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My son has had a sore on his leg for 11 weeks.  We've seen a dermatologist that did an outer cutler swab and a punch biopsy.  The swab showed staph and the pathologist said it was an insect bit.  The dermatologist thinks that's not the case.  He's been on a 10 day dose of minocycline and a 10 day dose of doxycycline-no change, it keeps getting bigger and has never stopped oozing.  They want to do another biopsy and also start him on another 10 day dose of doxycycline and see him in a month. We are very concerned as it has quadrupled in size over these 11 weeks and has had no change.  I have pictures of beginning and what it looks like today but I don't know if I can upload them to you.  My question is there a different type of doctor we should see and what can we do?
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563773 tn?1374250139
Thanks for posting your query.

I can understand your concern for the sore on your son’s leg. 11 weeks for a discharging, non healing sore is a pretty long time. You have not mentioned the first biopsy report if the culture swab report is coming positive for staph then it can be one component of diagnosis. What I mean to say that either the sore is due to STAPH infection or MRSA or staph infection is a secondary infection and the primary pathology is something different. This hugely depends on the first biopsy report and if the result was inconclusive from that then a repeat biopsy has to be done. Firstly the diagnosis needs to be confirmed and then the treatment started.

The first possibility is definitely a bacterial infection like staph or MRSA because the culture swab is also supporting it. One reason for the infection not showing any improvement after a 30 days course of antibiotic Doxycycline is that the infection may be showing resistance to doxy and may be sensitive to some other antibiotic. For the same a repeat culture sensitivity of the discharge and a biopsy makes sense.

Other than that few other possibilities also need to be evaluated. these include pyoderma gangrenosum (a condition that causes tissue to become necrotic, causing deep ulcers that usually occur on the leg; the disease is thought to be due to immune system dysfunction), necrobiosis lipoidica (a disorder of collagen degeneration with a granulomatous response ) or stasis dermatitis (skin inflammation caused by blood pooling in the veins in your legs). The first possibility needs to be evaluated in detail because the latter two are mostly found in women of elderly age group. Hence their chances are less.

Apart from these, we also need to think of the various reasons for the delayed wound healing also. Delayed wound healing can occur in vitamin C and vit K deficiency,diabetes,p-rotein deficiency,immunocompromised states and if the person is taking corticosteroids or immunosuppressants. Get a complete blood count, platelet count, blood sugar levels and vitamin C and vitamin K levels done for your son. Please get these causes also ruled out from your son’s physician. The biopsy has to be done by your son’s dermatologist. Basically it should be a teamwork between a physician and dermatologist so that a diagnosis is made and treatment planned.

Hope that this information helps and hope that your son gets better soon.

Wishing you and your son good health.
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