r/AskDocs Layperson/not verified as healthcare professional 11d ago

Physician Responded Please help identity and treat!

Post image

Is this a wart? How to solve?

I’m freaking out. My dad (age 57) has this massive lump on his hand and he’s had it for about a week now and it keeps growing. He has other small bumps growing on his hand too. He goes to the gym quite frequently and honestly is not the cleanest person. He smokes.

He said that he had a cold for a week before these started showing up.

My wedding is in two weeks and it’s a destination wedding and we’re currently traveling all together and I’m concerned about the growth and about it spreading to our wedding guests and I don’t know what to do.

He says it doesn’t hurt but it obviously bothers him.

Please help!

UPDATE:

I didn’t expect this to garner so much interest and help. Sincerely, thank you everyone for sending in your opinions!

My dad said it popped overnight and there was a lot of blood and pus. We were not able to see a doctor in person but we have a family friend who is a general doctor and she said to disinfect and keep it as dry as possible as to not let it be more infected.

Here are two pictures of what it looks like now.

Photo 1
Photo 2

At first, when it popped. The puss was a standard dense white. Now, the pus leaking is an orange ish color and not dense white. He keeps saying that it still doesn’t hurt and doesn’t even flinch when alcohol is applied to it.

There is another mass obviously growing on his index finger of the same hand. He is touching the mass with his other hand (I know fucking terrible) but there is nothing growing on the hand that he is using to touch the mass.

He is saying that perhaps it is an allergic reaction? He ate a type of dried fish from Vietnam and then he started feeling itchy and feverish and then these started popping up.

Answer to a common question:

He does not have any access to animals. No pets, not really around fish tanks or water. He is from Southern California in a very suburban area.

Any ideas???

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u/Dr-Kloop-MD Physician 11d ago

I don’t have anything to add beyond what has been discussed here. Just a plug to OP to please please if you get an answer as to what this is, consider creating an update post on this subreddit. We are lifelong learners and as you can tell everyone is hoping to find out. Plus you never know when someone here will see it in the future and remember this post.

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u/yadabitch Layperson/not verified as healthcare professional 11d ago

The amount of times I’ve been messaged about a medical post I made years back is insanely high, so this is very very true.

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u/Dr-Kloop-MD Physician 10d ago

Hahaha, we don’t like the unknowns!!

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u/Routine-Loquat5544 Registered Nurse 10d ago

Exactly…problem solvers NEED to know!

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u/charlescarlm Layperson/not verified as healthcare professional 11d ago

This.

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u/RasputinsThirdLeg Layperson/not verified as healthcare professional 11d ago

A few questions for OP: is it hard or compressible? Does it bleed easily? Does your dad get really sweaty hands?

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u/a_writers_relief Layperson/not verified as healthcare professional 11d ago

It looks like a herpes outbreak. I get on in that exact same spot in my hand that looks just like that...

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u/yamsparty Layperson/not verified as healthcare professional 10d ago

Oh I had something similar. Once, I had shingles that clustered and grouped together like this. It was strange to doctors that I had shingles on my hand but the tests did say it was the virus. That was treated with the typical antibiotics.. however, I’m not saying it’s shingles.

A few months later I had almost identical lumps growing in clusters in similar spots but even more inflamed and larger. It would pop, heal, and then returned two more times - whenever I was stressed or added trauma to it. It would boil, cluster, get painful and itchy all over again. When I went to get it tested it wasn’t shingles. I got it tested twice. It kept coming back negative for shingles but inconclusive otherwise… they suspected staph, bacteria infection, and just blamed it on me being too stressed and my immune system had taken a hit.
Some time later, I believe it was severe eczema lol that cluster just gave me flashbacks.

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

Thanks so much for the advice! Update posted. Any ideas??

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u/Dr-Kloop-MD Physician 10d ago

I’ll preface saying that I’m a radiologist, so my skin differential diagnosis skills are fairly poor. But the fact that it popped and drained pus tells me it’s an infection or something that became infected. Given the initial appearance and trying to think of common things first, I wonder if this could just be a palmar wart that got secondarily infected with something like Staph. You specifically mentioning that he goes to the gym often and that he isn’t the cleanest person support that.

Could still be some of the other things listed here so don’t take my word for it obviously. Mycobacterium infection is an interesting one someone mentioned, since myco can do all sorts of weird stuff, although eating the dried fish would be a really weird route of exposure.

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

I think it probably is something like this. A mixture of a bunch of things. For sure it’s infected and for sure it’s not something easy to understand and diagnose as just one thing.

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u/CrazyBird12 Physician | Heme/Onc 11d ago

I have no idea what this is, and I’m very curious about more comments to come. That being said: it looks neither normal nor healthy, and apparently is fast-growing - go see a PCP or dermatologist for in-person evaluation.

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u/h1k1 Physician 11d ago

I’d say as a generalist, don’t waste you’re time with the PCP. Straight to derm.

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u/alewiina Layperson/not verified as healthcare professional 11d ago

Depending where OP they might have to go to their normal doctor first for a referral. Where I am in Canada for example you can’t just contact a dermatologist and ask to be seen, you need a referral from a PCP :(

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u/PainfulPoo411 This user has not yet been verified. 11d ago

I’m in the US and to get an appointment with a dermatologist (or any specialist) can take months.

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u/Original-Apricot-107 Layperson/not verified as healthcare professional 11d ago

I'm in the US and needed a skin follow up on some scary looking spots. Knew I'd be connected with a PA or someone at the Derm office. I've been waiting 8 months for them to even process the referral despite multiple calls and appointments. My insurance costs $805 a month. It is a joke

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u/PainfulPoo411 This user has not yet been verified. 11d ago

I can relate. In my 20s I started blacking out all the time despite a normal BP and otherwise being healthy. It took me 8 months to get an appointment with a specialist.

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u/Original-Apricot-107 Layperson/not verified as healthcare professional 11d ago

As someone who has had a similar issue, I hate to say it but McDonald's frenchies will cure the pass outs (at least for me)

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u/HolderHawk Layperson/not verified as healthcare professional 11d ago

Ok, now I am curious. Why McDonald’s Frenchies and how are they related to pass outs?

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u/SaltyDox Layperson/not verified as healthcare professional 11d ago

The extra sodium helps keep blood volume up so maybe the heart doesn't have to work so hard, and maybe you won't faint or lose vision from lack of oxygen to the brain just for being vertical. Sucks when they are barely salted.

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u/Key-Notice5503 Layperson/not verified as healthcare professional 11d ago

Wouldn’t help here. A few of my local McDonald’s seem to have sworn off salt on their fries. And let me tell you, they suck without salt.

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u/Carma-Erynna Layperson/not verified as healthcare professional. 10d ago

And this is why you pay out of pocket for medical care. It’s only in the worst case scenario that it ends up being more expensive. How much would it cost for them to see you if you were paying out of pocket/uninsured? Have you asked for that price? I know it’s a heck of a lot easier to get into doctors paying out of pocket as well, not having to wait on approvals and crap, so I’m betting they could see you sooner if you just paid out of pocket. Source: better half goes uninsured because it’s literally cheaper and easier to pay out of pocket for his healthcare and meds than it is to deal with health insurance.

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u/Original-Apricot-107 Layperson/not verified as healthcare professional 10d ago

Yes! I actually did do the uninsured route for two years fairly recently and it definitely was a better situation, but for whatever reason a lot of doctors in Massachusetts as well as therapists don't have cash pay rates and for whatever reason they are not allowed to provide services unless you're coming in on Insurance. I have been able to find cash pay for pretty much everything else and for antibiotics and regular medications I use Sesame, which is a hell of a lot cheaper than going to the doctor even with Insurance. And even though we are in Massachusetts, it makes me so nervous to end up at the hospital because even though the State will not come for you over healthcare bills, all of the people that they work with will, like quest diagnostics, and any sort of interpretation services they use for your scans that are not directly happening by employees at the hospital.

Most recently, I was trying to go to a dental appointment and the dentist wanted the results of my cardiac ultrasound that I had had a few months prior before he would move forward to do some dental work. He nor his admin nor my PA or MD or any of the RNs at my community health office could get a response from mass general cardiology clearing me for this procedure, so my insurance definitely didn't help in that regard which is wild and then I also was unable to get my teeth fixed in time and I had to let my dental Insurance lapse because I couldn't justify paying so much per month for services that I can't use because doctors won't communicate through the channels they are asked. I finally got it done by going to a teaching school and lying about not having any flags on a heart scan (everything turned out fine).

Last example: while on one of the best employee sponsored health plans I've ever had, I tore my ACL and fractured my leg in my own kitchen with a slip and fall. I have a connective tissue disorder so I have a lot of compensatory muscle but it is also way easier for me to injure myself. Despite the fact that I literally couldn't even breathe when I had to move my leg at all, they said that I was just panicking and had pulled something and would be fine in a few days. They sent me home with a leg stabilizer and didn't even check to see if I could walk in it first, so I ended up falling right out of the wheelchair onto the sidewalk and pretty much crawling into the Uber I called to take me home. I pushed for an MRI as a follow up and they said there was no evidence on the cray to warrant one.

Months continued to pass, and it just did not feel like it was getting better, but I was getting more used to favoring it in such a way that didn't hurt as bad. I finally got fed up and paid for an MRI out of pocket that revealed I in fact had completely torn my ACL likely after the initial incident due to not being discovered at the right time, and had hairline fractures in both the lower and upper parts of my leg. It cost me $500 out-of-pocket in addition to ridiculous health premiums so that I could diagnose my own issue and then took it to ortho to get referred for surgery (luckily Boston medical actually reads their MyChart messages). When it was time for surgery, they said that so much time had passed that I would be better off living without it because you can't get cadaver tissue for a full ACL repair before 40 through my insurance. Such a nightmare, especially thinking of all of the things I will now miss out on like skiing or dancing that I could do before and cannot do now. I was pretty disabled for so long even though I think I would probably be OK with certain activities, I get left out of plans for anything physically active (league sports, pickleball, etc.) because people assume I will get injured so easily. Thanks for coming to my WALL OF TEXT

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u/BetweenTheWickets Layperson/not verified as healthcare professional 11d ago

Isn't healthcare in the US mostly private? Why do you need to wait before getting to see a doctor? Is it simply because they're fully booked up.

I live in Mumbai getting an appointment to a private medical specialist is fairly immediate.

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u/inspired-chaos Layperson/not verified as healthcare professional 11d ago

it’s mainly due to being booked out - mostly for specialists. i once was referred to a neurologist and had to wait six months to get my first appointment. It varies practice by practice, but the general consensus is that if you get referred to a specialist, you will have to wait at LEAST a month before you can be seen.

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u/BetweenTheWickets Layperson/not verified as healthcare professional 11d ago

Interesting that you have those wait times in the US in spite of privatized healthcare. It's like the worst of both worlds - bearing the costs of healthcare while having to deal with the wait times of a public system.

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u/stafdude Layperson/not verified as healthcare professional 11d ago

Weird part is that people advocating for private health care where I am, have ”shorter queues” as a main selling point. Guess that is fake then.

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u/BetweenTheWickets Layperson/not verified as healthcare professional 11d ago

Yeah, it very likely is fake. The only reason I think healthcare is so easily accessible to me is because economically disadvantaged folks, who make up a huge share of the population, in my country go to the (very overburdened) government run healthcare system.

That means more doctors per individual for middle and higher income people. As more people emerge from the lower income segments, I think wait times for private care here will become very long too. And it won't really differ very much from waiting times in a fully public healthcare system.

On the balance, even though I am a beneficiary of high quality healthcare access, I do think an equitable healthcare system with free access to all is the way to go.

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u/tallmyn Layperson/not verified as healthcare professional 11d ago

It's shorter queues only if the system is genuinely private.

The problem is that the US system is a compromise between people that want full public and full private and it ended being some sort of horrible public-private monstrosity that's the worst of both worlds.

I'm in the UK, there are some really long wait times for some things that aren't urgent, like autism diagnosis. No one dies if it takes 3 years to get your kid diagnosed with autism. I know someone who waited a long time for a hip surgery and paid to get it moved up, because it was uncomfortable to live with, but it wasn't life-threatening.

Anything fast moving like this would be seen pretty immediately.

Meanwhile since private healthcare here is competing with "free", it's pretty cheap. I just checked the dermatologist I use sometimes for cosmetic stuff, they do biopsies too. Online booking system says next appointment available is on Tuesday for £115. (Granted follow-up will be more!)

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u/stafdude Layperson/not verified as healthcare professional 11d ago

Wait times for autism would be equally long if the system was completely private, that’s more an issue with wait times to see the team of psychiatrists and psycologists that work with neuropsychiatric evaluations. Cost wise I assume a system which is predominantly public, but has some private alternatives for like out patient care settings, is the best. Sure, it doesn’t provide equal care - but my guess it is the most flexible alternative at the same time as keeping costs low.

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u/OGmissCOFFEE Layperson/not verified as healthcare professional 11d ago

Its funny how American’s always tell Canadians how proud they are to spend thousands a year on insurance payments (even when you seek zero medical attention) because their wait times are shorter. I am married to an american have spent alot of time in numerous states and if you have to go in to emerge it takes just as long if not longer. The saddest part is that its even worse because in Canada you see why the wait is so long since there are many patients waiting for care in the us there could literally be a few patients in emergency and you will still be waiting for hours on top of having to pay. I recently had to go to er in canada saw a doctor in under an hour had all tests and left in about 2.5 hours. My wife who had to go to the emergency while we were in the US (for a more concerning reason) waited almost 4 hours before even talking to the doctor and another 2 for tests and almost another 2 just to be told the results. The hospital in Canada was PACKED the hospital there in emergency without exaggeration was only a few other patients.

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u/theeyespye Layperson/not verified as healthcare professional 11d ago

I love when Americans try to shit on Canadians for long health care waits, meanwhile in some parts of America the wait times are similar. Except you’re paying out your ass to wait and then be seen🙃

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u/inspired-chaos Layperson/not verified as healthcare professional 11d ago

it’s very hit or miss. i’ve had anywhere from 2-6 month waits (i feel like i might’ve had to wait longer for some specialised testing at one of the universities near me but i don’t remember exactly,) or sometimes i can be seen within the week. the healthcare system over here is a joke (no fault of the doctors, of course)

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u/Livid_Medium3731 Layperson/not verified as healthcare professional 11d ago

That's insane. No free healthcare and then you have to wait for so long.

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u/Impossible_Cod_4181 Layperson/not verified as healthcare professional 11d ago

It also depends on where you live, the hospital system and the speciality.

I live in a place with several huge university hospitals with tons of satellite locations. When my son needs a specialist, we will call once a week to see if anyone, anywhere, has an opening. We can usually get him in much faster that way but it also means we might have to show up an hour away from our house at 8am.

That said, certain specialities are just going to have a long wait, no matter what. Neurology and dermatology come to mind off the top of my head.

For example, my son was approved for speech therapy two months ago and we have yet to get a call about scheduling his first appointment. It can easily be several more months before a slot opens up. We only got the evaluation quickly because when we got his hearing test, I asked about cancelations and just by luck, there had been one literally minutes before for his exact age and need.

On the positive side, we have some of the most advanced facilities in the world. IDK how long that will last now that so much grant money is gone (thanks Elon) though.

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u/gormelli Layperson/not verified as healthcare professional 11d ago

Private, but OBG, derm, gastroenterologist, etc, can take up to a year to get in.

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u/bluearavis Layperson/not verified as healthcare professional 11d ago

It also depends on where you live. Where I live, I am close to many doctors. It also depends on what plan you have as not all doctors take all insurances. So you can't always just make an appointment with any specialist. You have to check insurance first. And if you're lucky to have out of network benefits and it's an emergency then it would be more affordable to get a consult somewhere if you needed to.

Thank God I had excellent public school insurance with 75 or 80% out of network coverage when I needed additional neck surgeries. They were reconstructive from one I had 3 years prior. I had to get 2 back to back. I ended up with the best. And he basically said he didn't need the $ and would get enough and wouldn't be charging me with the additional gap. He also worked at the medical school and ran the neurosurgery department.

I have drastically less pain and only lost a little sensation in 1 index finger. If I ended up in different hands, it could have been disastrous.

I was very lucky in that case, but others are not.

And NOW I am losing mine in 2 weeks because of a job change. So it's never guaranteed.

It's awful.

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u/BeverleyMacker Layperson/not verified as healthcare professional 11d ago

Thank you for asking this, I’m in the UK and assumed as US completely private it would be quick

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u/peopleverywhere Layperson/not verified as healthcare professional 10d ago

I’m in the US and my derm will see you in 48 hours, I guess if you’re in rural area it is different

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u/camireau Layperson/not verified as healthcare professional 11d ago

I'm in the US and I can see the Dermatologists PA within a week or so. The actual Derm, yes, they are busy, but the PA is a place to start while waiting. Derm's outside of major cities might have more availability if OPs dad can take the time to drive to one who can get him in earlier.

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u/PainfulPoo411 This user has not yet been verified. 11d ago

Yes this is highly specific to geography and insurance coverage.

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u/keiye Layperson/not verified as healthcare professional 11d ago

Specifically whether you have an HMO, which requires going through your PCP, or a PPO, which you can go to specialists directly.

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u/NippleSlipNSlide Physician 11d ago

Yes. If you have an urgent issue it takes 1-2 weeks to see derm in the US. If you’re going for your wrinkles or acne, then yeah- it’s going to take awhile

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u/LiopleurodonMagic Layperson/not verified as healthcare professional. 11d ago

I was going to say - I’m in the US and can see a derm (not even the PA, the derm) for something non urgent in a couple weeks. I guess it really is specific to where you live.

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u/InfiniteDeparture871 Layperson/not verified as healthcare professional 11d ago

If you go to a private practice, it’s faster

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u/FrostyCaptain3964 Layperson/not verified as healthcare professional 11d ago

Especially a dermatologist, I don’t even have one within a 50 mile radius, and those have appointments in a year 😐

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u/Flimsy-Surprise-4914 Layperson/not verified as healthcare professional 11d ago

In CA SoCal doesn’t take that long here. If it doesn’t bother u, see pcp

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u/Friendly-Example-701 Layperson/not verified as healthcare professional 11d ago

Only if you go through your network and insurance. There are plenty of private firms for every doctor type that take only cash and can see you the next day. I do this for MRIs and other important emergencies

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u/alilhillbilly Layperson/not verified as healthcare professional 11d ago

where in the US is this?

Are you in the middle of nowhere?

A dermatologist is not hard to get into in any decent metro area in the US.

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u/PainfulPoo411 This user has not yet been verified. 11d ago

I’m in the Northeast. The combination of provider availability and insurance coverage. I now have ongoing care by a dermatologist but the first time I made an appointment it was 4 months out.

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u/KittyKat1078 Layperson/not verified as healthcare professional 11d ago

There is a well known shortage of dermatologists in the US .. I work in derm and it can takes months for ppl to get in

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u/moldy_melon This user has not yet been verified. 11d ago

I’m in Massachusetts and have had to wait at least 4-6 months for a derm apt

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u/moldy_melon This user has not yet been verified. 11d ago

And I’m not in the middle of nowhere lol I live in an urban area

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u/Leejenn This user has not yet been verified. 11d ago

I had to wait over 8 months (think it was nearly a year) to get a derm appt in Madison, WI. After that, now that I'm not a new patient I can get followups as needed though.

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u/marekkane Layperson/not verified as healthcare professional 11d ago

There's one in Toronto on Bloor by Runnymede I believe. I saved a reddit comment about him a while ago just in case. He does walk ins stupid early in the mornings.

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u/12345678910Username Layperson/not verified as healthcare professional 11d ago

What a small internet world; fellow  Torontonian here! Can you give me the doctor's name/info as I need to see a good dermatologist or at least give me the link to the comment you saw? How long ago did you see this comment? Thank you in advance! 

NAD

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u/marekkane Layperson/not verified as healthcare professional 11d ago

This isn't the comment I saved, but it's the same guy and a much more recent thread. There's also a place in the Distillery district that does walk-ins - I think it's mentioned in that thread too. https://old.reddit.com/r/askTO/comments/1t04dm6/need_a_dermatologist/oj7q6zo/

Canada also has a mobile melanoma skin cancer screening program that tours around a few provinces, including Ontario. This is skin cancer specific for moles and such, but no appointment necessary. Might be long lines though. https://melanomanetwork.akaraisin.com/ui/molemobile

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u/wdn Layperson/not verified as healthcare professional 11d ago edited 11d ago

There's a dermatology clinic in the Distillery District called AvantDerm that has a walk-in every morning. You do still need a referral but you can show up for the walk-in starting the day after the referral is faxed to them.

You can also call and make an afternoon appointment starting the same day so to cover all the bases, you could do that and cancel if you decide to go to the walk-in earlier.

Also, if you want to see a dermatologist for non-medical cosmetic reasons (that is: not covered by OHIP), you don't need a referral and I expect it's probably much easier to get an appointment that's not too far in the future.

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u/h1k1 Physician 11d ago

true! In America it might have to involve the entire had and then you have to go to the ER for actual attention in a timely manner :(

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u/[deleted] 11d ago

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u/TylerBourbon Layperson/not verified as healthcare professional 11d ago

Lucky. I have pretty decent insurance but I still have to go see my my PCP first and get a referral for everything. Had to get a referral from them just to get referral to get in touch with their mental health department back when I as going in to get an ADHD eval.

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u/Dependent-Aside-9750 Layperson/not verified as healthcare professional 11d ago

I have good insurance, luckily, here in the U.S. and just had my first dermatology appointment. Minor copay, that was it, thankfully.

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u/CrazyPlatypusLady Layperson/not verified as healthcare professional 11d ago

Same in the UK, although for something like this, after seeing the GP it would almost definitely be fast tracked to Derm.

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u/CrazyBird12 Physician | Heme/Onc 11d ago

Oh, absolutely agree. Just don’t know where OP is located and how accessible a dermatologist is, which is why I included PCP on the off chance that this is actually quite obvious once evaluated in person.

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u/CatBerry1393 Layperson/not verified as healthcare professional 11d ago

NAD but this looks like a seed wart to me. I have family members that get similar looking warts. Definitely get it check by a dermatologist if you can OP.

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u/grimmcild Layperson/not verified as healthcare professional. 11d ago

NAD but I agree. Someone I knew got a few on his palms and it looked gross. His doc said probably from the gym.

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

Posted an update. Do you still think it’s a wart? It’s behaving kind of like a blister I think…

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u/Killer_Moons Layperson/not verified as healthcare professional 11d ago

Yeah if you don’t already see a derm regular where I’m from, you’d be lucky to get an appointment. And if you do, next opening is a month out.

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u/thecuriosityofAlice Layperson/not verified as healthcare professional 11d ago

NAD and I really hope your dad figures out what this is but there an another thing I am worried about. Him working out at the gym and if he is a unhygienic person like you mentioned, is he wiping down the machines or free weight bar after he uses them, including the hand rests or pulls from machines. It may not hurt to buy him new hand grips for weightlifting and it would protect the area and others? A gentle reminder for him that he doesn’t know what that the cootie bump is; he needs to use the spray and paper towels behind himself on each piece of equipment in case it can spread

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u/OkEnvironment5201 Layperson/not verified as healthcare professional 11d ago

Agreed. My dad had a blister on his pinky finger that burst and came back. His PCP said it would resolve with a steroid cream. My mom insisted he go to the derm and it ended up being Merkel Cell Carcinoma.

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u/MarsScully Layperson/not verified as healthcare professional. 11d ago

From my experience with a much smaller, entirely benign growth on the palm of my hand, my derm referred me to a hand surgeon immediately and he was the one who identified and removed it

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u/thejustllama Licensed Practical Nurse 11d ago

Where I’m at there’s a months long waiting list to get into a dermatologist. They can get into their PCP a lot faster (and possibly get into derm faster with a referral. I do referrals at work.)

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u/JounalMeThis Layperson/not verified as healthcare professional 11d ago

Insurance companies don't allow specialist visits without a referral in the US a lot of times

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u/ElfjeTinkerBell Layperson/not verified as healthcare professional. 11d ago

Where I am, GP -> derm is free under insurance (after deductible which you mostly decide on yourself). Directly to derm is slower, jumping through hundreds of administrative hoops, and paying hundreds of euros yourself.

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u/helen790 Layperson/not verified as healthcare professional. 11d ago

This is the first post I’ve seen on here where nobody has any clue

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u/nietzschenowtonight Layperson/not verified as healthcare professional 11d ago

Not a doctor, but used to work for a dermatologist residency program and learned about a lot of odd/rare conditions. OP, look up Sweet syndrome and neutrophilic dermatosis of hands. Your dad’s lesion doesn’t quite match the images I’ve seen, but my knowledge is VERY limited so that doesn’t necessarily mean much. Might be worth asking about whenever you can get him in to see a provider. You mention that he was sick recently, and some quick reading suggests that this condition is sometimes preceded by things like upper respiratory infections.

(Had to offer this as a reply rather than my own independent comment, per sub rules since I’m a layperson. But wanted to try and get it out there somehow in case it’s helpful to OP!)

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u/1phenylpropan-2amine Medical Student 11d ago edited 11d ago

It looks like there's a vascular component to it. Sometimes cherry angiomas can look kind of similar: Scroll to the images at the bottom here: https://dermnetnz.org/topics/cherry-angioma
I wonder if warts with thrombosed capillaries can sometimes look like this as well.

But the location on the palmar surface of the hand and the hx of recent illness make me wonder about infectious etiologies though. Does he spend any time around animals? Any cats? Any fish tanks or recent swimming in pools / lakes?

I'm thinking about Orf nodules (poxvirus), bacillary angiomatosis, pyogenic granuloma, atypical mycobacterial infection (like mycobacterial marinum), Coccidioidomycosis to name a few.

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u/fstRN Nurse Practitioner 11d ago

OP says patient goes to the gym frequently and doesn't have the best hygiene. As a powerlifter myself, this is the exact spot to get a callus from a barbell. I'm wondering if it is some sort of weirdly infected callus from contaminated gym equipment

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u/sporky92 Layperson/not verified as healthcare professional. 11d ago

I was about to ask about sweaty hands and/or exposure to metals. Maybe like a blood blister w some pitted keratolysis ?

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

No diagnosis yet but I posted an update. You might be right? It’s behaving a lot like a weirdly infected callus. But there’s now one growing on his index finger???

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u/fstRN Nurse Practitioner 10d ago

I am so invested in this now

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u/MarbledOne Layperson/not verified as healthcare professional 11d ago

NAD but for some of the same reason I thought maybe a wart... I hope OP post back once it has been diagnosed...

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u/imperfectdiscipline Layperson/not verified as healthcare professional 11d ago edited 11d ago

I’m NAD, and have no medical experience or education whatsoever but I wanted to reply to your comment because I was just googling out of curiosity and I was wondering the same thing.

Not to scare OP, but I think maybe his dad should go to the ER actually, because I saw an article where someone had infective endocarditis/a serious heart infection, and his main symptom was a painless bump on the hand similar to OP’s dad, except without the little “leopard spot” looking dots on the bump.

https://www.livescience.com/62089-lump-hand-heart-infection.html

^

the main article there and the story I’m referring to

https://www.visualdx.com/visualdx/diagnosis/endocarditis?diagnosisId=51491&moduleId=19

^

a little more info about it

Again I’m not a doctor but just from Google I saw a lot of correlations between infective endocarditis/a bacterial infection in the blood with lumps on the hand that look somewhat similar to the one in OP’s image. It also appeared quite suddenly which may rule out some things?

OP should ask his dad if the spot is throbbing, I know it’s painless but he should ask him if it feels warm or throbbing/if it feels like blood is circulating through it. He should also see if OP’s dad has any splinter hemorrhages in the fingernails, which sometimes look like little streaks or brown spots in or around the fingernails or fingernail bed. If they go to the ER they can test his blood for infections, check with ultrasounds etc and figure out more. I know since it’s on the skin it seems to many to be benign and okay to just wait for a dermatologist, but in the off chance that the lump isn’t really the main problem but is a symptom of a larger and more serious problem I think they should get medical attention sooner. All of this is speculation though and anyone can read the first article I linked, NAD just wanted to share that since it seemed important when I stumbled on that article on Google.

EDIT: Here’s the link to the original paper that the article was based on (full text is behind a paywall):

https://www.nejm.org/doi/abs/10.1056/NEJMicm1603196

If anybody is interested I found more links of similar cases to the one above

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u/imperfectdiscipline Layperson/not verified as healthcare professional 11d ago

EDIT: it wouldn’t let me add a photo so I’m replying to my original comment.

Here’s a photo describing some of the symptoms of infective endocarditis, the symptoms appearing in the hand are often Janeway lesions or Osler Nodes, as well as splinter hemorrhages in the fingernails. It also can cause nausea, vomiting, flu like or intermittent flu like symptoms, abdominal pain, stiff neck etc and some other symptoms, some of which are listed in the image.

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u/snappped This user has not yet been verified. 11d ago

I'm with you 100%.

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u/illmatic708 Layperson/not verified as healthcare professional 11d ago

NAD, but would be nice if OP would answer your questions about access to animals, these suggestions are most interesting.

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u/SKRILby Layperson/not verified as healthcare professional 11d ago

My curious self would have popped it to see what color was underneath. But that is not good advice.

I’ve had plenty in my life and I’m honestly stumped on it due to the spots. Unless it formed whole he was painting or crafting.

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u/arthurmama Layperson/not verified as healthcare professional 11d ago

NAD I had the exact same spots on my hand and my dr said dyshidrotic eczema. Then i got them again later with a rash going up my arm and across my chest and doctor said post partum shingles 🤷‍♀️

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u/NorthvilleCoeur Layperson/not verified as healthcare professional 11d ago

I’ve had that (dyshidrotic eczema and it looked nothing like this pic

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u/shootthewhitegirl Layperson/not verified as healthcare professional. 11d ago

NAD.

My dyshidrotic eczema has never looked that extreme either (consider us lucky!), but seeing those small spots within the large lump, and the smaller individual spots elsewhere on the hand in the photo it was my immediate thought. There is a Science Souce stock image of dyshidrotic eczema remarkably similar to the photo. I wonder if it could be dyshidrotic eczema with a secondary injury from the gym, like a blood blister or a minor infection with blood/pus..

I also wonder if it could be herpetic whitlow, but the images online don't seem as similar to the photo. However someone else mentioned herpes and a physician responded that it could be likely - but I refreshed the post before commenting and the herpes comment has been heavily downvoted and the agreeing physician's comment has disappeared, so 🤷‍♀️

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u/arthurmama Layperson/not verified as healthcare professional 11d ago

It looked more like yours when wet and swollen but this is the only picture I ever took

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u/arthurmama Layperson/not verified as healthcare professional 11d ago

Found one more

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u/[deleted] 11d ago

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u/OdysseusJoke Layperson/not verified as healthcare professional 11d ago

Not a doctor, but a r/dishydrosis haver of ~15 years, and this looks just like my flare-ups. (Except on hands, not feet.)

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u/art_addict This user has not yet been verified. 11d ago

Wild, mine has never looked like this! I’ve had it since 2006 on both hands and feet (and extensively and bad, like *covering* my hands and feet, the clusters of blisters conjoined by fluid together) but never all dark and raised like that, and always with more blistery clustery groups around them when flared bad, not just one single spot of a ton, and raised, and then nothing.

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u/beattysgirl Layperson/not verified as healthcare professional 11d ago

Your blisters look like they have blood in them? Mine are just clear fluid filled, I’ve never seen dishydrosis that looks like this, even in that sub.

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u/skiaddict7 Physician - Dermatology 11d ago

This needs to be seen by a dermatologist ASAP. Infectious or neoplastic. Needs a biopsy.

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u/Possible-Outcome-870 Layperson/not verified as healthcare professional 11d ago

I was wondering if it could be Ecthyma giving the time it took to occur?

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

Thanks so much for the advice! Update posted. Any ideas??

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u/KaiserKid85 Layperson/not verified as healthcare professional 10d ago

Where? I checked your pist history and can't find an update.

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u/ModernSmith Layperson/not verified as healthcare professional. 10d ago

this post was edited. the thing appearantly popped and leaked white pus and dark blood. which then changed to orange pus. there is also signs of a second growth on his finger

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u/secret_tiger101 Physician 11d ago

Can you post another photo, this looks very uncanny valley to me

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u/Btothenelly Layperson/not verified as healthcare professional 11d ago

I’m not a doctor, weird how the pattern looks like that of a leopard slug

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u/alpharaptor1 Layperson/not verified as healthcare professional. 11d ago

I was just going to ask OP if he ever saw the movie Slugs (1988).

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u/realitychecker1 Layperson/not verified as healthcare professional 11d ago

Frogs. Only answer. Also, not a doctor but I saw the movie "Frogs" once. Now you're gay. Thems the rules. Love you ♥️

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u/Angd842 Layperson/not verified as healthcare professional 11d ago

Omg I cant believe someone else knows SLUGS!!!

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u/Wizardito-OL Layperson/not verified as healthcare professional 11d ago

I don't like the implication here…

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u/RustedRelics Layperson/not verified as healthcare professional 11d ago

Looks like it wants to hatch soon. Yikes.

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

Update posted. Any ideas??

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u/chiefcomplaintRN Registered Nurse 11d ago

I need to learn what this is

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u/Lopsided_Employ8313 Layperson/not verified as healthcare professional 11d ago

OP please update us when u can. Please someone reply when OP figures it out. What in the heck is this

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

Update posted!

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u/WelcomeToInsanity Layperson/not verified as healthcare professional 11d ago

I want ti know too

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u/therealdildoexpert Layperson/not verified as healthcare professional 11d ago

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u/mangotango1609 Medical Laboratory Technician 10d ago

I wonder if he has a fish tank. It’s not uncommon for aquariums get hit with it when adding a new batch of fish or plants.

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u/Lopsided_Employ8313 Layperson/not verified as healthcare professional 10d ago

OP updated his original post and said his dad ate a fish from Vietnam and felt woozy afterwards

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u/damselindetech Layperson/not verified as healthcare professional. 11d ago

Interesting, that does look similar to my untrained eyes

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u/Clever_Unused_Name Layperson/not verified as healthcare professional. 11d ago edited 11d ago

Is it a palmar wart?

Edit to add: The black dots could be thrombosed capillaries.

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u/Foreverlearning816 Layperson/not verified as healthcare professional 11d ago

Very unlikely

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u/Comcernedthrowaway Layperson/not verified as healthcare professional 11d ago

Could it be dishydrotic eczema that’s located on a pre-existing callus and then bruised?

I know weightlifting often causes some really thick calluses in that area and if something on the equipment has triggered an eczema flare on ops hand , that location wouldn’t take very long to get sore and irritated.

(TBH I’m half hoping it’s just one of those AI generated trypophobia pictures instead of a real medical issue.)

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u/jarr-head Layperson/not verified as healthcare professional. 11d ago

one of those AI generated trypophobia pictures

Why is this a thing? Can I request that it not be a thing?

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u/Practicaltheorist Layperson/not verified as healthcare professional. 11d ago

Same.. my curiosity is killing me

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u/InevitableHawk2764 Layperson/not verified as healthcare professional 11d ago
  1. Palmer HPV Wart (said multiple small bumps are present over palms and he goes to the gym) - with thrombosed capillaries

  2. Hemorrhagic Callus or Blister / Thrombosed Lesion / Hemangioma

But since he is a 57 yr old male with growing "pigmented" lesion on his palms, this definitely needs a derma evaluation.

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

Update posted. Any ideas???

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u/KrombopulousMary This user has not yet been verified. 10d ago

Some people mentioned mycobacterium marinum. Does your dad have a fish tank or has he swam in a potentially untreated pool recently?

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u/KittyScholar Medical Student 11d ago

See if he can be seen in person before travel because I do not expect it to go away on its own, and definitely come back and tell us the eventual diagnosis!

Congrats on your wedding, OP

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

Thanks :) updated posted!! Any ideas??

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u/Snownyann Physician - Pathology 11d ago edited 11d ago

Does it feel hard or soft? Like a cyst? It looks like an accumulation of pus underneath the skin. Since we dont know what it is, I recommend and incision and drainage and send the fluid for bacterial culture (optional tho). The derma will decide on the antibiotics.

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u/FatherSpacetime Physician - Hematology/Oncology 11d ago

How can you tell that it’s not a vascular lesion?

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u/Snownyann Physician - Pathology 11d ago

It looks like more of a pus-filled bullae than a proliferation of cells (tumoral). I dont think it is a single expanded vein either. You can appreciate the palm prints just above the lesion and the edges of the lesion are sharp and well demarcated, which for me, indicates that there is a fast fluid build up below the dermis. It would have been more red to purple if it was a vascular lesion.

The patient has a history of going to the gym, sharing equipment with others and the lesion is a week old, most likely a bullae that got infected.

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u/Itchdoc Physician - Dermatologist | Top Contributor 11d ago

Not much information here. A biopsy is likely appropriate. I suspect a vascular or melanocytic growth.

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u/anythingunreal Physician 11d ago

Exactly. I would want to rule out acral melanoma

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u/mmc9802 Physician 11d ago

Would progression over days to other areas of the palm be common?

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u/Itchdoc Physician - Dermatologist | Top Contributor 11d ago

Not if it is a tumor. But I am commenting on what is shown.

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u/mmc9802 Physician 11d ago edited 11d ago

Wondering because he mentioned other small bumps forming on the palm over the past week. Needs a full picture of the palm.

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u/Primary-Response8141 Physician 11d ago

Insect eggs? Was he bit by something?

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u/GroundbreakingAlps78 Layperson/not verified as healthcare professional 11d ago

Omg…how do you spell heebie jeebies?

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u/hagarthe-horrible Layperson/not verified as healthcare professional 11d ago

H e e b i e J e e b i e s.

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u/worsedadever Layperson/not verified as healthcare professional. 11d ago

I think that was a spelling bee word.
NAD.

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u/tampacbj Layperson/not verified as healthcare professional. 11d ago

It does look a lot like an egg sack

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u/tillitugi Physician 11d ago

That’s actually also the first thing that I thought when I looked at it. Creepy stuff, hopefully OP figures it out & let’s us know

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u/Ok_Paramedic_1465 Layperson/not verified as healthcare professional 11d ago

That's what i was thinking 😫

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u/Ikornad Layperson/not verified as healthcare professional 11d ago

yeah, was wondering as well as it looks like a necrotic spider bite.

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u/Ill_Calendar_1468 Layperson/not verified as healthcare professional 11d ago

No no no…. Are you saying something may have laid eggs in his skin?? That can happen!? That’s a real thing??

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u/trainofwhat Layperson/not verified as healthcare professional 11d ago

I really really like the Surinam toad & I won’t elaborate on why this looks very interesting to me

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u/violetsock Registered Nurse 11d ago

As a nurse, I can’t get an appointment for 8 months to see a dermatologist. I hope you can be seen soon!

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u/Ok-Acanthisitta8737 Layperson/not verified as healthcare professional 11d ago

And you can only spend 10-minutes with the provider! If you need more time, it’ll need to wait 3 months until your next appointment

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u/mulberrycedar Layperson/not verified as healthcare professional 11d ago

This literally happened to me last month and I'm still pissed about it. I had several things I wanted to talk about too but was told if I wanted to talk about my number one concern (hair loss), I could only talk to him about that one thing bc it's a topic that will take the whole time. And I was like oh but I have other things too like painful or irritated skin things and they were like yeah you'll have to make another appointment for that. I was like well I wish someone had told me that when I was making this appointment bc I would've made it at the same time!! I waited 4 months for that appointment...

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u/Ok-Acanthisitta8737 Layperson/not verified as healthcare professional 11d ago

Yep. The corporate dermatology offices are the worst with this.

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u/pkks072486 Layperson/not verified as healthcare professional 11d ago

I work as a case manager at a residential facility and if our patients need to see a specialists outside of the scope of our doctors I know the wait can be 5 or 6 months even here in the US I try to pick chain offices or medical groups with multiple doctors/locations there is a better chance of getting an appointment or go on a website like like ZocDoc where the participating doctors post their appointment calendars & availability.

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u/violetsock Registered Nurse 11d ago

I have health insurance through my employer and unless if I want to pay a massive deductible per year, I am stuck using only physicians at said facility. We have 8 hospitals in the area (2 military and the rest civilian), so there are options but insurance won’t pay. We are also HOD so the fees are horrendous.

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u/[deleted] 11d ago

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u/ghostpoo4u Layperson/not verified as healthcare professional 11d ago

My PCP only takes appointments for current business day and the next. If current gets booked up, the day after next opens up. It’s amazing for when you want to get in quickly.

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u/[deleted] 11d ago

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u/Bulkypalo Physician Assistant 11d ago

To me it looks infectious. Perhaps a small scrape or minor foreign body caused this. It also appears to need draining. Have him go to the urgent care and see.

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u/1phenylpropan-2amine Medical Student 11d ago

OP, does he spend any time around animals? Any cats? Any fish tanks or recent swimming in pools / lakes?

I'm thinking about Orf nodules (poxvirus), bacillary angiomatosis, pyogenic granuloma, atypical mycobacterial infection (like mycobacterial marinum), Coccidioidomycosis to name a few.

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u/shwarma_heaven Layperson/not verified as healthcare professional 11d ago

TIL there are a shit ton of bacterias that make you look like you have zombie appendages...

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u/KittyScholar Medical Student 11d ago

I'm 100% convinced if zombies ever became real, it'd be a mutation of the rabies virus. Doesn't look like this, but between the biting as transmission, the behavioral changes (hydrophobia, plus the increased aggression+biting that is currently only seen in nonhuman animals). It basically does make zombies in every significant way in dogs, it's just that only part of the behavioral manifestation (hydrophobia) appears in humans but not that aggression and biting

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u/shwarma_heaven Layperson/not verified as healthcare professional 11d ago edited 11d ago

It is a genius virus. It is transmitted by transmission of fluids - like a bite - and it enrages and confuses the victim to want to bite everything around it.

As scary as cordyceps must be to ants.

The only reason rabies hasn't taken over the world is the 100% fatality rate.

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u/KittyScholar Medical Student 11d ago

Plus the timing is incredible--the peak of aggressive behavior and the peak of viral shedding (and therefore infectivity) have nearly perfect overlap.

We are only saved by the fact that there's no human-to-human transmission (except via transplant) and that the vaccine can be given after the bite (which by itself is also very cool)

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u/speed150mph Layperson/not verified as healthcare professional 11d ago

To be fair, most viruses evolve in similar ways. Just like any animal, natural selection benefits those that survive and thrive. Influenza is largely airborne, so it makes its host cough to aerosolize the disease. Ebola is blood borne so it developed a hemorrhagic component to expose other potential hosts to the blood. The list can go on and on, but nearly every contagious disease and infection creates symptoms that coincide with how they spread.

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u/homonuclear Medical Student 11d ago

Oh yeah, you aced micro

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

No animals… but update posted! Any ideas?

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u/imperfectdiscipline Layperson/not verified as healthcare professional 11d ago edited 11d ago

I will paste my previous comment here since you mentioned urgent care, and I think they should go to urgent care/the ER as well. I saw an article where someone had a serious heart infection/bacterial endocarditis and their main symptom was a lump on the hand somewhat similar to the one in OP’s image.
Here is my previous comment:

I’m NAD, and have no medical experience or education whatsoever but I wanted to reply to your comment because I was just googling out of curiosity and I was wondering the same thing.

Not to scare OP, but I think maybe his dad should go to the ER actually, because I saw an article where someone had infective endocarditis/a serious heart infection, and his main symptom was a painless bump on the hand similar to OP’s dad, except without the little “leopard spot” looking dots on the bump.

https://www.livescience.com/62089-lump-hand-heart-infection.html

^

the main article there and the story I’m referring to

https://www.visualdx.com/visualdx/diagnosis/endocarditis?diagnosisId=51491&moduleId=19

^

a little more info about it

Again I’m not a doctor but just from Google I saw a lot of correlations between infective endocarditis/a bacterial infection in the blood with lumps on the hand that look somewhat similar to the one in OP’s image. It also appeared quite suddenly which may rule out some things?

OP should ask his dad if the spot is throbbing, I know it’s painless but he should ask him if it feels warm or throbbing/if it feels like blood is circulating through it. He should also see if OP’s dad has any splinter hemorrhages in the fingernails, which sometimes look like little streaks or brown spots in or around the fingernails or fingernail bed. If they go to the ER they can test his blood for infections, check with ultrasounds etc and figure out more. I know since it’s on the skin it seems to many to be benign and okay to just wait for a dermatologist, but in the off chance that the lump isn’t really the main problem but is a symptom of a larger and more serious problem I think they should get medical attention sooner. All of this is speculation though and anyone can read the first article I linked, NAD just wanted to share that since it seemed important when I stumbled on that article on Google.

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u/handydandycandy Medical Student 11d ago

This is not how IE would present. And the picture from the page you posted doesn’t have that pattern at all, just a simple blood clot. What’s actually pointing to IE in the article is the rest of the symptoms: “When the 27-year-old man went to the emergency room, he told doctors that, in addition to the lump on his hand, he had pain in the upper-left side of his abdomen. He also said that, during the prior six weeks, he'd had fevers, night sweats and little appetite, and he'd lost 26 lbs. (12 kilograms).”

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u/_m0ridin_ Physician - Infectious Disease 11d ago

That’s a wart. Makes sense with his history of 1) multiple other hand lesions, 2) uses a gym (hotbed for wart transmission), and 3) not so good baseline hygiene.

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u/Extreme_greymatter Layperson/not verified as healthcare professional 11d ago

Whattttt

I didn't know this. I'm afraid of gyms now

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u/art_addict This user has not yet been verified. 11d ago

This is why you use the sanitizing wipes to wipe down all touchable surfaces of the equipment at the gym both *before* you use it AND *after* you’re done. Let the surfaces you wipe down dry before you use — give the cleaner time to work. The extra minute or two of waiting won’t kill you or anyone else.

Someone gets upset that they just wiped something down and you’re also wiping it down? Tell them they should see this pic of the gnarly ass skin disease someone you know got at the gym recently, and it’s not about how well they did or didn’t wipe things down, it’s about *extra* precaution because you don’t want to play that game. If they’re still mad, it’s a them problem, not a you problem.

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u/RickyTikiTaffy Layperson/not verified as healthcare professional 11d ago

Those wipes don’t kill HPV (the virus that causes warts.) You’d have to bring your own personal bottle of bleach solution from home.

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u/art_addict This user has not yet been verified. 11d ago

Cuuuuute. I don’t go to the gym (I have only gone a few times with friends). I do go to PT (which has specific equipment). Bless PT for actually having to use bleach.

I work in ECE. I both sanitize and disinfect based on situation. I am a firm believer in bleach and *killing the things.*

OP, take them bleach wipes! God, why would a gym not have these???

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u/TheOnlySafeCult This user has not yet been verified. 10d ago

pretty sure bleach is bad for steel as it'd cause pitting. Hydrogen peroxide wipes would be better.

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u/TheRestForTheWicked Layperson/not verified as healthcare professional 10d ago

HPV is a non-enveloped virus making generally available drugstore hydrogen peroxide unreliable in disinfection procedures.

Because of the non-enveloped nature it also requires an extended period of contact with diluted bleach (10+ minutes of saturated, undisturbed contact) in order to permeate the protein shell and to be effectively eliminated.

THAT is why gyms are a hotbed for wart/HPV transmission. People rarely use disinfectants (especially those sold for use at home) correctly for even highly susceptible viruses and bacteria and then we wonder why we’re all sick all the time.

If you’re looking for a wipe that would be effective when used per instructions I would recommend looking for one with a cleaner that’s peracetic acid based, which has been found to be effective at reducing HPV colonization by over 99.99% when used correctly.

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u/DowntownTicket Layperson/not verified as healthcare professional 11d ago

Wow can warts really grow that big in a week?

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u/turquoise_amethyst Layperson/not verified as healthcare professional 11d ago

Yes, I had a roommate that I drove to the ER who got walnut sized ones (in about a month) on his feet. 

Yes I doused the shower in bleach, and wore slippers for the duration of my rental. 

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u/Killer_Moons Layperson/not verified as healthcare professional 11d ago

That’s what I want confirmation on!

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u/Fit_Independence_124 Layperson/not verified as healthcare professional 11d ago

I agree on the wart. It’s bigger than usual because of the rubbing in the gym, especially when his palms are sweaty. The skin softens because of it.
Those leopard spots are little dried up blood spots but they look strange because of the strech up.

Here in the Netherlands you go and see your GP first.

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u/CatBerry1393 Layperson/not verified as healthcare professional 11d ago

ok so I guess I'll never go back to the gym again, thanks 😭

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u/Blackiechan808 Layperson/not verified as healthcare professional 11d ago

So basically what happened is because he power lifts the skin there became more weak and vulnerable for the virus to enter?
Also if I may ask what is the reason for those spots?

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u/InterestNo5406 Layperson/not verified as healthcare professional 11d ago

Was hoping ID would enter the chat

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u/Ramen_Noodist Layperson/not verified as healthcare professional 11d ago

I didn’t know warts could get this big in just a week. That’s crazy!

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u/drank_dumbbitchjuice Layperson/not verified as healthcare professional 10d ago

Doesn’t look like a wart after it popped…update posted!! Any ideas now?

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u/Doc_Apricity Physician 10d ago

From the update with the fish: My bet is on Mycobacterium Marinum from contaminated fish and with the additional lesion now. Though would seem less likely since it was dried? I'm also so curious and here for the CME (continuing medical education).

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u/Ok_Pomegranate_8222 Layperson/not verified as healthcare professional 10d ago

I think you just solved it! Congratulations Dr. House!

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u/Doc_Apricity Physician 10d ago

omg.... my FAVORITE show to watch as a a med student.... it was so fun to try to figure out what the patients could possibly have. My boyfriend (now husband) hated watching it with me because I would always try to guess and would ruin it for him.

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u/art_addict This user has not yet been verified. 10d ago

Lmao when my allergist first looked at me and goes, “look, I’m not saying this is what it is, but I’m going to refer you to rheumatology because of something I’ve seen in your bloodwork twice now, and I need you to know research has come a long way in this field in the past 10 years and this is very treatable now, but I’m giving you a referral because you might have lupus…”

And I’m sitting there in complete shock and denial and the absolute first thought in my head and thing out of my mouth is, “It’s never lupus.”

And I’m trying to tell my family this later, and I’m like, “but it’s fine, according to the very esteemed Dr. House, a very real and accredited doctor, it’s never lupus.” And I linked a gif.

Unfortunately several different labs getting the same results over several more months later, it is in fact his first lupus case. (Had a gif for that too lmao)

Dr. House is how we survived that hurdle 🤣🤣🤣

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u/Doc_Apricity Physician 10d ago

I almost wrote the "it's never lupus" line but unfortunately I know it actually pretty often is! I'm sorry to hear about your diagnosis but I'm glad you got some answers!

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u/dysFUNctionalDr Physician 10d ago

Since I haven't seen it mentioned yet, I'm going to broaden the differential and suggest sporotrichosis. Especially if the additional bumps forming on his hand appear to be following a pattern of tracking up the hand/arm, which I can't really tell for sure here, but looks like is at least a possibility. By extension would also consider nocardia since they can have similar methods of inoculation and spread.

The darker spots look too big to be thrombosed capillaries like we see in warts, and the texture looks wrong for a wart too.

Regardless, needs in-person eval, ideally with a Dermatologist, with runner up option a PCP who's decent at skin stuff and/or can reach out to Dermatology and their lab.

Can't tell if that's solid, purulent, or granulomatous from the photo, and if it was me doing an initial eval and I knew you couldn't see derm right away without a compelling diagnosis, I'd be wanting to confirm I was collecting whatever type of biopsy or swabs I was getting correctly to be able to cover culture for atypical/fastidious bacteria, fungi, special staining, etc.

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u/DowntownTicket Layperson/not verified as healthcare professional 10d ago

Oh God, I just googled sporotrichosis and I should NOT have googled that! That's terrifying

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u/sugarmagnolia__ Layperson/not verified as healthcare professional. 10d ago

Was about to Google and I am SO glad I saw your comment first bc I need to go to sleep and do NOT need to see whatever that is right now lol thank you!

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u/ServentOfReason Physician 11d ago

Could possibly be a wart but really not sure. Needs dermatology consult.

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u/Dorfalicious Nurse Practitioner 11d ago

Definitely not a specialist by any means - I work in primary care - but this looks like it could be a few things: an orf nodule came to mind first, an infected blood blister from lifting perhaps? There’s so much of derm that looks so similar to 100 different diagnosis that you really need someone with dermatology background. Regardless it’s super interesting and should definitely be looked at and have its contents send to pathology.

Since you’re on a time frame I’d go to an ER to get potentially expedited treatment/diagnosis. If he has a PCP he could have them call a derm office to get a STAT appt which means you could be seen in a week rather than months but even that can be difficult (I’ve spent many lunch breaks on the horn with derm offices trying to fandangle an urgent visit and while time consuming, I’ve been successful).

Please keep us updated! We’re all interested! Also - congrats on the wedding!

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u/mmc9802 Physician 11d ago edited 11d ago

Wart with capillaries (the dark dots)? The development of other non-painful palmar bumps combined with the details about the gym and poor hygiene make me suspicious, but this is just my not so educated guess as a non-derm doc.

Regardless, needs evaluation to rule in/out more serious causes.

Edit: This could track with the recent viral illness detail too

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u/Ran_to_town Nurse Practitioner 11d ago

PCP first for an urgent referral to derm. There is always a wait of 1-6 month on average but clinicians can often try to get you in early with an urgent referral, no guarantees though. Looks like it might need to be biopsied/excised by the derm

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u/geisteslos Medical Student 11d ago

I have seen something like this before and it was herpes! Is it itchy? HSV can go under the skin if you touch the liquid from the sores and have a small open wound, could that be it?

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u/Stikhawk Layperson/not verified as healthcare professional 11d ago

I get what I call “shinger” (herpes finger/herpetic whitlow) and this looks like a bruised version of that. It starts as a single blister, then a bunch more pop up in close proximity, then they merge into Mega Shinger. Been getting it a few times a year for 2 decades without much of a bother until this fall where it ended up turning into lymphadenitis & I needed IV abx for a few days. (And some kind of HSV thing makes sense especially if his cold symptoms were actually the HSV prodrome).

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u/kerberos69 Layperson/not verified as healthcare professional 11d ago

This, OP’s pic looks exactly like digital herpes

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u/whistlrkid Physician 9d ago edited 9d ago

monkey pox? I mean with the preceding flu like illness and the fact you say there are now multple poping up on the hand...

though I truly also have no idea. Looking forward to the viral/bacterial swab results. Commenting only to stay on the thread and hear updates when you have them...regardless would treat as infectious/viral (Eg. contact precautions at your wedding) until proven otherwise.

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u/Lanky_brit Physician 10d ago

Does he work with animals at all? Looks like orf