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I have an odd rash pattern on my ankle, and it hurts a lot; I've been to two doctors about it who gave very different diagnosis.

One said it looked like osteomyletis, the other said it looks like impetigo, both took cultures, that said it confirmed their diagnosis.

Image of "rash"

What does this rash represent? Clear answers would be nice, currently I feel like I'm getting the run around.

It itches a lot, and it hurts quite a bit to put pressure on.

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  • Welcome to Health.SE! This might be a borderline question. I will not however vote close yet. Are you on antibiotics? What did the cultures say? Obviously it is some kind of inflammation. You should update your question. It is a kind of rebus now. – arkiaamu Aug 10 '15 at 13:50
  • Did you break a bone or injure yourself in that location recently? I'm not a doctor but that doesn't look like empetigo at all, or even a rash for that matter. It looks like cellulitis, which could be secondary to osteomyelitis. I would be very surprised if the doctor who diagnosed osteomyelitis didn't insist on beginning antibiotics. – Carey Gregory Aug 10 '15 at 20:44
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    How long have you had that "rash"? Why do you have an occlusive dressing on it? – anongoodnurse Aug 10 '15 at 22:56
  • Agreed with @anongoodnurse - That is more reminiscent of an infection, not a rash. Doesn't really look like impetigo either. What cultures did they take and what were the results? – JohnP Aug 11 '15 at 18:22
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    @JohnP You sure it's anongoodnurse you agree with? ;-) – Carey Gregory Aug 11 '15 at 19:08
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No one can diagnose your particular problem over the internet, not even with the superb picture you've provided us with.

Health Stack Exchange is for educational purposes only and is not intended as a substitute for individualized diagnosis and treatment by a qualified healthcare provider.

However, discussing osteomylitis and impetigo might help you.

Impetigo

The garden-variety of impetigo is a superficial skin infection characterized by redness, broken skin, and serous fluid leakage which when allowed to dry form honey-colored crusts.

enter image description here enter image description here

It is highly infectious, and untreated, it spreads to not only others, but to the surrounding skin, in that more lesions develop and cover a larger area of the body.

The most common offending organism is Staphylococcus aureus; Streptococcus is next. It is so superficial that it's one of the few infections that can be treated with a topical agent (Bactroban) unless there is too much skin to cover, making a topical treatment unwieldy.

Impetigo can sometimes infect deeper into the dermis resulting in deep dermal ulcer with a raised and indurated (hardened) surrounding margin. Then, it is called ecthyma. The infection may start in skin that has been injured due to a scratch or insect bite, and for this reason, the infection often develops on the legs. These infections need oral, and sometimes intravenous antibiotics.

Osteomyelitis

Osteomyelitis is infection of the bone. It can be caused by a skin infection that reaches the bone, an open fracture (even long after the fracture and overlying skin has healed, or from spread of infection by blood into an area of bone. Posttraumatic osteomyelitis is more commonly seen in adults and typically occurs in the tibia (some part of the "shin" bone, which is where your skin lesion is.)

Osteomyelitis is a serious infection and more difficult to treat. S aureus is the most common pathogenic organism (Thus, if both doctors have S aureus from cultures, they can both take this as a "confirmation" of the diagnosis.)

Posttraumatic osteomyelitis requires a detailed history for diagnosis, including information regarding the initial injury and previous antibiotic and surgical treatment. Weight bearing and function of the involved extremity are typically painful.

The diagnosis of osteomyelitis should include imaging studies of some kind which confirm the diagnosis.

Although one can't tell which you have, the information provided here might help you to have a more informed dialogue with your doctor(s). At this stage, though, it's safe to say it's not the garden variety of impetigo.

Common Bacterial Skin Infections
Ecthyma
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America
Osteomyelitis

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