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LisaM
01-24-2007, 12:05 PM
do any of you get sores for absolutely no reason at all...or when you get sores, do they heal slowly? I have them all over my legs....on the NON-RSD parts of my body. Anyone else? On the NON-rsd parts?




HubbyWithRSD
01-24-2007, 01:05 PM
Hey Lisa - Yes my husband has had these sores. Mostly they have been on his affected parts but have shown up occasionally in other areas. The sores he has are open and weeping and will not heal. They have tried creams and such but nothing has seemed to work - The largest one he ever had was the size of a silver dollar on his leg. His arms now with the new RSD are getting sores on them - 3 currently. The best thing we have found with the sores is to make sure they are getting plenty of air and to apply an antibacterial so that they do not get infected. Thats about it tho - Nothing much seems to work - They come and go as they want.....

LisaM
01-24-2007, 03:40 PM
Thank you so much. Mine are small, but every now and again, I get like a dime sized one. They are almost like, say, if you have a pimple and you pick and pick and pick it....it turns into a yucky, oozy sore. It will scab up but it always breaks open. And they are scarring up, so I have all these dark spots nowon my legs where these spots were.

I can't let them breathe, cuz they are on my legs...and I work....and I can't come to work with no pants on! LOL! But, I do change right away once I get home from work into my jammies cuz I love to be comfy.

Sigh....perhaps do you think neosporin would help?

fmichael
01-24-2007, 03:42 PM
Dear Lisa -

Although I have not (yet) had to deal with the issue of skin lesions, there's a fair amount of literature out there on it. Let me first of all refer you to the following articles - and corresponding photos - that are listed on the RSDSA Medical Articles Archive page at http://www.rsds.org/2/library/article_archive/index.html, under the heading of "Complications:"

Author: Goris RJA
Title: Skin Complications in RSD patients

Author: Greipp ME, Thomas AF.
Title: Skin Lesions Occurring in Clients with Reflex Sympathetic Dystrophy Syndrome. Source: Journal of Neuroscience Nursing. 1994;26:340-341.

Author: Webster GF, Schwartzman RJ, Jacoby, RA, Knobler RL, Uitto JJ.
Title: Reflex Sympathetic Dystrophy, Occurrence of Inflammatory Skin Lesions in Patients With Stages II and III Disease.
Source: Archives of Dermatology. 1991;127:1541-1544.

That said, I am personally quite familiar with the general case of the issue you raise, which falls under the heading of peripheral vascular abnormalities. For me, that's manifest by constriction of peripheral blood flow, to the point that it's often very difficult to (1) draw blood from my veins or (2) insert any form of a catheter wider than a 22-gauge needle, and that's getting fairly small. For a good article on that point, see, "Vascular Abnormalities In Reflex Sympathetic Dystrophy (CRPS I): mechanisms and diagnostic value," Gunner Wasner et al (incl. Prof. Dr. med. Ralf Baron), 124 Brain 587-599 (2001):

"In conclusion, it is suggested that, in CRPS I, unilateral inhibition of sympathetic vasoconstrictor neurones leads to a warmer affected limb in the acute phase. Secondary changes in neurovascular transmission may lead to vasoconstriction and cold skin in chronic CRPS I, whereas sympathetic activity is still depressed."

I would be happy to send a copy of this article to you or anyone else who may be interested in it. (At 491.48 KB it's too large to post as an attachment here.) Just drop me a pm with your email address.

Mike

Curious
01-24-2007, 04:15 PM
lisa, have you tried a product called Nu Skin? it's a liquid bandage. it''s antibacterial. keeps the wound water tight.

products like Mederma ( and the store brands) will help fade any scars

frogga
01-24-2007, 08:55 PM
Heya

I have those - both on my bum (from pressure) and over my arms and legs - I get ulcers from the RSD and weird lumpy sores - especially at the end of my toes? (Bizzare).

I use magnesium sulphate to draw the infection out and then leave it to the air - I also have the nurses come in to help with them. Have you considered HBOT? I have had that for nasty ones.

Hope it imrpoves!!

Rosie xxxxx

GalenaFaolan
01-24-2007, 09:53 PM
I get those sores too. Most of the time they're on my legs. I've had quite a few and they always take a couple of weeks to heal and leave a scar. My skin has gotten so bad a small cut even takes a long time to heal and leaves a scar. My sores come from small red spots that look like blood blisters. It started not long after the RSD started. It sucks but just keep them clean and if they get big or look infected go to the doc.

Hugs,
Karen

frogga
01-24-2007, 09:56 PM
have you been checked for folicolutis? I had a bad case of this cos of RSD and that caused the small purple sores to develop..

Rxxxxx

LisaM
01-25-2007, 08:42 AM
Thank you, Mike. You have directed me to that site in the past, and I don't know WHY I didn't go there first cuz it is EXTREMELY helpful. In fact, I've printed out several of the articles for my family to read, and it's helped them tremendously to understand. Especially the one (I don't remember the title) about the PT who is confronted with an RSD patient. It is direct, to the point, and easy for people to understand because it's not written in medical jargon so much so that people don't "get it." It's a GREAT site.

I would VERY MUCH appreciate it if you could email me the article that you have. I do have dsl, so can handle the file. Please do email it to me. I will send you a pm with my email addy pronto.

I do see a photo of what my lesions look like. the one on the left CLOSELY resembles them, but they aren't so close together that they look like a rash, as this picture does. They are quite far apart. If you can picture, for example, the seam of your jeans, that's about how my lesions run. Perhaps that's part of why they are there (though I do not wear tight jeans), as well as on my rear end (pretty attractive, eh?). The picture on the right resembles what they look like after they finally heal. The scars arent raised, but they turn into a discoloration....a greyed, brownish spot, almost like an "age spot" I suppose.

LisaM
01-25-2007, 08:45 AM
lisa, have you tried a product called Nu Skin? it's a liquid bandage. it''s antibacterial. keeps the wound water tight.

products like Mederma ( and the store brands) will help fade any scars

Thanks, Curious, for your response. I did purchase some mederma (boy, that stuff is EXPENSIVE!) and have been using it. I haven't seen any improvement yet, but the tube says for existing scars it takes 6-8 months to see if it works, applying it 3x's a day. So, we'll see. In readig the tube, it stated more that it takes care of the raised skin, smooths it out, but mine aren't really raised...it's the discoloration. I was wondering about lemon juice. I know it bleaches hair. Do you thik it would bleach skin?

In reading Mike's literature, it doesn't sound like much of anything will heal the lesions.

LisaM
01-25-2007, 08:48 AM
Heya

I have those - both on my bum (from pressure) and over my arms and legs - I get ulcers from the RSD and weird lumpy sores - especially at the end of my toes? (Bizzare).

I use magnesium sulphate to draw the infection out and then leave it to the air - I also have the nurses come in to help with them. Have you considered HBOT? I have had that for nasty ones.

Hope it imrpoves!!

Rosie xxxxx

Thanks Rosie....I know you have full body rsd, and that you are in a chair. The ones on your bum (which I do also have them there), do you think the pressure is from sitting all the time, and does your rsd extend to your bum? My lesions are on my legs, and my rsd is NOT on my legs. I'm wondering if pershaps the lesious are a sign that the rsd is getting ready to move there.

I've heard of HBOT, a lot, but to be frank, if something is posted here that doesn't relate to me at the moment, I don't really read it right away. Can you explain it to me a little? Is that something that is common and paid for by insurance?

LisaM
01-25-2007, 08:52 AM
I get those sores too. Most of the time they're on my legs. I've had quite a few and they always take a couple of weeks to heal and leave a scar. My skin has gotten so bad a small cut even takes a long time to heal and leaves a scar. My sores come from small red spots that look like blood blisters. It started not long after the RSD started. It sucks but just keep them clean and if they get big or look infected go to the doc.

Hugs,
Karen

Karen, are the sores on your rsd affected parts of your body, or the non-rsd parts? Yes, some of them start as blood blisters. I do know that some of them itch, and really without thinking about it, I scratch, and THERE THEY GO! Off and running. And some of them get so bad that they actually "crater" - get really deep. I haven't been putting anything on it, mainly because (and this will sound silly!) recently one of my puppies had an ear infection which made him scratch so badly that he had a hot spot near his ear. I put some neosporin on the spot and the vet said it was a no-no, cuz the air couldn't get to it to dry it out. That thought went thru my head when I started to get these sores. That if I covered them, they wouldn't heal. Welll......they still aren't healing! I shower every day, and they remain clean, but there are so many, I really can't put bandaids over every single one, and the nuskin I believe Curious spoke about....it would probably take a whole bottle each time I did cover them once! LOL!

Have you talked to your doc about them? If so, what has he/she said? Do they leave scars afterwards? Raised skin or just a discolored spot?

frogga
01-25-2007, 10:15 AM
Hey Lisa

Firstly - I think you should be checked for folliculitis - as it sounds like you may have a type of this - the drs can then rx a steroid cream - it does work. Folliculitis causes itches, almost dark purple blood blister spots, which then pop and leave a crater/ scar type thing.

My bum is mostly pressure - cos I can't change my position independently - I also have the "spots" there as well but my bum is more pressure stuff.

I personally would recommend mag sulph - it is cheap, simple and does make a difference - or alternatively a barrier cream. Leaving sores to the air is all very well - but a) risk of blood poisioning b) unless your skin is totally open to the air (eg wearing skirts or something) then you are likely to get your clothes stuck on the sores - which even without RSD hurts like hell.... ).

HBOT - hyperbaric oxygen therapy - has worked wonders on cleaningup my ulcers (I had them all over my legs and feet). i don't know if it is avaoible on insurance - it is high pressure oxygen - so oxygen is forced in to the nerve cells which gives extgremeities oxygen etc.

Hope this helps!!

Rxxxxx

Curious
01-25-2007, 11:09 AM
lisa, you might want to try regular ole skin lightening creams, like Porcelana. they are in the beauty products isle. the are mainly for lightening age spots, freckles and the brown patches women get get called Melasma. it contains Hydroquinone. usually just 2%.

i had used a product that was 3% after getting a some freckles across my nose and cheek bones. :o i thought i had used sunsceen...oops. it was called Nadinola. i got it at WalMart. about $5 for the jar.

the Mederma is very expensive. my daughter tried it about a year ago hoping to reduce a scar from surgery. well, nore like trying ot get rid of the last of the red of her hememgeoma. didn't work. i should have called and asked plastic surgeon.

LisaM
01-25-2007, 11:17 AM
Thank you Curious and Frogga. Frogga, I looked up the folicalwhatchamajigger and it doesn't look reallylike what I have. But, I will drop my drawers at the pain doc on monday and let them see for themselves :)

Curious, that's what I was thinkign. A skin lightening cream. But I wasn't sure if they made anything like that. Thank you so much for the recommendation!

Curious
01-25-2007, 11:25 AM
:hug: you're welcome lisa. i hope you get some relief from the sores and can get the spots to go away.

daily i am amazed at all the wealth of information the rsd and other forums here have. :)

LisaM
01-25-2007, 11:54 AM
:hug: you're welcome lisa. i hope you get some relief from the sores and can get the spots to go away.

daily i am amazed at all the wealth of information the rsd and other forums here have. :)

Me too! I thought I was just weird! LOL! Now I know I'm not! WE ALL ARE! :grouphug: (just teasing!!!!!)

GalenaFaolan
01-26-2007, 12:22 AM
Karen, are the sores on your rsd affected parts of your body, or the non-rsd parts? Yes, some of them start as blood blisters. I do know that some of them itch, and really without thinking about it, I scratch, and THERE THEY GO! Off and running. And some of them get so bad that they actually "crater" - get really deep. I haven't been putting anything on it, mainly because (and this will sound silly!) recently one of my puppies had an ear infection which made him scratch so badly that he had a hot spot near his ear. I put some neosporin on the spot and the vet said it was a no-no, cuz the air couldn't get to it to dry it out. That thought went thru my head when I started to get these sores. That if I covered them, they wouldn't heal. Welll......they still aren't healing! I shower every day, and they remain clean, but there are so many, I really can't put bandaids over every single one, and the nuskin I believe Curious spoke about....it would probably take a whole bottle each time I did cover them once! LOL!

Have you talked to your doc about them? If so, what has he/she said? Do they leave scars afterwards? Raised skin or just a discolored spot?


I have full body so yeah, they're on the RSD parts. LOL I mostly get the sores on my legs but I get the blood blisters everywhere, arms, fingers, torso. I had a couple of really small ones turn into sores on my torso and it's one of the few spot I don't have any rsd. I know about the scratching thing, I've just reached down to scratch an itch and bam! Oh, one thing I absolutely love, adore, worship is Gold Bond Body Lotion. Rub it on itchy spots and in seconds it stops itching! I wouldn't recommend rubbing it on a sore, burns a little, but for all other itchiness it's wonderful!! My boy cat Seamus loves the lotion too. It's sooo funny, I rub it on my legs and feet and he comes trying to lick my feet and then he rolls on my feet and go nuts!! LOL It's hilarious and I guess it's his "catnip". :D

I can see you trying to cover them all. LOL That would be a BIG bandaid huh? I think air is the best thing for them personally and just make sure you keep them clean and if any look a little inflamed then neosporin is a good thing to use, just a dab.

I have quite a few scars now but they're just like any old scar, like when you cut yourself and it heals up. I've never had any raised spots other than when they're sores then they're raised up off the skin a bit. I did bring it up with my pm when I first saw him and was told it's the RSD. He told me that keeping them clean and keeping an eye out for infection or inflammation is the right thing to do. He told me that if any started looking inflamed at all to call and come in so we could make a decision on what to do. Whether I'd need to see a dermatologist or if he could just give me something to help. Thankfully none have gotten that bad so haven't had to deal with that aspect. Hoping I won't either. The slow healing is part of RSD too. Anytime I get cut anywhere on my body it takes a long time to heal up. I noticed that right away cause I've always been a fast healer. Last year I stabbed myself in the hand with a pair of scissors. Oh man did that hurt!!!! Left a nice hole and now a really nice scar. Well anyway, it took 2 months to completely heal up and it should've healed up at least in 3 weeks or less. *sigh* RSD does suck!!!

Hugs,
Karen

frogga
01-26-2007, 08:10 AM
yep it does suck - the slow healing is horrible - any small graze or anything lasts for AGES! I scrapped my thumb in November and I now have a nice hole going through it... (i did't realise my arm had slipped and caught it between the bed and wheelchair) - suppose it's not as bad as my bum (4cm hole going through that).

I sometimes feel like a piece of cheese....... (though I, hopefully, don't smell like one).

Sorry the foliculitus stuff wasn't helpful! only other thing I can suggest is that it's just one more stupid thing the RSD does... (out of interest - if they are not on your bum, do you have a pic? I reckon we should start a comparison sticky - so people can post pics of things like that and ask other people if they have had similar - cos purple spots could be anything (thus my suggestion).

Hope things are improving!!

Love Rxxxxxx

LisaM
01-31-2007, 10:58 AM
Well, I spoke with my doctor about it on Monday, and basically she wants me to see a dermatologist. At this office (my pain doc) if anything comes up, they won't give opinions...they either refer me to my MD, or they refer me to another specialist. They won't dx me, really. HOWEVER, she did say that she has seen this before, and not ONLY in rsd patients, but also in patients who are on pain meds. Even though I may not have had a reaction to the pain meds before (I've been on the same ones for quite a while) I may have suddenly contracted some type of allergy to it. But she won't say that's for sure.

And now...I have one on my BACK! Arggghhhh! So it's traveling. It's moving. the only thing I REALLY hope is that this doesn't mean the rsd is going to move along with these sores. And they are DEEP! Yes, some are crater-like, with a deep hole in the center. Others are just flat...but they are LARGE - they dn't even start small and get bigger...they just start out large. And I turned and lookjed at my "bum" the other day, frogga, and there is a large purple spot on it...almost like I pinched it on a door or something. But it's not sore, and isn't breaking open, so it's not like th others. By now, the others would have turned into these sores.

the doc didn't want me to put anything on them, cuz she said if there is infection in it (whcih, in looking at them, she does't think ay are infected), she doesn't want it all covered up keeping the infection inside. So, I'll let you all know when/if I get to the dermatologist what they say....

thank you all so much for your responses and advice. Yo are an awesome group. And frogga, I do think your idea of a comparison photo gallery is great. But may take up too much bandwidth. I'm not sure. I'll try to get a good pic of my OWN sores, though. I won't take a pic of my rear ones, that may scare ppl. I have plenty on my legs and the one on my back that I can take a pic of.

And I'm sure you dont' smell like cheese :)

siccy
02-01-2007, 01:20 PM
I hope you find a good derma.My heart goes out to you.Please do post and let
us know.You seem to be in good spirits.A positive is a +.:hug:
siccy

buckwheat
02-01-2007, 01:47 PM
Lisa,
This could be anything. I hope they get to the root of the problem. Hugs, Roz

LisaM
02-01-2007, 02:21 PM
Lisa,
This could be anything. I hope they get to the root of the problem. I personally am considering a biospy. Hugs, Roz

Roz...a biopsy for what? For these? Oh hon...is there sopmething you need to talk about?????:grouphug:

buckwheat
02-02-2007, 12:24 AM
Could be off the beaten path

fmichael
02-02-2007, 02:45 PM
Lisa -

In addition to the other references I sent you last week, you might want to check out the attached story form the Harvard Gazette on the work of Anne Louise Oaklander, MD, PhD, who has found interesting changes in skin (nerve densities) on the opposite side of the body - a mirrored imaged as it was - from that part of the body where the injury had been sustained. For your consideration:

Pain produces mystery nerve loss
Mirror-image pain distresses researchers
By William J. Cromie
Harvard News Office

People who injure an arm or leg sometimes develop pain, swelling, or other unexpected symptoms in the opposite, uninjured arm or leg. Medical reports of such mirror-image effects go back at least to the Civil War and usually are blamed on overuse of the undamaged arm or leg.

Anne Louise Oaklander, director of the Nerve Injury Unit at Massachusetts General Hospital in Boston, saw the glimmering of another explanation while studying patients with nerve damage from shingles. Caused by the virus that produces chicken pox in children, shingles inflicts adults with a painful rash of crusting blisters. It usually occurs on one side of the body. When the rash is treated, the pain goes away for some people, but lingers in others.

Oaklander, who is also an assistant professor of anesthesiology and neurology at Harvard Medical School, removed pinhead-size skin samples that allowed her to count how many nerves are working in small areas of skin. She found dramatic, long-lasting loss of nerve endings in areas previously affected by shingles. That was expected. But when her team checked skin from unaffected areas directly opposite the shingles outbreak, they were startled to see half the nerve endings had been lost there as well. . . .
http://www.news.harvard.edu/gazette/2004/05.06/01-pain.html

Dr. Oaklander's recent study, "Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy)," 120 Pain 235243 (2006), can also be found on my favorite webpage, the RSDSA Medical Articles Archive. Click here http://www.rsds.org/2/library/article_archive/index.html and scroll down for an alphabetical listing of the study - by author- under the heading of "Research."

take care,
Mike

Becca
02-02-2007, 02:52 PM
I scar very easily. Last summer I got some mosquito bites on my foot, and I can still see them. Just not even a week ago I got a sore on my foot for no reason. I can't think of anything I would have done to get them.

frogga
02-07-2007, 10:06 AM
are those pictures yours??

I will try and upload mine - (it is a relief though seeing the top one because thats what mine are like - but mine are apparently pressure sore things? dunno, that's what the DN's said).

and the evil bum sore is back..... I just don't have the ability to stay still enough (or for LONG enough)to avoid my bum! grrrrr!!

take care!!

Rosie xxxxxxx

PS - I use mag sulph and i am now using honey dressings, iodine spray and something or other ribbon to go in the pressure holes. (Calkostat?)

carousel
07-29-2007, 01:08 AM
Thanks Mike,

I haven't been on here much as have been busy with the other health issues i have and so i hadn't really looked closely at the links you provided re the mirror image small nerve fibre loss study etc, .... perhaps something in this explains something affecting me now that is puzzling to the medical community regarding ears (don't mean to be obtuse here but this is an rsd site so i don't really want to clutter up here with other things I have as some of it's kind of rare but i simply wanted to say thanks as my rsd came first as far as i know and other stuff came later but maybe there is a connection and i will be mentioning this to a couple of my docs)

so again a big thank you...

all the best,
Ina

Alex Pollack
04-18-2013, 12:23 PM
Hi folks, Check out the relationship between sores that don't heal and spirochetes & Lyme Disease & Syphlyss (non-sexual transmission..

Brambledog
04-18-2013, 03:54 PM
Hi,

My CRPS has recently got a lot worse in my foot, and right on the end of my big toe, just under the end of the nail, I have a purple area of skin about 5mm round. When my foot is really cold it looks white, and when my foot is red and hot it looks a darker purple. It's really sensitive and causes me the worst of the pain at the moment because socks and shoes, and bed sheets etc all touch it. My physio doesn't think it's a big deal, but I'm worried it could turn in to a sore or something.

Am I worrying about nothing? Is it a 'normal' (ha) CRPS symptom on my skin? Is there anything I should or shouldn't do?!

Any thoughts gratefully received. Thanks! :grouphug:

Bram.

Djhasty
08-25-2013, 03:00 AM
I have these sores mostly on my left leg, both arms, and the left side of my neck. Though the sores do show up to a lesser degree on my right leg, my bellie, and left breast. I have a new one on my left eye lid. They take forever to heal and leave dark purple scars. Some start out looking like bug bites with an oozie center. When they bust open, I am left with a crater with yuck in the center. Others are red spots of peeling skin. They range from approximately 1-5 mm. Yes! They itch and I do scratch. I wake up scratching. I stop when I finally realize it. I've tried wearing long sleeves and long pants. The sleeves and pants only iritate me. It takes very little to bust the leisons open, and I have to start the healing process all over again. I have tried several different lotions (Epsome Salt [lotion], Aveeno, Vaseline [lotion], generic Walgreens brand, etc.), including the compounded katemine pain cream. I've tried antibiotic cream. I bathe the areas with Epsom Salts as recommended by mrsD. I have added more magnesium to my diet. Nothing seems to help. My Neuro Doc has referred me to a dermatologist, but I am leaving for Southern California in a week and a half for HBOT treatments. I do not have time right now to visit the dermatologist before I leave. I hope the HBOT might help with these sores as well; I (actually my husband) scheduled treatments as a desperate means to stop the progression of my CRPS.

I have read through this thread. my sores sound a lot like what is described here. I was wondering if others with these sores might have some suggestions for home treatment. Please share your thoughts. Thanks.

johnmaggie11
09-14-2013, 04:38 PM
Sores that don't heal + especially if they're weeping may be varicose ulcers caused by varicose veins, which are sometimes invisible externally.
A skin specialist will not be qualified to diagnose if this is the case.
A vascular surgeon is the only one who will know by external examination.

Kevscar
09-15-2013, 01:04 AM
Wounds that Won’t Heal
By Anita L, Davis, PT, MSM, CA-AAPM, CEAS
Life is full of its bumps and bruises. Who among us does not have a knee or elbow scar from a fall off a bike? I remember a phase where I must have fallen every few weeks running on a sidewalk, with a scarred up knee to show for it.

The healing response from these sorts of injuries usually occurs in a predictable sequence. First, the tissues respond with inflammation that can last anywhere from 7 to 14 days. The increased circulation caused by inflammation brings in a flood of specialized cells to clear out wound debris. The next phase, fibroplasia, lasts for 7 to 10 days, and may overlap part of the inflammatory response. Fibroplasia is critical for establishing the presence of cells that begin to produce the foundation for new tissues. The final phase, remodeling, can last for weeks as tissues mature and regain their strength.1

This is not the case when complex regional pain syndrome (CRPS) is involved, since nerves misfire and normal healing processes that are necessary do not occur. Although one study of 1,006 patients found that less than 7% of people with CRPS are affected by chronic open wounds2, this small percentage does not diminish the importance of addressing this issue. When left untreated or treated insufficiently, the wound can rapidly move to an infected state that jeopardizes the rest of the limb. Yet, because of the small proportion of people with both CRPS and chronic open wounds, there is very little literature to guide clinicians in the best practice.

Looking closer at issues that complicate skin integrity, vascular changes are the ones most reported, and the most problematic. Vascular changes have shown varying relationships between changes in the sympathetic nervous system and temperature differences.3 By assessing skin samples, others have noted changes in nerve innervation of hair follicles, sweat glands, and blood vessels.4

For those who have issues at the skin surface, chronic edema is frequently encountered. Using the same population as previously mentioned, 40% of those with complications presented with infection, 35% with ulcers and 36% chronic edema. Chronic edema has been consistently linked to further development of infection and additional complications. In the general population, edema can be managed with compression garments or other mechanical compression treatment, but with CRPS, this treatment is frequently intolerable without additional pain interventions.

Therefore, other strategies are employed, which can include lumbar sympathectomy, sympathetic blocks, or other similar treatments that have not only provided a degree of pain relief, but also assisted in healing the lesions.4,5 Some have even resorted to indwelling epidurals to provide a tolerance for mechanical compression to aid in healing.6,7 In addition, hyperbaric oxygen has been used in wound treatment.8 Although research is still in progress, some results are promising. None of the studies, however, involved the wounds of those with CRPS.8,9

Aggressive treatment may also include surgical reconstruction to aid in arterial blood flow. This even has its challenges in those not affected with CRPS.10 As with any surgical intervention, the surgery itself can pose a risk of increased pain for those with CRPS. It is estimated that 6% to 10% of patients with CRPS will require surgery on the affected extremity for various reasons.11 If provided with appropriate interventions, the probability of negative consequences can diminish. The recurrence rate of those receiving a stellate ganglion block with a surgical procedure was only 10%. This was also seen in those with intraoperative intravenous regional anesthesia using clonidine and lidocaine. The intravenous anesthesia was felt to be superior, given the inherent difficulty and complications with a stellate ganglion block.11

Other skin conditions include ulcers, bullae and other types of wound formation. Infection is a frequent complication of any skin lesion. Typically infections are addressed with antibiotics. However, topical treatments and oral antibiotics have been minimally effective in those with CRPS.7 Laan et al noted treatments such as intramuscular long-acting penicillin injections, intravenous mannitol infusion and intravenous penicillin.2 When infection repetitively develops in wounds of those with CRPS, antibiotics are frequently ineffective. Reasons for resistance to healing with conventional methods include impaired oxygen consumption and vascular abnormalities that affect blood flow in the extremities.2,3,7

With such difficulty in successful healing of wounds in individuals with CRPS, prevention is a critical component. There are generally recognized factors that one can control to minimize the potential of skin lesions. These include abstinence from cigarette smoking, clean hygiene, healthy eating habits, and exercise as able and proactively manage diabetes if present.12

Despite these basic efforts, wounds may still appear. The specific etiology of these wounds has not yet been identified to help determine the best course for prevention. Therefore, when such wounds present themselves on those with CRPS, immediate attention by a healthcare provider is recommended. Having a vascular surgeon involved may be necessary to provide good wound care and comprehensive treatment once infected wounds begin to appear.

Djhasty
09-16-2013, 02:37 AM
Thank you johnmaggie11 and kevscar for the information. I believe skin ulcers is what I have. They cover both arms and my left leg. I also have them to a lesser degree on my left foot, the left side of my neck, my left eye, left breast, and my belly. I have been taking Hyperbaric oxygen treatments for the last week. I am seeing some improvement. I have many more treatments ahead. I am sure the HBOT will help me beat the sores once and for all.