Jun 15, 2009 10:47 am US/Eastern
Dr. Mallika's Files: Case Of Red, Hot And Painful
Each week Dr. Mallika Marshall shares cases based on true stories from a local urgent care clinic, exclusively on wbztv.com. Names and identifiable characteristics of patients have been omitted or changed to protect patient privacy.
This Week's Case:
A 41 year old man comes to clinic complaining of a painful rash on his right lower leg. He says that he noticed some redness a couple of days ago but now the area is tender, swollen, and warm. He doesn't recall any injury. He denies fever. He tried an over-the-counter antibiotic cream but says it seems to be getting worse.
On exam, his temperature is normal but he has an 8 cm area of redness on his right shin. It is tender and warm to touch. There appears to be a small central abrasion.
Discussion
Skin infections, also known as cellulitis, are usually caused by bacteria which normally reside on the surface of the skin. When there is a break in the skin, like from a scratch or an insect bite, the bacteria can enter the deeper layers and grow, causing inflammation. The skin becomes red, hot, and painful.
Anyone can get cellulitis but people most at risk include those with diabetes and those on drugs that suppress the immune system. People with animal or human bites are also at higher risk.
Treatment depends on the extent of the infection and underlying medical conditions. Mild cases, in otherwise healthy individuals, can usually be treated with oral antibiotics. Patients with fever, large infections, or those at risk for complication may require intravenous antibiotics and hospitalization.
If you're concerned you have a skin infection, have it examined by a medical professional. Delaying treatment could lead to tissue damage or spread to a neighboring bone or to the bloodstream. There is also an alarming increase in the number of infections caused by drug-resistant bacteria which require special evaluation and treatment.
To avoid skin infections, prevent injury by wearing protective clothing and equipment while playing sports or at work. Clean any scratches, abrasions, or cuts with soap and water and consider using a topical antibiotic ointment.
Follow-up
Upon further questioning, the patient remembers getting scratched by a tree branch while running a week prior. The patient was treated with an oral antibiotic for a total of seven days. He was re-evaluated two days after the initial visit and the infection had improved considerably.
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