Category Skin/soft tissue

Chronic venous or dependency wound golden rules

Guest posting from Dr Nicole Organ, Vascular Surgeon, HNE LHD Golden rules Maintain lower limb skin integrity – trauma avoidance, protective routine skin care Treat acute lower limb wounds/skin tears aggressively to prevent chronicity – early use of wound compression Address modifiable risk factors – superficial venous disease, obesity, sedentary lifestyle, arterial disease Use simple […]

Magical thinking- do antibiotics improve chronic wound healing?

We’ve previously addressed this topic here.   It’s certainly the case that chronic skin ulcers (leg or elsewhere) drive an enormous amount of antibiotic prescribing, perhaps because these ulcers are so hard to heal and a degree of therapeutic impatience occurs. The annual survey of chronic wounds last year in our health district indicated that 28% of inpatients […]

Treatment of boils – Oz GPs reluctant to rely on scalpelmycin rather than antibiotics

Are you following best practice in the management of boils or recurrent skin infection?  We’ve previously addressed this matter detailing a NEJM study that indicated that a majority of US doctors surveyed use incision and drainage only. This recent Australian study investigated treatment of community staphylococcal skin abscesses by GPs and showed that a majority do not follow […]

Extrapolating antibiotic susceptibility for streptococci including the pneumococcus

This posting concerns betahaemolytic species of streptococci including S. pyogenes (Lancefield group A strep), S. agalactiae ((group B strep), S. dysgalactiae group (betahaemolytic large colony, groups C or G) (several species included) which are usually associated with pyogenic infection, especially of skin and soft tissue.   S. pneumoniae (the pneumococcus ) is also considered.  A key misunderstanding about […]

Recognising and treating skin conditions in Aboriginal and Torres Strait Islander people

The 2016 Northern Territory Healthy Skin Workshop proceedings are available here and have great relevance for all practitioners in other regions (especially Hunter New England) who care for similar patients.  The workshop aimed to develop a framework to enable a coordinated approach to Healthy Skin in the Top End. The proceedings highlight many useful resources and describe […]

Kawasaki disease in a 13 month old diagnosed at post mortem

Originally posted on Microbiology and Infectious Diseases postgraduate teaching (PRIDA):
Guest posting: Dr Leah Clifton, NEWCASTLE DEPARTMENT OF FORENSIC MEDICINE,  Forensic Pathology Registrar Kawasaki disease is characterized with acute systemic vasculitis, occurs predominantly in children between 6 months to 5 years of age. Patients with this disease recover well and the disease is self-limited in most cases…

What is the best way to treat skin abscess?

Skin (staphylococcal) abscesses (boils) are often treated with antimicrobials, but are they really needed? The New England Journal of Medicine recently presented a case vignette and asked prescribers to weigh in on whether they thought antibiotics were needed or if incision and drainage alone were enough.

Oral antibiotics for paronychia: unexpected outcomes of ‘killing a fly with a cannon’

The recommended treatment for mild paronychia is conservative. Warm compresses or soaks are used, along with topical antibiotics with or without topical steroids.  If an abscess has formed around the nail, incision and drainage is added. Oral antibiotics are only recommended in refractory cases or in patients with comorbidities such as diabetes or immunosuppression. We […]

Trap – cellulitis or an acute Charcot’s foot ?

An acute Charcot process within a neuropathic foot (often a diabetic patient) arises silently over some months and is often misdiagnosed as cellulitis due to the presence of skin warmth and redness. The process is usually unilateral.

Choosing wisely (IDSA): Avoid antibiotic therapy for lower limb stasis dermatitis or venous ulcers

The Infectious Diseases Society of America also has started a Choosing wisely campaign.  This advice is valuable. In the recent District-wide wound surveillance survey across Hunter New England Health hospitals and community nursing services, there were over 900 patients with active wounds identified (including many venous ulcers related to stasis dermatitis). Of these 28% had received antibiotics in […]