I have a 28 yo male patient with Cutaneous Crohn's Disease and Rheumatoid Arthritis, both diagnosed when he was 8 years old. Patient is currently taking Taltz for his autoimmune disease. Patient states he has been on biologics since the age of 15 for RA. Patient was also placed on Remicade when he was 14 years old and was on it for 11 years. Patient is allergic to Sulfa.
He developed an abscess on his right leg 2/2020 prior to seeing me and had tegaderm applied directly to his skin which created new wounds to form. He was trying to manage the wounds himself, however, has been unsuccessful. He recently was seen by another specialist that used xeroform on his legs which created a worse reaction on his skin.
Patient was seen by a vascular surgeon who performed an ultrasound on his bilateral legs and diagnosed him with Venous stasis. The vascular surgeon also placed an unnaboot on his right leg, which helped. A biopsy was taken from an abscess on his left leg which results showed: Pandermal and subcutaneous suppurative and granulamatous inflammation with necrosis, leukcytoclasis and granulation tissue formation.
He started coming to see me end of January, 2021. Since he has seen me I have placed him on unnaboot's which have helped. I took a wound culture which grew 3+ staph aureus. Patient finished a 10 day course of Doxycycline 100mg BID. He is constantly developing new pustules on his right leg. I have been seeing him 3x a week, recently, for debridements and chlorohexidene scrubs. Applying mupirocin ointment 2%, adaptic, abd pads and a multi-layer dressing. Originally, patient was scratching his wounds which negatively affected him, however, now that they are wrapped he cannot do so which has helped.

I am at a standstill. If anyone has any recommendations please let me know. Thanks in advance.