Abstract

Images in… Andre Khoo, Nick Levell Department of Dermatology, DESCRIPTION Norfolk & Norwich University Surgical debridement and amputation were consid- Learning points Hospital, Norwich, UK ered by the admitting team, for malodourous crusting legs with maggots in a 62-year-old man (figure 1A). Correspondence to ▸ An assessment of the skin should be made Dr Andre Khoo, We tried a simpler remedy: 500 g of a greasy emolli- only when the skin has been cleaned. This is andre.khoo@cantab.net ent (30% yellow soft paraffin, 30% emulsifying wax, particularly the case in patients with poor 40% liquid paraffin) was applied for 15 minutes fol- Accepted 2 October 2015 physical hygiene, as superficial debris can lowed by debridement with tweezers and compres- change the appearance of the skin. sion, giving a much improved appearance (figure 1B). ▸ Cleaning can be performed with the aid of The maggots were physically removed during the emollients and tweezers to unmask the true cleaning process. The patient admitted to poor state of the underlying skin. compliance to a gluten-free diet for his coeliac ▸ Always consider the possibility of systemic disease, explaining an albumin level of 19 g/L leading disease when confronted by cutaneous to lymphoedema with