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Suggest Treatment For Fluid Pockets Under Skin In An Elderly Person

Posted on Tue, 27 Oct 2015

Question: I have just seen a 97 year old lady with profound fluid pockets in both arms under her epidermis. They look like burn blisters. Her skin is fragile and her last INR was 4.2 and coumadin on hold. She is a delight but this showed up in her adult family home residence and the right upper arm is beginning to seep. I am a wound nurse and have not seen such profound fluid collection like this. For now, over the area seeping I have a piece of Xeroform and pads to collect fluid. Her arms are wrapped from wrists to axilla in Kerlex and I hesitate to apply compression until I investigate further. Any ideas?

I am thinking it might be toxic epidermal necrosis?

Answered by Dr. Deepak Sundriyal (8 hours later)

Brief Answer:
It is an emergency. Gear up please.

Detailed Answer:
Hello dear.
I have seen the images. You are right. On clinical grounds it appears toxic necrolysis. There is risk of secondary bacterial or fungal infections. She requires immediate admission in a high dependency unit and all supportive measures to be given.

Thanks and regards

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Above answer was peer-reviewed by : Dr. Vaishalee Punj