six months duration,middle aged woman,diabetic and hypertensive,ulcers present both hands and feet,kindly provide dd..Thanks in advance

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Dr Vasudha Since nails are normal, I can rule out vascular occlusion as a cause. Sensory loss associated with tophic ulcer would also be my view. Must be old case of Hansen's left undiagnosed.

Thank you sir
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In my 4 decades of medical practise ,I have seldom come across ,diabetic sensory nueropathy of hands in Indian set up ,but western literature revealed so. But Diabetic sensory nueropathy in lower limbs are very common ,and so the ulcers. In this case old treated Hansen is to be ruled out . This case may be syrngomaylia is to be ruled out .Go for CT sacn of brain stem and cervical spine.. There are humpten causes of sensory nueropathy ,one by one one should rule out.Even nutrition based is to be thought off.

Hansens disease look for anesthesia. Peripheral nerve thickening Glove and stocking anesthesia Whether from birth

DD Congenital sensory neuropathy.
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Typical punched out neuropathic ulcer in the foot. DD traumatic, Tb, trophic. Hand ulcers due to microangiopathy.

It's a case of DIABETES Hypertension with trophic ulcer Rx Control DIABETES Hypertension unappropriatedrugs that is O H G & Insulin & B1 B6 B12 orally/ parentraly & local Antiseptic dressings in addition to Antibiotic

आयुर्वेद के अनुसार यह क्षुद्र कुष्ठ की श्रेणी में आते हैं। चिकित्सा शुरू करें बिसान्दू के पत्तों को पानी में उबालकर उस पानी से स्नान कराएं कायाकल्प तेल लगाने के लिए त्रिफला चूर्ण 10 ग्राम रात को सोते समय दूध के साथ दे कायाकल्प वटी 2 सुबह शाम जल से सेवन कराएं महामंजिठ क्वाथ 25 ग्राम सुबह-शाम पानी मिलाकर पिलाएं। सुगर का स्तर कम करने का कष्ट करें। निश्चित रूप से लाभ होगा योग परिक्षित है पिछले 40 वर्ष से प्रयोग कर रहा हूं

Feet ulcer look like trophic/ chronic traumatic, while hand ulcers look more like of vascular pathology. I suggest, rule out leprosy first, get cbc, lipid profile, thyroid profile, RFT,serum globulin : albumin ratio, and importantly get autoimmune work up . and if vegetarian get serum vitamin b12. @Dr. Vasudha Varada , ma'am u should rule out autoimmune and leprosy in this patient. And treat accordingly.

And strict glycemic and htn control, and prevent trauma and secondary infection.
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It is diabetic ulcer

Diabetic foot ulcer. Rule out leprosy

@Dr. Avitus John Raakesh Prasad sir kindly provide your valuable input regarding the case

Thanks for tagging me madam. I agree with others.
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