I just received an email question from a teenager who happened to attach a picture of a skin lesion she was worried about. I think it is great that teens are being proactive about their health and are asking questions about issues that are concerning to them. BRAVO!!
So, this “bump” sounds like it started out as a possible “zit” on this 16 year old girl’s neck. She admitted to lots of “digging” into the lesion and then became concerned that it didn’t seem to be getting any better. She said that friends told her that it could be scabies, or possibly staph. Leave it to friends to make you more apprehensive about the mystery bump.
Looking at the picture it looks like it could be a simple pimple and in that case the best medicine is to LEAVE IT ALONE. The hardest thing to get teens to do (and also adults) is not to pick at pimples or bumps on their bodies, as this could lead to a skin infection.
Many times just washing the “zit” and leaving it alone, it will go away. When you go “digging” into it you break the skin and allow bacteria to enter the now open wound and you can get a skin infection. In many cases this may be due to staph or strep from your hands. This may sometimes require a topical or oral antibiotic to treat the infection, when it may have been something that should have been left alone.
There are skin infections that we are seeing in the community that are due to MRSA (methicillin resistant staph) which have become quite frequent in the last several years. In this case that small “bump” usually arises quite quickly, often times it is confused with an insect bite. But very quickly the bump becomes more inflamed, tender and often quickly grows in size.
Many times there will be drainage from the bump which now resembles a boil. In my experience the hallmark of MRSA infections is how quickly they arise and how painful they are. They have a fairly classic appearance (see old post on Staph).
MRSA infections often have to be drained and require different antibiotics than ”regular” skin infections. In most cases it is necessary to obtain a culture of the drainage so that the appropriate antibiotic may be selected.
In some circumstances the infection is quite extensive and may even require surgical drainage and IV antibiotics, requiring a stay in the hospital. MRSA is a serious infection and is often seen in teens who share articles of clothing or participate in sports where they are showering, using equipment etc that is shared. Remember to use your own towels, and athletic equipment when you can.
This teen also asked “if you have staph would you have it forever?” In actuality, many of us harbor staph in our noses and we all rub our noses throughout the day and then touch other parts of our body as well as other objects. This then passes the bacteria from person to person, sometimes via another object.
If you are not symptomatic, don’t worry about whether you have staph in your nostrils, but do adhere to good hand washing and try to keep your hands away from your face.
For patients who have had recurrent skin MRSA infections, I often prescribe an antibiotic cream to be put in the nostrils as well as in the nostrils of all close contacts (family members).
I also recommend that the patient bath in an anti-bacterial soap and take a bleach bath every week to help decrease the bacterial colonization with staph. It seems that this has helped prevent reoccurrences of staph for the individual as well as for other family members.
Lastly, this is certainly not scabies, but we have an older post on that too with pictures!
That’s your daily dose for today. We’ll chat again tomorrow.