Burst elbow tophi & lanced toe tophus

Stopping Gout Together Forums Help My Gout! Burst elbow tophi & lanced toe tophus

This topic contains 8 replies, has 4 voices, and was last updated by  nobody 3 hours, 8 minutes ago.

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  • #2275

    GoutPal Victim
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    My father’s gout rose to the surface and burst through. It started as milky fluid and cottage cheese like gout I guess. The fluid is blood tinged clear now but still clumps of stringy white goo. He now has two considerable holes leaking. This has been 2 days off and on.

    Is this an emergency or can it wait a few days to see the regular doctor?


    Gouty Tophi can be Painless photo

    Gouty Tophi can be Painless. But they can also be dangerous. How will you treat your gouty tophi? More info and tophi pictures in Tophi Facts Pages.

  • #2285

    Keith Taylor
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    There is a serious risk of infection. Get the tophi site dressed professionally immediately.

    Then, get uric acid safe. As quickly as possible.

    Let me know what your father’s doctor plans for uric acid control. Then, I can offer assistance. Hopefully, we can get him safe soon.

  • #2561

    GoutPal Victim
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    so just had my tophus lanced by a doctor….
    wound doesn’t seem like it’s closing due to uric crystals underneath…
    what should I do ???

    I clean it daily with hydrogen peroxide….

    • #2563

      Keith Taylor
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      Get to hospital today. Your butcher has left you at risk of infection. It needs to be properly cleaned and dressed immediately.

      Then get proper uric acid control, which prevents this type of disaster.

    • #4361

      Gainesville Gout Sufferer

      I have hard tophus on my hands, elbow, and feet. I went to an orthopedic surgeon and he said my tophus was so hard that it can’t be removed without severely damaging the skin. He said the tophus is so embedded in the skin that trying to scrape it off would damage the skin so bad that the skin would not heal because the blood vessels would be destroyed.

      I’ve had gout for 37 years. It’s the worse case ever.

      Is there a way to liquefy the hard tophus so it can be removed without killing the skin?

    • #4369

      Keith Taylor
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      Hi Gainesville Gout Sufferer,

      I hope you can see from my earlier replies that your surgeon was right to be cautious. Because surgery to remove tophi is a risky procedure. But, self-mutilation, under-qualified lancing, or simple neglect are all too common. Then, without careful, sterile, tophi removal, surgical washing, and medical dressing, the risks of infection are high.

      Also, burst tophi are often slow to heal. Because the damage you experience with your own tophus can affect skin healing.

      However, you should search for tophus removal using the search box at the top of the page. Because the first result is Tophi Removal Without Surgery. So, that picture proves you can ‘liquefy a hard tophus’. But, only by lowering uric acid.

      I’m surprised your surgeon hasn’t referred you to a rheumatologist. Because you need to get your uric acid as low as you can. Starting, as soon as you can.

      If you need help with that, you can reply to this topic. But, I think it would be better if you log in and start your own new topic.

    • #4370

      Keith Taylor
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      Also, I just read a nice summary of this situation[*].

      The authors make it clear that the first-line treatment for tophi should be uric acid lowering drugs including allopurinol, febuxostat, probenecid, lesinurad, and pegloticase. However, they also note that some tophi cause “urgent complications” that might warrant surgery. Those complications include infection, ulceration, and nerve compression (e.g. carpal tunnel syndrome). Also, when tophi develop near joints, they can damage joints, restrict movement, and cause function loss.

      Finally, they conclude that tophi removal by surgery is generally successful. Although they repeat the warning “surgery should be considered for the rare patient with impending or severe, debilitating complications”.

      So, it’s worth repeating that anyone with tophi should be taking allopurinol, or similar, at a sufficient dose to get uric acid well below 5mg/dL. But, each patient must have dose monitored to ensure it is safe and effective for that individual.

      Tophi, Surgery, Uric Acid Lowering Reference
      Kasper, Isaac R., et al. “Treatment of tophaceous gout: When medication is not enough.” Seminars in arthritis and rheumatism. Vol. 45. No. 6. WB Saunders, 2016.

  • #6083

    Brenda Plumpton

    Hi,
    I am a 71-year-old female who was diagnosed with gout 3 years ago after starting on diuretics, beta blockers, and ace inhibitors – I had an ICD fitted because of heart arrhythmia.

    My blood uric acid level was 705 at its highest. I was intolerant of Febuxostat and struggled with Allopurinol – I am now seeing a Rheumatologist and receiving treatment for tophaceous gout.

    There is a tophus on my left foot which “popped” through pressure from the adjoining toes about 2 months ago. This has now popped again during a gout flare up and my toe is very inflamed but less painful after the white exude came out. Is this normal?

    I take Colchicine when I have a flare up and have managed to take 200 mg Allopurinol for the past four months during which time my blood uric acid level has dropped to 447.

    I also have osteoarthritis in my knees and was told I had polymyalgia rheumatic for which I am taking 5 mg Prednisolone daily (30 mg on diagnosis decreasing to 5mg over the past 4 months). I had never taken any drugs before the ICD implant (apart from Paracetamol when I had a cold or headache) and am having to adjust to quite a rigorous drug intake.

    Is there anything else I can do?

    Brenda

  • #6103

    nobody
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    Hi Brenda!

    I don’t feel knowledgable enough to give you advice considering all the health issues your are dealing with. I’ve never had white exude coming out for instance.
    It’s good you are seeing a rheumatologist. If you can’t get in touch with them to ask if what’s happening to your toe is normal, perhaps your GP could take a look at your toe and contact your rheumatologist on your behalf if they think there is any cause for concern?
    If you are experiencing much pain, redness or swelling you shouldn’t be shy in complaining to your doctors about this because there are other things they might be able to do to help. I don’t know what would be safe in your situation so I can’t recommend anything.

    There’s general information about gout and uric acid you may be missing. Have you read the recommendations for patients issued by your local arthritis/rheumatism-focused organizations or your government?
    It’s encouraging that your uric acid dropped so much with 200mg allopurinol but it’s still too high. If it would not be safe for you to take a bit more allopurinol, perhaps you could try to tweak your diet and drinking habits in order drive your uric acid a little bit lower? Let us know if you want more information about that.
    There are also drugs or less powerful remedies you could possibly take alongside allopurinol but that would probably be more risky in terms of side effects, drug interactions and so forth than simply tweaking your diet. Even with foods and drinks though, I would recommend you check with your doctors before doing anything drastic.

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