I received another e-mail asking me my thoughts on what to do about this child’s bite. My first thoughts are, “is this really a bite, or is it an early staph infection?”
This is often a common problem even in the office setting. A parent brings in a child and there is no history of a known bite, and at this time of year there really are not that many bugs creeping around biting our arms and legs. At the same time, the lesion looks fairly benign, it is not warm to the touch, or tender, and the patient or parents aren’t sure how long it has been there. When faced with this dilemma, I often take a “sharpie” marker and draw a circle around the area and instruct the parent to keep the area clean with an antibacterial soap (don’t worry, “sharpie” does not wash off that fast). I also have them give the child a dose of an antihistamine, like Benadryl (diphenhydramine), which might help if it is indeed a bite. Then we wait and watch.
If it is a bite, in most cases it will look a little better by the following day, or at a minimum unchanged. In the case of a staph skin infection the area typically appears larger than the original “sharpie” mark. It is also usually hot, red and tender by now. It may have “declared” itself to be a bacterial infection as it has a purulent center that can be drained. When I say drained, I mean at the doctor’s office so it can be done in a sterile manner and also the purulent material may be sent for culture and sensitivity. DO NOT poke, squeeze, take a needle or anything to drain the lesion at home. Remember NO PICKING!! By doing this at home you may take a completely benign lesion that will go away on its own in several days, and actually break the skin and cause a secondary infection. This is hard for many to resist, but resist!
If the said “bite” turns out to be an actual skin infection, then by culturing the drainage, the organism which is often staph, may be identified as a “staph” that is susceptible to many antibiotics, or it may indeed be the unfortunately more and more common MRSA. MRSA or methicillin resistant staph is causing frequent skin infections within the community rather what we previously thought of as a hospital infection.
The most important thing is to pay attention to the “bite” and if is worsens make sure you go see the doctor. We should get up follow up in the next several days!!
That’s your daily dose, we’ll chat again tomorrow.