Scratch lesions

Bacterial infections result from scratch lesions or epidermolysis from overpeeMng. Bacterial infections do not occur... 

A recurrence of herpes lesions should be anticipated, and preventive treatment should be taken if necessary. Scratch lesions can trigger impetigo on the face. Scratching is the only explanation for signs of infection after a peel with Unna s paste or Jessner s solution. 

Localized erythema around scratch lesions after an Easy TCA peel to the papillary dermis. 

Any pruritus should be treated to avoid scratch lesions, a source of scarring. 

Apart from scratch lesions that can develop into very localized infections, a peel to the Grenz zone is not particularly dangerous as far as infection is concerned. If an infection should develop after a peel to this depth, a topical antibiotic is usually enough to control it. 

Easy TCA applied to pinpoint or cloudy white frosting causes virtually no infections, apart from a few potential transient infections of scratch lesions (the frequency is around 1 in a 1000). 

Local and loco-regional infections occur in cases of local overpeeling above all or after scratch lesions (Figure 37.45). Although peels to the papillary or reticular dermis are more likely to become infected, infections can nevertheless develop after a more superficial peel. 

Fortunately, serious local infections are rare, as the peeling agents, especially phenol, are germicidal. Moreover, the skin on the face is rich in blood vessels and has effective defenses against infections. With age, however, there are fewer blood vessels in the face and the skin becomes more susceptible to external aggression. Infections seem to develop more readily and are more serious when peels are performed in a hospital setting, because of the presence of multiresistant strains. I am fortunate enough not to have any dramatic photos of post-peel infections to show, but many cases of secondary infection and scratch lesions from streptococci, staphylococci and Pseudomonas have been... 

Secondary infection scratch lesions after Easy TCA . 

An infection can be assumed to be herpes if the patient has a personal history of herpes. If pain is felt on the upper lip first, this also suggests herpes, while pain felt on the cheek would rather suggest a bacterial infection, especially if there are scratch lesions and pus. Given that the epidermis has been exfoliated by the medium or deep peel, the doctor should not expect to see herpes blisters. 

Dermal Effects. Dialkyltin compounds, especially dimethyltin and diethyltin dichloride, are dermal irritants but several of them, like dibutyltin diacetate, dilaurate, maleate, and oxide, are not [42], Tributyl- and trimethyltin compounds are not allergic dermal and conjunctival irritants but are responsible for acute bums appearing several hours after the dermal contact [42]. The lesions last several days, and consist of follicular inflammarion, pruritis, and minute pustules that dry after 2 or 3 days. Recovery takes a week. The hair doesn t seem to be affected. Subacute contacts are responsible for pruritis and scratching lesions, reddening of the skin, and sticky skin. Lesions affect the lower abdomen, thighs, groin, and perineum. Tetraalkyltin compounds applied on the skin have never produced any effect [42]. 

Although Mg is generally considered non-toxic, the inhalation of fumes of freshly sublimed Mg oxide may cause metal fume fever. There is no evidence that Mg produces, true systemic poisoning. Particles of metallic Mg or Mg alloy which perforate the skin of gain entry thru cuts and scratched rilay produce a severe local lesion characterized by the evolution of gas and acute inflammatory reaction, frequently with necrosis. The condition Has been called a chemical gas gangrene . Gaseous blebs may develop within 24 hrs of the injury. The lesion is very slow to heal (Ref 23)... 

Skin inflammation is invariably associated with itching and lesions tend to be traumatized by scratching. This causes bleeding into tissues leading to haemoglobin... 

Pruritus is common, and scratching of the lesions may further spread infection through excoriation ofthe skin. Other systemic signs ofinfection are minimal. 

This formula is able to expel wind, nourish the blood, clear heat and eliminate dampness. It is used for treating skin lesions that are caused by invasion and accumulation of wind, dampness and heat in the skin, subcutaneous region, muscles and blood, which are manifested as itchy and red skin rashes that weep after being scratched, a white or yellow tongue coating and a superficial and rapid pulse. 

Drying lotions should not be used on skin lesions because they may increase scarring. In the child or adult for whom the skin lesions itch or are irritating, an oral antihistamine may help to prevent scratching, which can lead to secondary infection and thereby scarring. Recommended agents include oral chlorpheniramine or diphenhydramine.The use of cimetidine is controversial as an H2 blocker, oral cimetidine has an immunosuppressive action. The effects are not always consistent, however, and use of cimetidine is risky in autoimmune disorders and organ transplant patients. 

Lichen simplex (neuroderm ticis) Antipruritics topical corticosteroid explain scratch-itch cycle to patient. Covering the lesion so as to prevent scratching.e.g. with a medicated bandage, sometimes breaks the vicious cycle. 

Rocco, V.K., Roman, R.J., Eigenbrodt, E.H Cat scratch disease. Report of a case with hepatic lesions and a brief review of the literature. Gastroenterology 1985 89 1400-1406... 

A 29-year-old man developed an infiltrative maculo-papular eruption after 1 week of itraconazole 100 mg bd for tinea corporis (44). Itraconazole was withdrawn, and the lesions disappeared within 7 days. Scratch tests, patch tests, scratch-patch tests, and drug induced lymphocyte stimulation tests for itraconazole were negative however, rechallenge with systemic itraconazole induced a maculopapular eruption on the face, hands, and the dorsa of the feet. Empty itraconazole capsules had no cutaneous effects, suggesting an allergic reaction to a metabolite of the compound. 

Vaccinial lesions on the eyelids and the conjunctivae are seen after secondary infection with Vaccinia virus by scratching (42,43). From these lesions a keratitis can develop, which sometimes extends to deeper layers of the cornea, with concomitant iridocychtis. Papillitis with myelitis has been described after revaccination (44). 

There is a risk of skin atrophy when all of the appendages of a treated area undergo necrosis. The skin does not have any source of supply to regenerate cells quickly. The ker-atinocyte clones can only come from the (distant) edges of the necrotic areas they cannot be produced in sufficient numbers for rapid skin regeneration if the lesion is more than a few centimeters in diameter. Lesions smaller than 1 cm in diameter, even in the deep reticular dermis, do not pose a high risk of scarring unless there is a secondary infection or the patient scratches the scabs. 

Benzodiazepines " and strong analgesics" sedate patients and prevent scratching, secondary infections, pigmentation problems and permanent scars. Daily doctor-patient contact is essential to reassure the patient that the herpes lesions are healing properly. 

Medication is sometimes necessary for patients who tend to scratch and are at risk of causing lesions, secondary infections or scars. Sublingual lorazepam (2.5 mg) or promethazine (25 mg/tablet, 2-6 tablets a day) usually stops post-peel pruritus. A calm or sleepy patient tends not to scratch Cool compresses can also be applied. Cold compresses help the patient cope with the pruritus, but frozen compresses are not advised immediately after a dermal peel. 

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