Signs of a skin infection (cellulitis) from a cut or scrape

Skin infection after a scrape of the hand. The red streaks are a sign of the infection. Image by Dr James Heilman.
Skin infection after a scrape of the hand. The red streaks are a sign of the infection. Image by Dr James Heilman.

Our last post covered the basics about treating a minor cut or scrape.  One reason you should call your doctor after getting a cut or scrape is if you think your skin has developed an infection (aka cellulitis).  It’s normal for there to be a little redness around the cut or scrape, but here are signs to look for that can suggest that you have a skin infection.

  • Redness that spreads beyond the few millimeters around your cut or scrape
  • Redness that “streaks” in lines from your wound (aka lymphangitis)
  • A lot of pain over the area
  • Pus (a thicker whitish or yellowish discharge)
  • Swelling
  • Warmth
  • Fever or chills

The signs of infection are not immediately visible and may develop days after the initial injury.  A common mimicker of an infection around the wound is a contact allergy, most commonly from the bandaid/bandage used. In this case, the redness will be in the shape of the bandage.

Regardless, if you suspect you have a skin infection, seek medical attention. You may need a procedure to clean your wound and/or antibiotics.

Treating a minor scrape or cut

Scrape (abrasion) of the hand after a fall from a bicycle
Scrape (abrasion) of the hand after a fall from a bicycle

Alas, it is snowing up here in Boston yet again!  With all the icy streets and sidewalks, it’s no surprise that many of us have shared the common plight of slipping, falling and scraping an elbow, knee, hand, or other body part.

So how should you treat a minor scrape (aka abrasion) or cut (aka laceration)?

First off, take a look at your scrape or cut.

Did something puncture your skin?

Did you skin fall on something dirty like rusty metal? Did dirt get lodged in the area?

Are you left with a wound more than a few millimeters deep?

Is your scrape bleeding profusely and not stopping with pressure?

If you answered yes to the above, you may need to see your doctor to see if you need special cleansing of the skin, a tetanus shot, stitches or other treatment.

If the scrape is otherwise minor — e.g. clean, not actively bleeding, etc, you can clean it off with running water.

Next, gently pat the area dry.

You can cover the area with petroleum jelly.  A lot of people like using Neosporin or bacitracin ointment — just keep in mind that these are also common causes of contact allergies which can delay healing.  For minor cuts, liquid bandage can be used.

You can also apply a regular bandaid/bandage over the area to protect the area.

If there are any signs of a skin infection, let your doctor know.  Stay tuned for a future post on signs of skin infection.

Erythema ab igne – rash from your laptop or space heater?

These days, erythema ab igne is often caused by laptop users placing the laptops on their thighs. The rash then shows up on the thighs.
These days, erythema ab igne is often caused by laptop users placing the laptops on their thighs. The rash then shows up on the thighs.

Erythema ab igne, aka fire stains, toasted skin syndrome, or hot water bottle rash, is a rash that occurs after exposure to heat.  A reddish, purplish, or brownish discoloration appears in a lacy pattern.  The rash is caused by repeated exposure to a heat source.

Some examples of these heat sources include:

– laptops – The rash occurs on the thighs where people rest their laptops.

– space heaters, infrared heaters – These direct heat to a confined area.

– hot water soaks – For example, frequent soaking of the feet in hot water.

– heating pads

– hot compresses

This patient had erythema ab igne on the belly from using heat to relieve belly pain. Photo by Dr. James Heilman.
This patient had erythema ab igne on the belly from using heat to relieve belly pain. Photo by Dr. James Heilman.

– hot water bottles

– chair heaters, car seat heaters

– fire/fireplace

– hot stove

In most cases, the pigmentation from erythema ab igne eventually goes away. However, in some longstanding cases, the pigmentation does not resolve.  In these longstanding cases, the skin may have a different texture as well.  If you are diagnosed with erythema ab igne, your doctor will likely advise you to avoid continued use of the focal heat source that you are being exposed to.

Highlights from the AAD 2013 in Miami

Alas, the 2013 annual meeting of the American Academy of Dermatology is nearing its close.  It’s been a great 4 days in Miami — albeit a little colder and cloudier than expected, but hey, we’re all indoors enjoying the sessions anyways right?

courtesy of Flickr user ceiling
courtesy of Flickr user ceiling

After a jam-packed schedule, I now have a little bit of time to give you an update on the meeting.

This has been an exciting year in dermatology and yesterday’s Plenary Session attested to that.  Dr. Daniel Siegel gave remarks as his term draws to a close and as Dr. Dirk Elston  looks towards his incoming presidency of the AAD. Dr. Siegel remarked on some of the challenges that we have as dermatologists as the government continues to look at the proper way of reimbursements for all of medicine including dermatology.  Dr. Siegel was optimistic about his forecast for the  coming years of dermatology, predicting advances in science and technology which would allow for personalized treatment for the deadly cancer melanoma and “biopsies” without having to cut the skin.  He also called for us to continue to work together as a group as dermatologists continue to be the expert group that provides skin care.

It’s been an exciting year under Dr. Siegel’s direction, and of course, we will always remember his getting his head shaved at the Summer AAD in Boston afterSkinPAC raised more than 1 million dollars!

Wet wraps for atopic dermatitis at the Mayo Clinic

In a follow-up post to September’s post on wet wraps, I thought we would review one of the articles from the Mayo Clinic on the use of wet wraps in pediatric patients with bad atopic dermatitis.

The Mayo Clinic has had a tradition of using wet wrap therapy for a multitude of skin conditions including atopic dermatitis.  In their paper in the July 2012 issue of the Journal of the American Academy of Dermatology (JAAD), the authors reviewed their medical charts as it pertained to the use of wet wrap therapy with steroids over a period of 30 years and in examining 218 patients.  Pediatric patients with severe atopic dermatitis were admitted to the Mayo Clinic where they received wet wrap therapy.  Patient were treated with topical steroids and moisturizer which were covered with wet wraps (with either water or vinegar soaks) which were then covered with dry wrappings and a warm blanket.  They had these applied 5-8 times a day, and had dressings removed every 3 hours for dressing changes (and so that the child could walk around, urinate, etc).  A number of these patients also did get oral antibiotics for skin infection over the eczema.  The authors found that many of their patients had good results. For instance, 45% were deemed to have 75-100% improvement.

This study highlights that wet wraps with topical steroids is an important potential therapy to consider. While there are limitations to the study design, it is worth educating patients, their families, and other providers about this therapy.

Melasma: the Mask of Pregnancy

Melasma is frequently referred to as the “mask of pregnancy.”  This is because it frequently occurs in women who are pregnant. However, don’t let the term fool you.  Melasma can last after the pregnancy, and it can occur in people who are not pregnant.

So what is melasma? It’s a condition where brown or tan patches appear on the face. It is usually symmetric and most commonly affects the cheek, temple and forehead areas.

Why does melasma occur? We don’t really know.  It predominantly occurs in women, and its occurrence with pregnancy or the use of oral contraceptives implies a hormonal factor.  However, it can occur without an apparent hormonal change as well.  It also frequently affects Hispanics and Asians as well, suggesting a demographic or genetic connection as well.

So how do you treat melasma? Well, first off, make sure to sun protect!  Melasma worsens with sun exposure and sometimes it doesn’t take all that much sun (e.g. just from walking to and from work) to set it off.  Get a broad-spectrum sunscreen for your face.

But how do you get rid of melasma if you already have it? Well, it is TOUGH.  First, I’d recommend that you see a dermatologist.  It would be important to make sure that your dark patches are melasma and not something else.  Your dermatologist may then recommend products to use on the skin or certain procedures. Keep in mind that melasma is hard to “cure” and these techniques may be variable in their effectiveness.

So, do you have melasma? And if so, what has or has not worked for you?

What are cosmeceuticals?

You may have seen or heard the term cosmeceuticals on the web, on TV, in your local department store or in beauty product store like Sephora or Ulta.  So what does the term cosmeceuticals refer to?  The word was coined to reflect products that have aspects of cosmetics and pharmaceuticals by Dr. Arthur Kligman. These are products that are applied to the skin, but unlike cosmetics, are meant to do more than to simply mask or color the face.  Unlike pharmaceuticals, these products do NOT need to be FDA approved and thus do not undergo the rigorous testing that the FDA requires to show that they have some biologic effect.  Additionally, they do not need to undergo testing that the FDA requires for drugs.

You’ve probably seen skin care lines that fall under cosmeceuticals; many of these lines were developed with or by physicians.  These products may include anti-aging products, sunscreens, or lightening products.

So now the next time you see the term cosmeceutical, you’ll know what it means!

What is your favorite cosmeceutical product?

PUPPP = Pruritic Urticarial Papules and Plaques of Pregnancy = Itchy bumps during pregnancy!

It’s been a while since we’ve talked about pregnancy and the skin!  We already know from our previous posts that pregnancy can cause many changes in your skin, including acne.  Several rashes are associated with pregnancy as well.

One of these rashes associated with pregnancy has an acronym PUPPP which stands for “Pruritic Urticarial Papules and Plaques of Pregnancy” [translation: pruritic = itchy, urticarial = hive-like, papules = bumps, plaques = plaques].  PUPPP is one of the more common rashes to occur in pregnancy and usually happens in the late third trimester.

Who gets PUPPP?  Well, a pregnant woman.  Risk factors for getting PUPPP include being in one’s 1st pregnancy, having twins (or more), and obesity.

What does PUPPP look like and present as?  This rash presents with very itchy pink to red bumps, often within the stretch marks.  Sometimes blistering or “bulls-eye” looking spots can be present.

Is there any effect on the baby if the mother has PUPPP?  To our knowledge, no.

So what should you do if you develop an itchy rash during pregnancy?  See your obstetrician and/or dermatologist.  This is a fairly common rash in pregnancy.  Various medications can be used to help relieve the itching — otherwise, it can be really hard to get a good night’s rest.  The rash usually goes away 1 week after delivering.

Wet Wraps for Eczema

Continuing on the theme of eczema after the wonderful guest post by Marcie’s Mom, I thought we could talk about wet wraps in more detail.

Wet wraps have been shown in research studies to be quite effective in helping to treat and prevent eczema and is a remedy that can be easily done at home.  And it’s not expensive!  So what does it entail?

1) The skin must be moistened and hydrated. And by moistened, I mean in a bathtub ideally.  After stepping out of the bath (or shower if you don’t have a tub), pat the skin dry. Avoid rubbing.

2) Apply a thick moisturizer or topical medications as instructed by your physician.

3) Prepare a set of damp cotton pajamas by soaking it in a tub of lukewarm water and then wringing dry.  If you want to get fancy, you can buy special pajamas or wraps for this purpose.  Put on the pair of pajamas — it may be more comfortable to have the seams facing outward.

4) You can wear a set of dry pajamas on top.

Some people like having waterproof bedding just in case there is some dampness that seeps through.

Kids are beautiful. Just the way they are.

As a parent, how do you deal with a cosmetic but non-medical issue in your child?

I’ve been thinking about this issue a little more after seeing several kids this week with vitiligo (a skin condition where white patches appear on the skin) and hemangiomas (usually strawberry colored growths of blood vessels which usually do not cause medical issues).

For kids who are old enough to read reactions to the cosmetic issue or disfigurement, it’s important that we reinforce that our kids are beautiful the way they are — treatment or no treatment. The decision to treat these spots is made out of love and for a desire for the best possible outcome, but an obsession with the skin abnormality can cause kids to feel stigmatized even in their own home.

One of the doctors in our clinic has a nice way of putting it. “Tigers and leopards have spots. Your kid is allowed to have spots too.”