Skin Infections (keep your shirt on!)

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There are several types of skin infections. I know this is gross, but we’ve all had some of these and will probably have some in the future.

Acne is caused by glands that produce oil in your skin being overactive due to hormone changes. The oil gets plugged and can’t come out easily. A bacteria feeds on this and produces a local infection. Acne can be papular (a little red bump), pustular (a red bump with pus) or cystic (larger pus collections that leave scars, divets. We try to use a cleanser with an abrasive and a drying agent first. Second line is a topical antibiotic, and third line is an oral antibiotic. If those don’t work we use pills. These pills can cause birth defects so they ask males and females to sign a statement that they are aware of the risks. Even with pregnancy tests and this counseling and signing, some girls still get pregnant and have deformed babies and sue the company. For the males, the thinking is that the male donates DNA to the child so there is an outside chance for him to cause the birth defect, and also he may sneak some of his pills to a female friend.

Folliculitis is a Staph infection of the skin surrounding the hair follicle. Furunculosis is a larger pus collection that is commonly called a boil. A carbuncle is an even larger boil. An abscess is even much larger pus collection. All but the folliculitis needs an incision and drainage. The larger ones may need packing with gauze by a medical provider. Scrubbing well and often prevents these pretty well. If you work in a dusty, dirty job and get these, you may consider scrubbing lightly with a brush and soap on the affected areas. A brush from the 99cent store works well.

Folliculitis barbae or shave bumps are when the curly beard hairs do not come out of the normal hole in the skin but get caught in the tract and keep growing so that the body reacts with a red bump. Those of African descent are more prone to this. They should try shaving with an electric razor, keep a beard (short or long) or use a depilatory such as Magic Shave.

Hot tub folliculitis is a rash that develops on the chest from the jets from a hot tub shooting water that is not clean and bacteria into the skin under much force at the chest level. Don’t drink the water!

Spreading infection of the skin without pus or near one of these pus pockets is cellulitis, in which the skin is red and tender.

Impetigo is a more superficial infection of the skin, mainly in small children, with a honey-colored crust.

Most of these can be prevented by keeping clean. But even clean people get an infection at times. The elderly and those with HIV can have more of these and more severely. An antibiotic, either orally or intravenously, is many times necessary if the infection is deep or invades the surrounding skin enough.

If the infection is mainly a collection of a moderate amount of pus, then drainage and good wound care is all that is needed. The abscess should be opened completely, after local anesthesia, and then explored with a cotton swab to knock off the dead tissue. If deep enough then it is packed with gauze which is removed every day or two and then the swab procedure is repeated.

Sometimes it is not obvious that there is a collection of pus below the red skin. A trained health provider can sometimes tell; sometimes an ultrasound examination is helpful. Other times we anesthetize the skin with a thin needle, and then insert a thicker needle to see if we can withdraw pus; if so, then more anesthesia and an incision, etc is performed.

Resistant Staph will not respond to the antibiotics we used to use. First this was mainly in intravenous drug users, then we noticed it more in gay men, and now we assume all have it and treat accordingly. Sometimes we are able to get cultures of the infection to double check which antibiotics to change to if the first prescription isn’t working. It takes 3-5 days for the culture to grow and the antibiotic information to become available. If there is no culture, then we treat based on statistics, the odds of which bacteria is probably the cause. If the culture comes back, we check if the correct antibiotics are being used if the infection is not improving.

If a person has an infection, it is probably best not to be preparing food for others. Although, I don’t want to imply that young people with acne shouldn’t be cooking; perhaps they could make sure they, like EVERYONE, should wash their hands when preparing food, and not touch their face or nose.

When I worked in a prison, I noticed an unusual number of sore throats over a few days so I called the state health department who investigated and found that food preparers were infected and passing their germs onto the other inmates through the food.

It is very hard to rid a person of the resistant Staph. The most common reservoir is in their nose. Sometimes we treat them with an antibiotic ointment to rid them of this germ, but they may get it back from their contacts.

Keep clean!

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