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Ulcer in left leg

My brother has an ulcer in left leg for the last 3 years now. He was already tested for diabetes and bone infections, and the reports ruled out both. Please note he is mentally retarded and keeps standing for long hours. We have seen dermatologist and general surgeon but there is no permanent relief. Also because disciplined medication is a challenge since he is not open to take medicines or any other treatment. Doctors have advised to keep his leg at an angle above the heart but again he does it only rarely. Please advise. Your help will be much appreciated. Thank you.
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Dr. Pradnya Shastri
Dermatologist 9 yrs exp Mumbai

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I understand the difficulties in making him follow instructions... but here is what you can start doing : 1. Whenever he sleeps or lies on the bed keep a cushion under his leg for 10 min and then remove it. If not in the entire day at least there will be once or twice a day where leg elevation will be possible. 2. Apply coconut oil 30min before bath , this will help soften the tough skin 3. Use lukewarm water for bathing (hot water hurts the skin) 4. Use mild soaps not those antiseptic or antibacterial soaps. 5. In the day, make him wear cotton lehenga ( pyjamas) and on top of the pyjamas wrap a crepe bandage (skin colored ones we use when we sprain legs) on the leg... make sure the pressure isn't too much. Keep it wrapped 3 hours in the morning (or whenever he is most active) and 3 hours in the evening. Make sure you're using the (pure cotton )pyjamas underneath the Bandage because otherwise the crepe bandage (since it's not cotton) irritates the skin. These are somethings that have worked fairly well (not 100 % though)for similar other patients of mine. So you could try it out...And once you get in to the above routine, visit an allopathic dermatologist again and start prescription medicines ... hopefully this should help you a little more than the last time.
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Dr. Manoj Agarwala
Dermatologist 11 yrs exp Delhi

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It appears as Stasis dermatitis with venous ulcers. Most of the information suggested is correct and it needs precise management, An ultrasound doppler is sometimes useful and following that some other form of therapy can be recommended. It is indeed a difficult situation. Meet with your family physician and find some alternative ways to the suggestions by specialists.
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Your dermatologist will decide a treatment plan for you after a consultation.
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