A Family Doctor's Tale - SKIN INFECTIONS

DOC I HAVE A SKIN INFECTION

SKIN INFECTIONS are part and parcel of the types of diseases seen by family doctors.

Scratching of the skin is one of the causes of breakage of the protective skin layer and infection from germs caught in the finger nails can enter the broken skin and cause pus formation in the skin. 

Abscesses are easily formed in any part of the body. 
Most large abscesses require incision(cut into the abscess) and drainage to release the pus collected to prevent infection spreading further and causing septic shock.


One memorable case was a small 3 year old girl who developed a large abscess on her scalp. 
There was no other way except to incise and drain the large abscess. 
She was very brave and cried once when the needle for local anesthetic injection entered the skin to provide local anesthetic. Then the knife was used to open the abscess and the pus was allowed to drain out.
After that she had the wound bandaged and given antibiotics, painkiller and antibiotic cream. 
Although she was told to wash her hands and not use them to scratch her head, she had a recurrence 2 years later and had the same procedure done on her again. 
Since then she did not have any more skin infection.


Infected acne can occur in adolescent boy or girl through hand contact with the acne. 
Antibiotics and antibiotic creams may be necessary for the treatment of the infected skin. 
The best antibiotics are those of the tetracycline group and erythromycin. 


In women who are breastfeeding, engorgement of the breast may occur due to blocked breast milk ducts.
If this happened warm compress may soften the milk stuck in the breast milk duct. 
If this does not happened the accumulated milk stuck in the duct may become infected resulting in abscess formation . 
If safe antibiotics such as ampicillin does not clear the infection the abscess may require incision and drainage.

Other infection may also occur at the nipple due to infected skin and clogged milk ducts.

Skin infection may also occur in the vulval area of any women if unhygienic conditions are present during sexual intercourse, urination and defaecation ( passing bowel motion). 
Very often infected Bartolin cysts in the vulva region may occur and require incision and drainage.

Infection of the penis may also occur due to traditional circumcision in children.
Some infection may also result from scratching the genital area and from sexual intercourse. 
In most cases blood tests and urethral (internal tube that leads from the bladder to the opening of the penis) swabs for bacteria may be done for sexual infections. 
Those sexually transmitted which can be treated  are given antibiotics and flagyl. 
Herpes infections can be treated with antiviral drugs sometimes successfully.
HIV infections however cannot be cured as yet.

 In housewives, a common infection is paronychia of the finger nails - infection of the side of the fingernail due to pressure or injury to the side of the nail. 
Very often the patient will have an abscess of the side of the nail by the time she sees a doctor. 
The abscess is usually pricked with a sterile needle to release the pus which normally cause pain due to pressure on the nail. 
This is followed by antibiotic and antibiotic creams.

Infection of the naval is very common in babies and are usually treated with antibiotic powder or creams.
Less often infection of the navels may occur in adults due to attempts at removing dirt in deep navels.

I had a elderly female patient who was actually referred to me by another family doctor who was unsuccessful in getting rid of the pus discharge from her navel in spite of  antibiotic treatment. There was an abscess in the lower part of the navel which was discharging pus. I had to incise the abscess completely and do daily antibiotic dressing of the navel until she was completely cured.


In Diabetic patient foot care is very important. 
Any wound in the foot can developed into abscesses and carbuncles (collection of abscesses) which needed special control of his diabetic condition, removal of all the abscess and carbuncle, strong antibiotic and daily dressing of his foot wound.

One of my diabetic patient had to be treated for about 4 weeks before his infected wound in the foot finally cleared up. 
However the next time he had his foot wound, he was bought to the Hospital where the doctor immediately sent him to a surgeon to do an amputation of the leg below the knee.


The worst infection I had seen in my family practice was that of the infected toe of a lorry driver.

He was dirty and smelly and obviously had not bathed for several weeks.
He complained of pain and swelling in his right big toe which was obviously very infected. 
So what I did was removal of the pus in the wound. 
What came out besides the pus was maggots about almost a hundred of them. 
I had to catch these wriggling maggots one by one until I finally reach the bottom of his wound. 
I cleaned the wound and did daily antibiotic dressing for about 2 weeks before the wound finally recovered. 
I also advised the patient to bathe daily. 
It was obvious that there was total neglect of his wound that allowed flies to lay eggs in the wound resulting in the maggots.


All skin infections can be treated if you are persistent with daily cleaning and antibiotic dressing of the wound.
However in Diabetes there is always the danger of the wound spreading in uncontrolled diabetes which may require amputation to stop the infection from spreading. 

It is important to emphasize to any patient with skin infection never to scratch or touch their skin with hands which may be dirty and full of germs