In general, the blood under the skin which causes the discoloration of bruising should be totally reabsorbed by the body in three weeks or less. In your daughter’s case, as the symptoms are persisting for more than 4 weeks, so it may be due to formation of hematoma because of blood trapped in tissues. This blood may need to be drained. You should get this possibility evaluated from her doctor because your daughter is also complaining of feeling fluid under the scar. This happens when after an injury or bite, blood collects and pools under the skin (hematoma), giving the skin a spongy, rubbery, lumpy feel.

Other than that any deep seated infection should also be ruled out. I agree with the treating doctor that an x-ray of the foot is needed to rule out any fracture of the toe which may also be causing the purple discoloration of the toe. This may occur after an accidental trauma to the toe.

Hematomas of the skin and soft tissues are often treated with RICE (rest, ice, compression, elevation). So if a hematoma is confirmed then these can be tried. If there is any deep seated hematoma then it may need drainage.

Hope that this information helps and hope that your daughter will get better soon.

Wishing her good health.

[JillibilliMom]

We'll get the xray today, and will follow up with her her doctor in regards to the hematoma.  Many thanks!