Unexplained Skin Wounds: Possible Causes and Concerns for Diagnosis

Unexplained skin lesions?

On June 25, I suddenly discovered an unknown wound on my chest while taking a shower, and it was bleeding.
Afterward, the wound scabbed over, but every time I showered, the scab would fall off, causing the wound to bleed again.
I initially didn't think much of it, but the wound has not healed for a long time.
It seems somewhat different from a typical chancre, but I am concerned about the possibility of a syphilis infection.
The area around the wound appears swollen and circular, resembling a mosquito bite (is this a button-like appearance?).
There is often fluid, blood, or a small amount of pus oozing from the wound, and it is painful to touch.
It has been half a month without improvement.
I would like to know if this could be a primary chancre of syphilis, a chancroid-like pyoderma, or another condition.
Here are the photos from July 7: http://i.imgur.com/uDfwF4R.jpg http://i.imgur.com/SrhGqwM.jpg http://i.imgur.com/uAKhwgj.jpg and from July 10: http://i.imgur.com/NxDJ0r1.jpg http://i.imgur.com/Mth5xJx.jpg http://i.imgur.com/5modFph.jpg

Niming, 20~29 year old female. Ask Date: 2015/07/15

Dr. Wu Yuxin reply Dermatology

It is recommended to see a breast surgeon as soon as possible to confirm whether there are any lesions.

Reply Date: 2015/07/15

More Info

Unexplained skin wounds can be concerning, especially when they persist and show signs of infection or other complications. Based on your description, it seems you are experiencing a wound on your chest that has not healed for over two weeks, is painful, and has a discharge that could be blood or pus. Additionally, you mentioned that the area around the wound appears swollen and resembles a mosquito bite, which raises concerns about potential infections or other dermatological conditions.

Firstly, it is essential to understand that wounds that do not heal can be indicative of several underlying issues. In your case, the characteristics of the wound—such as the presence of discharge, pain upon touch, and the fact that it has not improved over a significant period—suggest that it may be infected. The fact that the wound reopens when it comes into contact with water indicates that it is not healing properly, which could lead to further complications.

One potential concern is the possibility of a syphilitic chancre, which is a painless ulcer that can occur in the primary stage of syphilis. However, you noted that your wound does not resemble a typical chancre, which is usually firm and painless. The presence of pain and discharge may suggest a different condition, such as a bacterial infection or an inflammatory skin condition.

Other possibilities include:
1. Infected Folliculitis: This occurs when hair follicles become inflamed and infected, leading to painful, pus-filled bumps that can resemble your description.

2. Abscess: A localized collection of pus that can occur due to bacterial infection. Abscesses are often painful and can cause swelling and redness in the surrounding skin.

3. Dermatitis: Conditions like contact dermatitis or atopic dermatitis can lead to skin breakdown and wounds, especially if there is ongoing irritation or scratching.

4. Skin Cancer: Although less likely, persistent wounds that do not heal should be evaluated for potential malignancies, especially if they change in appearance over time.

Given the duration of your symptoms and the characteristics of the wound, it is crucial to seek medical attention as soon as possible. A healthcare provider can perform a thorough examination, possibly including a culture of the wound to identify any bacterial infection, and may recommend a biopsy if there is suspicion of a more serious condition.

In the meantime, here are some general recommendations to care for your wound:
- Keep the Area Clean: Gently wash the wound with mild soap and water to prevent further infection.

- Avoid Irritation: Try to keep the area dry and avoid exposing it to water until it has healed.

- Do Not Pick at the Wound: Picking can introduce bacteria and worsen the condition.

- Use a Sterile Dressing: Cover the wound with a sterile bandage to protect it from further injury and contamination.

In conclusion, while there are several potential causes for your skin wound, the best course of action is to consult with a healthcare professional who can provide an accurate diagnosis and appropriate treatment. Early intervention is key to preventing complications and promoting healing.

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