<s>[INST] My. Dad will be 94 in 2 weeks. He was diagnosed with CHF in July 2012. He is on diuretics n Pradax, K, n BP pill. He has Gilbert's synd. so his bilirubin is always elevated . For past 6 months it hs been elevated . He is jaundiced. This has caused severe itching of body. During the nite he  accidentally itched ,, his leg n has reoccuring. Blisters on left leg for 6 months. We have been to primary mid, dermatologist, and now he is getting leg wrapped by PT at a lymphadema clinic. The blisters healed after 3 weeks n we stopped wrapping n in 2 days  blisters reoccur n we resume wrapping? We had them cultured  2 days ago as even PT is puzzled? Yes he has edema of both legs from CHF. He is very alert n with it mentally. If you can give any suggestions we would love it! [/INST] Hello! Thank you for asking on HCM! Regarding your concern, I would explain that it is not a rare finding when chronic limbs edema complicates with skin irritation and superimposed infection. Besides the advices given by dermatologist, I would recommend to promptlty treat the predisposing substrate; that is edema (it leads to inadequate blood circulation to the surface tissues, predisposing to more readily skin inflammation).I would recommend to adjust CHF therapy; especially loop diuretics. At least an intravenous root of administration would be preferred, to decrease congestion as soon a possible, and an appropriate oral maintenance dose should follow.A comprehensive clinical evaluation; physical examination, coupled wit hcardiac ultrasound conclusions, liver and renal function tests, blood electrolytes, chest X rays would better guide optimisation of CHF therapy.You need to discuss wit hhis cardiologist to review these data and make the best decision.Hope to have been helpful. Greetings! Dr. Iliri </s>