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Suggest Treatment For Soreness On Tip Of Finger And Diminished Blood Flow
Question: I
Since September I have been suffering with a "sore" on the tip of my middle finger, right hand which doesn't heal. Have been to two rheumatologists, my family doctor (internist), and a vascular surgeon. All seem to think it is a problem from Raynaud's. I have diminished blood flow to that finger. A compounded cream has been used since November and though it helps the pain the raw area is getting larger and the skin around it is peeling. I am worried that I may lose the tip of my finger. Do you have any thoughts on what I should do? What specialist should I go to see?
Since September I have been suffering with a "sore" on the tip of my middle finger, right hand which doesn't heal. Have been to two rheumatologists, my family doctor (internist), and a vascular surgeon. All seem to think it is a problem from Raynaud's. I have diminished blood flow to that finger. A compounded cream has been used since November and though it helps the pain the raw area is getting larger and the skin around it is peeling. I am worried that I may lose the tip of my finger. Do you have any thoughts on what I should do? What specialist should I go to see?
Brief Answer:
Raynauds Phenomeon
Detailed Answer:
Good evening
Thank you for writing on health care magic
The sore on the tip could be very well a part of an ishcemic injury. But what we need to know is how the injury has happened as the treatment will differ accordingly.
As for Raynauds, starting at your age for the first time is a bit unlikely. Unless you have had symptoms before for it, it is very unlikely that it is presenting at this age.
1. I would like to know any other comorbitidies if you have like Hypertension, Diabetes mellitus, Raised Cholesterol?
2. Did you have any previous episodes of Raynauds before?
3. Is it affecting your other fingers also?
4. Any other skin complaints which you have??
Rheumatologist and Vascular Surgeon are the best people to look into this problem. If it is raynauds, rheumatologist is the best person for it. You can consult them regarding starting Nifedipine for the raynauds and some other medicines to increase the blood flow to the area. Nifedipine does wonders in Raynauds. Just the creams wont be of much help.
But do let me know these queries. I still have my doubts on diagnosis and would try to guide you in the right way
Regards
Dr Naval
Raynauds Phenomeon
Detailed Answer:
Good evening
Thank you for writing on health care magic
The sore on the tip could be very well a part of an ishcemic injury. But what we need to know is how the injury has happened as the treatment will differ accordingly.
As for Raynauds, starting at your age for the first time is a bit unlikely. Unless you have had symptoms before for it, it is very unlikely that it is presenting at this age.
1. I would like to know any other comorbitidies if you have like Hypertension, Diabetes mellitus, Raised Cholesterol?
2. Did you have any previous episodes of Raynauds before?
3. Is it affecting your other fingers also?
4. Any other skin complaints which you have??
Rheumatologist and Vascular Surgeon are the best people to look into this problem. If it is raynauds, rheumatologist is the best person for it. You can consult them regarding starting Nifedipine for the raynauds and some other medicines to increase the blood flow to the area. Nifedipine does wonders in Raynauds. Just the creams wont be of much help.
But do let me know these queries. I still have my doubts on diagnosis and would try to guide you in the right way
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Shanthi.E
This is not another question. I will answer your questions.
1. This started out with getting a splinter underneath the fingernail. A surgeon numbed the finger and probed under the nail to see if some of the splinter was still there. She couldn't see a splinter. She said her procedure seemed to increase blood flow to the tip of the finger. This was in September
2. I was diagnosed with CREST syndrome about 20 years ago and Raynauds has been a big part of that. Cold affects all my fingers - turn purple or white.
ANA tests show very high count.
3. My other skin complaint is dry skin.
4. I have low thyroid and am on Synthroid for it.
4. I do have hypertension and right now am in atrial fibrillation. Take vaparamil, lisinopril, amiodorone, prednisone, and lasix.
1. This started out with getting a splinter underneath the fingernail. A surgeon numbed the finger and probed under the nail to see if some of the splinter was still there. She couldn't see a splinter. She said her procedure seemed to increase blood flow to the tip of the finger. This was in September
2. I was diagnosed with CREST syndrome about 20 years ago and Raynauds has been a big part of that. Cold affects all my fingers - turn purple or white.
ANA tests show very high count.
3. My other skin complaint is dry skin.
4. I have low thyroid and am on Synthroid for it.
4. I do have hypertension and right now am in atrial fibrillation. Take vaparamil, lisinopril, amiodorone, prednisone, and lasix.
Brief Answer:
Crest Syndrome
Detailed Answer:
Good evening
Thanks for your reply
Well with CREST Syndrome background, raynauds is gonna be a big nuisance throughout. The medications you are taking, does not have the medicines which would help the cause for Raynauds.
Nifedipine and Verampil are both calcium channel blockers but belong to a different group. Nifedepine does have a better role in raynauds as i mentioned Earlier, but yes you may need Verampil as well for the control of Atrial fibrillation. You should talk to your rheumatologist about this option and i feel it will be ok to combine if we can monitor the Blood pressure.
Trust me, it will help. Rest of the medications like sidenafil and Prostaglandin analogues are useful but they are 2nd line and we have to be a bit careful in the heart condition you have.
Hope the information has been useful
Do let me know for more queries. Would be happy to help out
REgards
Dr Naval
Crest Syndrome
Detailed Answer:
Good evening
Thanks for your reply
Well with CREST Syndrome background, raynauds is gonna be a big nuisance throughout. The medications you are taking, does not have the medicines which would help the cause for Raynauds.
Nifedipine and Verampil are both calcium channel blockers but belong to a different group. Nifedepine does have a better role in raynauds as i mentioned Earlier, but yes you may need Verampil as well for the control of Atrial fibrillation. You should talk to your rheumatologist about this option and i feel it will be ok to combine if we can monitor the Blood pressure.
Trust me, it will help. Rest of the medications like sidenafil and Prostaglandin analogues are useful but they are 2nd line and we have to be a bit careful in the heart condition you have.
Hope the information has been useful
Do let me know for more queries. Would be happy to help out
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dr. Mendiratta: Thank you for your answer.
You mention the medications sidenafil and Prostaglandin analogues are useful.....
Are these medications I am already taking?
I will look into Nefedipine. I believe that medication is in the compounded cream I have been using along with verapamil and lidocaine.
You mention the medications sidenafil and Prostaglandin analogues are useful.....
Are these medications I am already taking?
I will look into Nefedipine. I believe that medication is in the compounded cream I have been using along with verapamil and lidocaine.
Brief Answer:
Treatment for Raynauds
Detailed Answer:
Good evening
No, you are not on sidenafil or prostagladin analogues yet. We normally use it as the 2nd line of management. The compounded cream you are using will be Nitroglycerin( NTG). It is a nitrate which helps in local vasodilation of the fingers. In our practice, it has not been of much help in the patients. You can discuss about Nifedipine. I strongly recommend that. It will help accelerate the process of healing
Do let me know for more queries
REgards
Dr Naval
Treatment for Raynauds
Detailed Answer:
Good evening
No, you are not on sidenafil or prostagladin analogues yet. We normally use it as the 2nd line of management. The compounded cream you are using will be Nitroglycerin( NTG). It is a nitrate which helps in local vasodilation of the fingers. In our practice, it has not been of much help in the patients. You can discuss about Nifedipine. I strongly recommend that. It will help accelerate the process of healing
Do let me know for more queries
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your responseI had a culture taken of the sore area on my finger. I received the results yesterday and it was positive for "enterococci" (not sure of the spelling) and 2 other named bacteria. The antibiotic vancomycin is recommended, but it is too expensive over $400) and with my history of allergic reactions not sure I want to try it. Is there an alternate antibiotic?
I also saw a dermatologist yesterday and she recommended a 2% nitroglycerin cream to use below the ulcer to help with blood flow.
I also saw a dermatologist yesterday and she recommended a 2% nitroglycerin cream to use below the ulcer to help with blood flow.
Brief Answer:
Linezolid is an option
Detailed Answer:
Good evening
Well, Enterococcus is a very unsual organism to grow on the fingers, and that with 2 more bacteria. If you allergic to lot of medicines, Vancomycin is not a good choice. It is definitely a good antibiotic but the reactions are high. If you could scan the culture report, i can tell you better. But if you cant get your hands on it, ask your physician for Tablet Linezolid 600 mg twice daily. It is as effective as Vancomycin and you can take oral tablets as well. I am sure it will be cheaper. But i would like to get an exact culture report to recommend you the antibiotic.
NTG ointment helps a bit but not too much as it does not affect the blood vessels inside. So we need a systemic medicine for it. Did you ask your physician about NIFEDIPINE?
Do let me know. Would be happy to guide you further
Regards
Dr Naval
Linezolid is an option
Detailed Answer:
Good evening
Well, Enterococcus is a very unsual organism to grow on the fingers, and that with 2 more bacteria. If you allergic to lot of medicines, Vancomycin is not a good choice. It is definitely a good antibiotic but the reactions are high. If you could scan the culture report, i can tell you better. But if you cant get your hands on it, ask your physician for Tablet Linezolid 600 mg twice daily. It is as effective as Vancomycin and you can take oral tablets as well. I am sure it will be cheaper. But i would like to get an exact culture report to recommend you the antibiotic.
NTG ointment helps a bit but not too much as it does not affect the blood vessels inside. So we need a systemic medicine for it. Did you ask your physician about NIFEDIPINE?
Do let me know. Would be happy to guide you further
Regards
Dr Naval
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Shanthi.E
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