Hibiclens Soap

Q:

About 1 week ago, I developed a red bump on my thigh that became painful, and swollen.  I went to see a doctor at an urgent care and was told it was a “staff” infection.  He put me on “cephalexin” and it has gotten worse.  Any ideas?

A:

I had a patient who told me he thought “staff” infections came from the staff working at the ER.  No!  Staph refers to staphylococcus aureas, which is a bacteria that can infect many areas of the body, but the skin is its favorite.  When it infects the skin, it can cause an abscess.  Unfortunately, because of the widespread use of antibiotics, many staph infections are now resistant to antibiotics including cephalexin.  Most ER doctors are seeing drug resistant staph infections daily.  If an abscess has formed, it may need to be drained to allow the pus to get out.  A culture of the infected fluid can be obtained at that time.  I recommend you get a second opinion about this problem.  If in fact you have a staph infection, appropriate antibiotics that have activity against the staphylococcus bacteria can be prescribed.  Additionally, I often prescribe a powerful skin soap called to decontaminate the skin.  Proper hygiene and hand washing is critical to treating staphylococcus and preventing its spread.

When to Stitch a Wound?

Q:

Dear ER Doc

Is there a general rule to when a cut needs to be stitched up? 

With major cuts that are long and/or deep – it is pretty obvious that a trip to the hospital in needed. And for everyday minor cuts – it is equally obvious to wash it and slap on a band aid. 

                                                                                                                                                                                          But sometimes there’s an “in between” cut in my family. Be it me with a
kitchen knife or my son getting a cut from some glass on the playground.
These are not “minor” but I am not sure if it really makes sense to go
through the time and expense of getting stitches. Any thoughts?

A:

Briefly, the first thing you want to do is take a look at the wound and determine if the skin edges are lined up well.  Then, see if the skin stays together when the area is moved.  You will find that in highly mobile areas, such as fingers, wounds often open up when there is movement.  In this circumstance I will usually put in stitches to keep the skin edges together and healing.

Also, you want to be sure that there is no deep structural injury to the tendons, blood vessels, nerves, etc.  This often requires evaluation, and “exploration” of the wound by a doctor.  It is especially important to make sure there is no foreign material in the wound itself, and that the wound has been thoroughly cleaned.

This may not be a satisfying answer, but I usually tell people that if there is any doubt, have the wound checked out by a physician, so that proper wound care can be done.

Be sure and look at my upcoming entry on “when you cut yourself” as well.