Cellulitis, again!

[Crossy]

Members may remember my previous brushes with the bug!

 

https://forum.thaivisa.com/topic/934025-your-mother-was-right-that-splinter-could-make-your-finger-drop-off/

 

https://forum.thaivisa.com/topic/1126208-you-dont-even-have-to-break-the-skin/

 

Well here we are with yet another bout, same place (lower left leg) as September last year. Saw the same doctor, of course she remembered me.

Same treatment, straight in with the IV antibiotics as we didn't score with oral last time.

 

I'm sure the treatment will sort things but I'm more interested in any preventative measures other than, drink less, exercise more, try to lose some weight (which I am attempting to do with variable success).

 

Any pointers to reduce the risk?

 

[BritManToo]

1 hour ago, Crossy said:

Any pointers to reduce the risk?

Antibiotics at the first sign, Amoxicillin 500mg (30bht from Makro pharmacy) for 5 days, keep a few packets in your fridge.

Usually caused by Strep bacteria from your own body (or someone in the household) getting scratched into an insect bite or minor abrasion. Clean door handles and work surfaces with antibacterial soap/wipes/sprays.

Stop touching your nose then scratching.

My daughter (age 22) gets it often, last month about 2 square inches of her back rotted off before we stopped it.

 

More common in the village than the city.

If my lot go back to their dirty village they all come back with it.

 

Nothing to do with your weight, drinking, eating or exercising.

Edited June 18, 2020 by BritManToo

[johng]

7 minutes ago, BritManToo said:

Usually caused by Strep bacteria from your own body (or someone in the household) getting scratched into an insect bite or minor abrasion.

Maybe stroking dogs or other pets then scratching ?

[Pilotman]

3 minutes ago, johng said:

Maybe stroking dogs or other pets then scratching ?

I hope not.  My dog sleeps with his head on my pillow. 

[Cake Monster]

Washing the infected area at least every 2 Hours with an Anti-Bacterial Soap, and warm salted water may help.Also
You could also try washing the infected area with Surgical Water 7% Alcohol

Applying  ( Fucalin Ointment ) could also help. Think thats what its called

Fascino Pharmacy will help you on that one.

And dont forget to keep the area covered with a loose bandage.

[Jai Dee]

1 hour ago, Crossy said:

Any pointers to reduce the risk?

 

I get the occasional flare-up on my lower legs above the ankles. I originally contracted it overseas when I took a short-term assignment there... a little over 1 year actually.

 

Every Sunday (my only day off) I would go for a stroll on a beach on a point north of the city... no swimming because of jellyfish and crocodiles, but I used to walk along the the splash zone of the waves (ankle deep) for several km and back again.

 

Many people used to exercise their dogs there which I didn't think much of at the time, but there was a lot of dog excrement on the beach (and probably in the water too). What I also didn't know was that there was a waste water treatment plant just around the corner of the point and this discharged into a stream which discharged into the sea near the point.

 

The beach water was probably heavily contaminated with all sorts of pathogens, and by regularly walking in the splash zone my skin got infected. Both legs were heavily infected from the ankles to the knees... not pleasant at all.

 

Like you, antibiotics and IV drips overcame the worst of the infection, followed by a long course of oral antibiotics to keep it under control.

 

How to reduce the risk?

 

Keep your skin healthy... use a moisturiser and don't let your skin dry out. Dry and flaky skin has tiny cracks in it that can become infected.

 

Use a good moisturising cream like Jergens, or if you suffer from really dry skin locally, try Balneum Intensiv cream.

 

The more healthy your skin is, the less susceptible it is to infections. 

[Jai Dee]

28 minutes ago, BritManToo said:

Amoxicillin 500mg (30bht from Makro pharmacy) for 5 days.

 

Too light a dose... needs to be 1000mg/day for 5-10 days... but you should really see a doctor and not self-prescribe any medication.

 

I forgot to mention... any minor cut or scratch should not be taken lightly if you have previously had cellulitis... especially here in Thailand's climate.

 

Thoroughly clean and disinfect the wound with Dettol or tincture of iodine, and if there is any inflammation and/or swelling, cool the affected area with a damp cloth and keep it elevated to reduce the swelling. 

[fredwiggy]

The good people here have helped you. I'd just like to add the WebMD link also.................https://www.webmd.com/skin-problems-and-treatments/guide/cellulitis#1

[thequietman]

1 hour ago, BritManToo said:

Nothing to do with your weight, drinking, eating or exercising.

.

Edited June 18, 2020 by thequietman

[uhuh]

6 hours ago, Jai Dee said:

 

 

How to reduce the risk?

 

Keep your skin healthy... use a moisturiser and don't let your skin dry out. Dry and flaky skin has tiny cracks in it that can become infected.

 

Use a good moisturising cream like Jergens, or if you suffer from really dry skin locally, try Balneum Intensiv cream.

 

The more healthy your skin is, the less susceptible it is to infections. 

Second that. 

 

Wear shoes and socks,  not sandals. 

Don't get your leg bitten by fleas,  mosquitoes etc (socks,  repellents)

Edited June 18, 2020 by uhuh

[uhuh]

6 hours ago, Jai Dee said:

 

Too light a dose... needs to be 1000mg/day for 5-10 days... but you should really see a doctor and not self-prescribe any medication.

. 

Both correct,  but even 1000mg/day is too little.  

And amoxicillin is not the first choice for farangs in Thailand, anyway. Should be either Dicloxacillin or Amoxicillin/clavulanic acid. 

Better see a doctor then self-medicating

[Sheryl]

As others have said key is avoiding breaks in the skin. That and seeking treatment immediately at very first sign of inflammation. Also helpful to circle the perimeter with a felt tip pen so that any increase will be readily apparent

 

Was there a cut or scratch prior to this current bout? If not then it is possible the prior infection was not 100% eradicated.

 

If you have not done so in the past year, should be evaluated for diabetes (blood test) and peripheral vascular disease (clinical exam abd possibly doppler).

 

Do not under any circumstance self medicate with antibiotics, will potentially add to what is probably already considerable antibiotic resistance.

 

If there is any discharge they should do a culture and sensitivity.

 

[Crossy]

@Sheryl thanks for that.

 

Yeah, the doc drew on my leg (and then asked if I wore shorts to work, I don't).

 

No skin break that I am aware of, but that doesn't mean there isn't one that I've not noticed.

 

Diabetes test both this time and the last (borderline but "acceptable"), I'll ask about peripheral vascular disease when I see the doc again on Sunday.

 

Agree on the self medication, I have insurance via work so it's off to the doc at the first sign of anything untoward, I know these things can go awry very rapidly.

 

[Sheryl]

I much suspect then that (1) prior infectionwas not 100% eradicated and (2) that this was due to some degree of resistance to the antibiotic previously used.  You should push hard for a culture & sensitivity.  That and evaluation to rule out peripheral vascular disease.

[Cake Monster]

3 hours ago, Sheryl said:

I much suspect then that (1) prior infectionwas not 100% eradicated and (2) that this was due to some degree of resistance to the antibiotic previously used.  You should push hard for a culture & sensitivity.  That and evaluation to rule out peripheral vascular disease.

It was  my belief, that Cellulitus is the same kind of skin complaint as Dermatitus.

Only in the fact that once you have been afflicted by either of these horrible things, they will always be latent within your body, and are ready for action at the slightest hint of an infection.

Please correct me if im wrong

[Sheryl]

They are quite different.

 

Dermatitis is usually an allergic process.

 

Cellulitis is an infection, usually bacterial.

 

People who have had dermatitis  are indeed susceptible to getting it again because they have allergies (and people with allergies to one thing often become or are allergic to other things as well).

 

But having had cellulitis does nto make you more susceptible to getting it again.

 

However there are some underlying chronic health conditions that can make a person unusually susceptible to cellulitis, particularly diabetes and peripheral vascular disease

 

[dddave]

On 6/19/2020 at 1:17 PM, Sheryl said:

I much suspect then that (1) prior infectionwas not 100% eradicated and (2) that this was due to some degree of resistance to the antibiotic previously used.  You should push hard for a culture & sensitivity.  That and evaluation to rule out peripheral vascular disease.

I think Sheryl is probably correct: that the resident bacteria wasn't eradicated during the last infection. 

I wrote before about coming very close to loosing my lower leg due to cellulitis contracted during by-pass surgery.  I was put on an iv drip of Vancomycin, 250cc twice a day for four days. That closed the infection down and it has never returned in the now 2+ following years.  

I hope Crossy's doctor takes an aggressive approach and makes the attempt to eradicate the bacteria entirely.  Our legs get more vulnerable as we age as the blood circulation gets less efficient and treatment becomes more difficult.    

[dddave]

On 6/18/2020 at 11:42 PM, uhuh said:

Both correct,  but even 1000mg/day is too little.  

And amoxicillin is not the first choice for farangs in Thailand, anyway. Should be either Dicloxacillin or Amoxicillin/clavulanic acid. 

Better see a doctor then self-medicating

Several inexpensive local brands of Amoxcillin w/clavulanic acid are "AMK",  "Amoksilav",  "Cavumox",.  There are a few others as well. Usually sold for between B175-B400 for a box of 10 tablets. Available in 600mg & 1000mg

Hospitals will sell you "Augmentin", the Squib version for B2000+++/10 tablets.

[BritManToo]

Is the clavulanic acid important?

Edited June 22, 2020 by BritManToo

[orchis]

My doctor advised me to use bactroban in my nose twice a year, to kill of the reservoir of bacteria that live there.
I was hospitalized with broken skin caused staph infection twice. Maybe it's useful information.

[moe666]

I use to get cellulitis every year and no you do not need broken skin to cause infection. I have not had a attack in a number of years. I would recommend you start eating kimchee the frmented cabbage from Korea it will help replace the good bacteria klled by antibiotics. After moving to Thailand about 10 years ago I had one attack that put me in Ram hospital for 10 days. 

When living in the states I would use some chinese medicine to treat an outbreak and had some sucess with that. I feel for you not something that is fun to have. Take care.

[Sheryl]

4 hours ago, BritManToo said:

Is the clavulanic acid important?

Extremely. Gives it a range of efficacy that amoxicillin alone does nto have.

 

In Thailand, due to habit of prescribing amox like candy, very little is susceptible to it. It is virtually a placebo here.

 

However people should NOT self treat cellulitis, not with amox + clav or anything else. It is not something to take any chances with and moreo ften than not requires IV antibiotics.

[Konini]

A bit long, but something that may (or may not) help anyone with skin conditions. 

 

Mr K has an on/off rash on one side of his face which a doctors in UK said was cellulitis and prescribed antibiotics (which cleared it) and 2 doctors in Australia said was rosacea and prescribed very expensive creams which didn't work.  The UK incident was about 12 years ago, a one off it seemed, and it started up big time about 6 years ago.  One day he came home and said he'd seen another dermatologist who gave him the little pot of mystery cream (as they do) and a bar of sulpher soap.  I rolled my eyes, looked at the soap in horror - colouring and fragrance which is not good for skin.  I told him that he'd blown however much money it cost.

 

Two days later, rash gone.  I was gobsmacked, but a little skeptical until he went away on a bike ride and forgot to take the sulpher soap.  Three days later when he got home, rash back.  A couple of days after using it again, rash gone.  I don't know how it works but it does. 

 

I have mild psoriasis which flares up every now and again, I tried the soap a couple of weeks ago and was disappointed but kept at it; after about a week, psoriasis clearing and as of today it's pretty much gone.  Could be a co-incidence, flare ups happen then disappear, but it's definitely not a co-incidence with Mr K.  It's been about 2 years since he first got the soap, and whenever he stays in town for a couple of nights (pre-covid) without the sulpher soap it comes back, then after a couple of days back home, it goes away again.  I've tried to manage the flare ups he gets by restricting food groups to see if it's an allergy or similar.  It turns out that without a doubt chilli causes big, bad flare ups.  I insisted on zero chilli for a week, which he did because we were on lockdown and he was eating everything at home.  I made a curry and he said he could feel his face tingling whilst eating before it went boom a couple of hours later.  It's a shame, because he loves chilli.  I've been using small amounts of paprika instead and although it should cause a flare up, it doesn't seem to be hurting.  I'll just have to monitor it as I increase the amount.  Two other things that appear to cause flare ups are papaya and yoghurt, both of which he eats in huge quantities.  He's off the papaya and I haven't made yoghurt for a couple of weeks so we'll be experimenting further by introducing them one at a time.  Alcohol seems to bring it on too, particularly red wine (which he loves).  He doesn't want to experiment with the grog because if it's a trigger, he'll have to avoid it, better not to know for sure.

 

So, sulpher soap.  I stock up on a natural one without the colouring when we go to England, but as we haven't been able to go this year we're running out of it.  I bought a kilo of sulpher and will make some in the next few weeks.  The particular brand he got from the doctor here for anyone interested is Taylors of Halifax, available via Lazada, but we've found the pink and blue ones don't work for him, only the green and yellow.  Your mileage may vary. The colour shouldn't make a difference, but it does.  It shouldn't work, at all, but it does.  On our annual check-in with our GP in Australia, she agreed that it sounds implausible but said it's obviously working a lot better than the 4 different creams she's prescribed him over the last few years so keep using it.

Gotta be worth a try for anyone with skin conditions.  It's a bit smelly - it's sulpher, nothing can totally mask the smell, but nothing you can't live with if it works for you.

 

Hope this helps someone.

[tonray]

On 6/18/2020 at 4:26 PM, Pilotman said:

I hope not.  My dog sleeps with his head on my pillow. 

I would have the dog checked out immediately, I hope he has not contracted anything. ha ha ha ha