Question: My son is 6 yrs and 5 months old and his weight is 30kgs. The first time on April 17th my wife noticed some redness like a insect bite on his right forearm between the elbow and the wrist and ignored it for 2 days thinking about a mosquito bite as he gets bitten a lot by mosquitoes and scratches the area a lot and makes it red. But on 20th April when he came back from school in the evening there was a big red swollen area which was red or pink and was around 2 centimetre in diameter or maybe more and was a bit swollen like 2 or 3mm. I remember i spotted 2 holes (pin holes ) on the surface very tiny ones.

We took him to a dermatologist and the doctor said it was a insect bite though we didnt see any insect biting him and my son also didnt tell any bite or injury . The doctor prescribed - Teczine Syrup - 5ml once daily for 5 days and apply fudic bnf cream 3 times for 15 days. After 5 days we stopped teczim but continued the ointment fudic bnf cream . Again after 4 days the doctor again asked us to give teczim for 5 more days 5ml once daily and we did so. In the meantime the redness subsided and there was a firm area around the place which could be felt as a lump or node i do not know how to define it for which i am attatching the picture which has a green cap near it and the picture clicked.

We then took him to pediatrician after almost 2 weeks of initial treatment who on examining prescribed sporidex redimix syrup 250 - 6.5ml thrice daily but due to some other doctors advice this was stopped after 3 days and the complete course was not administered.

Exactly after 4 weeks of the initial redness we went to a surgeon and he suggested that it was a chronic abscess and it should be incisioned and drained and started moxclav Ds - 5ml thrice daily for 5 days and suggested usg and blood tests , the reports of which i have attatched herewith. We gave the entire antibiotics course and on the 5th day the area opened from the top and the pus was oozing out and at that moment we were in a pediatric doctors chamber and he took out the puss and bandaged the area with all his knowledge and next day opened the bandage and gave same antibiotic but name changed Augmentin DDS - 7.5 ml twice daily for 3 days and apply fucidin ointment for 10 days. The pediatrician didnt do an incision but removed all the pus from inside and didnt do a culture sensitivity test and irrigated with saline as he informed us .
During these 10 days as appearing to us the abscess was healing looking from the surface but after 10 days again the area started becoming red , little warmth to the touch and swelling starting slowly .

Around XXXXXXX 12th , i,e, , after almost 18 days of the drainage a surgeon in XXXXXXX suggested us to give augmentin tablet 375 - thrice daily for 5 days and then get a repeat usg done to see the result . But after giving the antibiotic for 3 days we saw the area becoming black and also the infection subsiding a little we decided to show to a pediatric surgeon as a few people had suggested . So we again went back to the same doctor , XXXXXXX Saha who had initially prescribed tests and on looking at the abscess he said to stop antibiotics and gave a multivitamin and to come after 3 days to get the incision & drainage done at a hospital. In the meantime without asking him we got a second usg done yesterday which is also attatched here and after getting the report we went to him and he did the incission and curettage under local anasthesia of the area and inserted a guage and did the dressing and gave Cetil 250 mg tablets - 1 tablt twice daily for 5 days and called us for dressing again today i.e., Sunday and he again did the dressing and removed the old guage and inserted a fresh one and some liquid came out today also. He has again called us on tuesday for dressing and today is sunday and now we are daily putting betadine solution to wash it then put ointment on it which is also same as betadine but ointment form cramer which is also povidine iodine i guess and just cover with a baindaid.

Physically the child is active and is playful active and eating well . he just had itchy eyes which is almost cured and a skin flare up redness for which we had given him allegra syrup 7.5 ml twice daily for 2 weeks . At present he has no other problems except the chronic abcess which is still to be healed

Now i would again request you to look at both the usg reports and blood reports and tell if there is any abnormalcy because one month back the pediatrician drained the pus but again infection happened though this time the swelling and pus was lesser and now the surgeon has done the curetage and incision draining after which for 4 days he inserted guage and then he removed the guage and asked to come after one week and just keep changing the bandaid.

i have done a lot of readings on the internet and i am dreaded by the word sarcoma. does it appear to be sarcome or the reports , usg or pic suggest anything like serious

Sir
Thanks for your reply , the question was closed i dont know why so i had to recharge again for follow up questions. hope you have the reports as i dont know these sites system. Also want to tell you its for my son who is 6 yrs 5 mnths old
I have read your answers and i have a few more doubts which i am asking for your expert views :-

01. The first usg report says dermal cyst showing internal echoes and vascularity seen along margin - are these lines at all suspicious of anything adverse . And the second usg says hypoechoic collection in the subcutaneous region.

02. Secondly sir i read about sarcoma in the internet so i had asked about it and it shows that it also happens in the soft tissue . Soft tissue means muscles ? and is his muscles 100% ok i mean i dont have to think about sarcoma or any malignancy at all ?

03. Thirdly as i had explained to you the two doctors treating the abscess did it differently . First the pediatrician drained it from the hole which opened up and pus leaked and irrigated with saline and then from next day asked it to be kept open and put fusidin cream after washing it with soap and water three times daily.

2 weeks after this infection recurred and we went to a surgeon and he treated a bit differently that he did an incision on the top , drained it cureted the inside and put guage inside it . then the next day he again changed the guaged and drained more pus and then two days after the same thing .After that he asked us to just wash it with betadine solution and then put armer cream on the tip and just close it with bandaid and come after a week.

Now my question is that why did the abscess recur and what is the chances of it recurring again this time too . What will we have to do if it recurs in 2 or 3 weeks like it did the last time .


Please give your opinion to all the doubts i have which i have numbered serially.Explain to me in a bit elaborate way as some words confuse a general person as me and sometimes internet readings adds to more of confusion



Regards
Rashmin XXXXXXX Modi

sir
the pus was not cultured and does it mean that if the infection recurs we have to culture the pus and accordingly give antibiotics? cyst if not removed will make infections recurrent is it so ? and is it possible that cyst disappeared or was removed during curetage ? first time when the pus was drained and irrigated with saline we had put fusidin for 3 weeks and after drainage taken augmentin for 4 days and this time the surgeon gave cetil 250 for 6 days one tab twice daily and just armer cream covered with band aid. so what do you say about his medicines . last time the infection recurred within 2 weeks ....there was redness around the area.
how do we know if there is recurrent infection and what to tell the doctor

sir
that is why i sent you both the reports of the usg....the first says there is a cyst but the 2nd one doesnt say there is a cyst.....pls see the reports again so what is the meaning of it......how did the cyst disappear before the 2nd drainage in which curetage was done .......the surgeon is also a XXXXXXX one who does major surgeries too so if i tell him pls remove the cyst he will noot like it .......pls see usg reports and tell what you make out about the cyst and what can we do or convey to the doc surgeon i mean

sir
the 2nd ultrasound was done before the curettage day in morning and curettage done in evening.....and when i asked the doc doing the usg he said i dont know abt previous reports but now i cannot see the cyst......so as of now what do we do ? if cyst remains in there is it of danger to the body and could it happen that it disappeared on it own.
also the surgeon before incision and curetting told us by physical examination of the area that he doesnt think there is any cyst........and when doing incision and drainage curetage would it not be possibl for the surgeon to see the cyst....