Case for Diagnosis: Ulceration of Leg, Three Years' Duration. Presented by Drs. Paul R. Griffith and (by invitation) Roland S. Medansky from the Veterans Administration Hospital, Hines, Ill.
Discussion
Dr. Stephen Rothman: The clinical picture is that of a dermatitis repens, meaning an infectious process with spreading destruction of epidermis and upper corium. The spread, as in this case, often occurs in circular or polycyclic fashion. Bacteriologically we find first staphylococci but if these are eliminated by locally applied antibiotics some other species settle in the wounds, such as proteus or pseudomonas. In our experience balsam of Peru ointments (5-10%) are most effective. (See: A.M.A. Arch. Dermat. & Syph. 70:819-822, 1954.)In this case there seems to be a stasic element, and I wonder if the process might have started with a stasic ulcer. After this patient starts to ambulate, he should have elastic bandages or stockings for support.
Morphea.