Content area
Full text
Cactus spine injuries to the skin are usually treated by removing the visible spines and applying a topical corticosteroid. With this approach, granulomatous inflammation usually resolves in 2 to 4 months.
We describe a case of a 54-year-old Caucasian woman who presented for treatment of painful cactus spine granulomas on her right hand. Unroofing the granulomatous papules and removing the cactus spine fragments under a dissecting microscope, and subsequent soaking in an antibacterial solution, resulted in rapid resolution of the granulomatous lesions.
Cactus skin injuries are not limited to the natural habitat of cactus plants in the Southwestern United States. They can occur anywhere due to the abundance of ornamental cacti in homes and the existence of botanical gardens.
Treating patients with very fine cactus spines or thorn fragments embedded in the skin can be difficult. We present a case study, a discussion of various methods of cactus spine removal, and a brief literature review on cactus skin injuries.
Case Presentation
A 54-year-old woman presented for evaluation of painful red bumps on the dorsal aspects of the second and third fingers of her right hand (Figure 1). Three weeks earlier, while on vacation in Arizona, she accidentally hit her right hand against a tall outdoor cactus while throwing a tennis ball. The patient's husband removed approximately 16 to 18 4- to 5-cm brittle thorns from her hand with tweezers, then applied Neosporin ointment. Two weeks later, the patient experienced pain and swelling of the affected fingers.
Physical examination revealed 16 2- to 4-mm, erythematous, hard papules on the dorsa and sides of the right second and third fingers. The patient had no fever, chills, or lymphadenopathy. Routine X-rays of the hand were unremarkable. The patient was unable to obtain a detailed description of the cactus plant.
A mid-potency topical steroid was prescribed for twice-daily application, with little change in the granulomatous papules. Four days later, using digital nerve blocks, all papules were unroofed with a number 11 Bard-Parker(R) blade under a dissecting microscope (100X objective) (Aus Jena, Germany). Five clear spines, smaller than 1 mm in length, were identified and extracted. The patient was instructed to soak her hand in diluted Hibiclens Solution for 10 minutes, twice a day for 3 days, followed...