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Suggest Treatment For Redness On The Forearm
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
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
Brief Answer:
Its subcutaneous abscess
Detailed Answer:
Dear Sir
Thanks for writing to me . First and foremost let me reassure you , its definitely not sarcoma. Internet is ocean of knowledge and many times it confuses the anxious parents.
Clinical photograph provided by you were really helpful. Clinically it looks like abscess which is superficial. It would have recurred as inadequate drainage was done by just squeezing the abscess. Inadequate drainage leads to presence of persistent infection which can recur. Its very good indeed that you have been to qualified Pediatric Surgeon , curettage and drainage done by him would suffice.
I assume pus would also have been sent for culture and antibiotic sensitivity.
Coming to the investigations, everything seems ok. CRP ( C reactive protein which is non specific marker of infection was marginally elevated last month and the latest report shows decrease in it ). Ultrasound scan also collaborates that its an abscess indeed.
Do not worry your child will improve indeed.
Do keep me updated.
Wishing you and your family a very happy and healthy life
Take Care
Regards
Deepak
Its subcutaneous abscess
Detailed Answer:
Dear Sir
Thanks for writing to me . First and foremost let me reassure you , its definitely not sarcoma. Internet is ocean of knowledge and many times it confuses the anxious parents.
Clinical photograph provided by you were really helpful. Clinically it looks like abscess which is superficial. It would have recurred as inadequate drainage was done by just squeezing the abscess. Inadequate drainage leads to presence of persistent infection which can recur. Its very good indeed that you have been to qualified Pediatric Surgeon , curettage and drainage done by him would suffice.
I assume pus would also have been sent for culture and antibiotic sensitivity.
Coming to the investigations, everything seems ok. CRP ( C reactive protein which is non specific marker of infection was marginally elevated last month and the latest report shows decrease in it ). Ultrasound scan also collaborates that its an abscess indeed.
Do not worry your child will improve indeed.
Do keep me updated.
Wishing you and your family a very happy and healthy life
Take Care
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Nagamani Ng
sir ultrasound both are normal i can assume that from your study ?
The surgeon who is doing the abscess drainage and curetage and subsequent dressing didnt do any pus culture sensitivity.....i suggested also but he said it would show nothing as preceeding 4 days and on day of doing also he was on antibiotics. I couldnt go over and above the surgeon otherwise he would have got irritated. Reason for going was he is a very XXXXXXX surgeon who is committed to work and very sincere.
if by chance there is recurrent infection then what should we do....will it mean to be a serious incurable disease or condition......
sir pls dont mind my asking so many questions and why do abscesses happen as i heard that they generally happen in groin neck armpits back anus region thighs and is it uncommon for such a small child to have an abscess and everyone talks of superficial word pls explain
hope you wont get irritated by plenty of questions as my son is small so more concerned abou
The surgeon who is doing the abscess drainage and curetage and subsequent dressing didnt do any pus culture sensitivity.....i suggested also but he said it would show nothing as preceeding 4 days and on day of doing also he was on antibiotics. I couldnt go over and above the surgeon otherwise he would have got irritated. Reason for going was he is a very XXXXXXX surgeon who is committed to work and very sincere.
if by chance there is recurrent infection then what should we do....will it mean to be a serious incurable disease or condition......
sir pls dont mind my asking so many questions and why do abscesses happen as i heard that they generally happen in groin neck armpits back anus region thighs and is it uncommon for such a small child to have an abscess and everyone talks of superficial word pls explain
hope you wont get irritated by plenty of questions as my son is small so more concerned abou
Brief Answer:
Ultrasound is suggestive of abscess
Detailed Answer:
Dear Sir
Being a parent myself I understand your concern and apprehension. You can go ahead and ask any question.
Superficial abscess means the pus is situated just beneath the skin without involving deeper to muscle and deep fascia. Abscess can occur anywhere in body , as you have been treated by XXXXXXX Surgeon , rest be assured there is no cause for concern. Chances of recurrence are rare if thorough curettage and debridement has been done. If the culture has not been done , there is nothing to be concerned about. Ultrasound scan done was suggestive of abscess and does not denote any serious disorder. Some children can end up with recurrence, its nothing serious , the things can be managed by simple gauge packing drainage and dressing .
Rest be assured you are getting treated with the best surgeon.
Do keep in touch
Regards
Deepak
Ultrasound is suggestive of abscess
Detailed Answer:
Dear Sir
Being a parent myself I understand your concern and apprehension. You can go ahead and ask any question.
Superficial abscess means the pus is situated just beneath the skin without involving deeper to muscle and deep fascia. Abscess can occur anywhere in body , as you have been treated by XXXXXXX Surgeon , rest be assured there is no cause for concern. Chances of recurrence are rare if thorough curettage and debridement has been done. If the culture has not been done , there is nothing to be concerned about. Ultrasound scan done was suggestive of abscess and does not denote any serious disorder. Some children can end up with recurrence, its nothing serious , the things can be managed by simple gauge packing drainage and dressing .
Rest be assured you are getting treated with the best surgeon.
Do keep in touch
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Prasad
sir
i was waiting for your reply and cudnt get sleep becos without a reply i cannot ask you something
the main mystery which i am not being able to solve is about the cyst
aas you must have seen the first usg indicates a dermal cyst 13x7 . then the pediatrician did the drainage without incision which we are assuming as incomplete whicog mystery and nightmare for me in order to see my son cured who himself is now exhausted as he comes from school and asks me today to which doctor and most of the last 2 months he has missed school.
sir
was waiting for your answer to ask the question which is the biggest mystery till now. i couldnt get sleep for it
the first usg as u must have seen shows a dermal cyst 13x7 and after which the pediatrician did the drainage which we assume as incomplete and hence recurrence
the 2nd usg was done before curetage and incision by the surgeon but it doesnt mention the cyst and when i asked the doc doing the usg he told me he is reporting what he is seeing
what i have leaarnt heard from various sources and many surgeons is
01. a cyst never disappears on its own
02. if the cyst is not completely excisioned it has chances of recurrence of infection
03. if just lining or wall of the cyst is removed there is chances of the cyst forming again.
now abt my surgeon , when he physically examined the area and i kept on asking abt the cyst he said to me i cant see or feel the cyst and this was one day before the 2nd usg
then he did his work ...so what shud i assume he didnt find any cyst when he opened the abscess and what happened to the cyst
it has become a nightmare for me and a big mystery which you would be able to solve . my son whenever he comes back frm school asks which doc today and most of the last 2 momths he missed school
i typed this on the follow up question but it didnt go completely
i was waiting for your reply and cudnt get sleep becos without a reply i cannot ask you something
the main mystery which i am not being able to solve is about the cyst
aas you must have seen the first usg indicates a dermal cyst 13x7 . then the pediatrician did the drainage without incision which we are assuming as incomplete whicog mystery and nightmare for me in order to see my son cured who himself is now exhausted as he comes from school and asks me today to which doctor and most of the last 2 months he has missed school.
sir
was waiting for your answer to ask the question which is the biggest mystery till now. i couldnt get sleep for it
the first usg as u must have seen shows a dermal cyst 13x7 and after which the pediatrician did the drainage which we assume as incomplete and hence recurrence
the 2nd usg was done before curetage and incision by the surgeon but it doesnt mention the cyst and when i asked the doc doing the usg he told me he is reporting what he is seeing
what i have leaarnt heard from various sources and many surgeons is
01. a cyst never disappears on its own
02. if the cyst is not completely excisioned it has chances of recurrence of infection
03. if just lining or wall of the cyst is removed there is chances of the cyst forming again.
now abt my surgeon , when he physically examined the area and i kept on asking abt the cyst he said to me i cant see or feel the cyst and this was one day before the 2nd usg
then he did his work ...so what shud i assume he didnt find any cyst when he opened the abscess and what happened to the cyst
it has become a nightmare for me and a big mystery which you would be able to solve . my son whenever he comes back frm school asks which doc today and most of the last 2 momths he missed school
i typed this on the follow up question but it didnt go completely
Brief Answer:
Infection alters anatomy of cyst
Detailed Answer:
Dear Sir
Apologies for late reply. Dermal cyst or sebaceous cyst usually occurs due to skin lining growing below the skin surface or sometime occurs as foreign body reaction to foreign substance. In case of later the its forms a pseudocyst ( no true epithelial lining , but the lining consist of inflammatory cells and fibrosis ).
These dermal cyst are usually non infective , but when they undergo infection , its difficult to distinguish them from abscess. Any infection in cyst distorts the normal anatomy and complete removal is not possible which is the preferred treatment. Previous incomplete drainage leads to distortion of anatomy , and also infection leads to destruction of lining which can't be picked up by ultrasound scan.
When complete excision is not possible , curettage ( Its like scopping out the abscess cavity ) ensures complete removal of the lining. Rest be assured as curettage has been done its unlikely to recur.
If there is no redness and the site of surgery is not grown in size there appears to be no cause for concern. In the absence of any other symptoms , i would suggest you to reassure your child. Instead of being tensed , a regular outing to a park /mall / movie will be reassuring to your child ( just my personal view )
Any issues kindly get back to me.
Wishing you and your family a very happy and healthy life
Regards
Deepak
Infection alters anatomy of cyst
Detailed Answer:
Dear Sir
Apologies for late reply. Dermal cyst or sebaceous cyst usually occurs due to skin lining growing below the skin surface or sometime occurs as foreign body reaction to foreign substance. In case of later the its forms a pseudocyst ( no true epithelial lining , but the lining consist of inflammatory cells and fibrosis ).
These dermal cyst are usually non infective , but when they undergo infection , its difficult to distinguish them from abscess. Any infection in cyst distorts the normal anatomy and complete removal is not possible which is the preferred treatment. Previous incomplete drainage leads to distortion of anatomy , and also infection leads to destruction of lining which can't be picked up by ultrasound scan.
When complete excision is not possible , curettage ( Its like scopping out the abscess cavity ) ensures complete removal of the lining. Rest be assured as curettage has been done its unlikely to recur.
If there is no redness and the site of surgery is not grown in size there appears to be no cause for concern. In the absence of any other symptoms , i would suggest you to reassure your child. Instead of being tensed , a regular outing to a park /mall / movie will be reassuring to your child ( just my personal view )
Any issues kindly get back to me.
Wishing you and your family a very happy and healthy life
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Nagamani Ng
sir
you are a surgeon and would be very busy so no apologies at all. sir in the first usg it says vascularity along margins is seen ? is it a sign of danger or any malignancy......sir my child keeps asking me papa when i will be alright because he is seeing the scar and repeated visits in last 2 months.
as i have explained to you all the details do u suspect any least chances of malignancy related to the cyst which is now not visible. being a surgeon u can read both the usg reports best and request you to once again read my msgs and reports once again thoroughly and give me a reply whenever you are relaxed. second usg also says solid mass of 9x2mm which they suspect foreign body.......is there any suspicion you would have
the questions my child asks me makes me cry sir didnt even know have to face all these ever ....im afraid for him not me im bold but for him im not
you are a surgeon and would be very busy so no apologies at all. sir in the first usg it says vascularity along margins is seen ? is it a sign of danger or any malignancy......sir my child keeps asking me papa when i will be alright because he is seeing the scar and repeated visits in last 2 months.
as i have explained to you all the details do u suspect any least chances of malignancy related to the cyst which is now not visible. being a surgeon u can read both the usg reports best and request you to once again read my msgs and reports once again thoroughly and give me a reply whenever you are relaxed. second usg also says solid mass of 9x2mm which they suspect foreign body.......is there any suspicion you would have
the questions my child asks me makes me cry sir didnt even know have to face all these ever ....im afraid for him not me im bold but for him im not
Brief Answer:
Clinco-radiologically its an abscess
Detailed Answer:
Dear Sir
Increased vascularity in the wall is due to inflammation in the surrounding region , in no way does it denote malignancy.
I have already seen the scan reports. Internal echoes suggests pus. In case of abscess all the contents may not be liquid, there may be some component which could appear as echogenic foci in the ultrasound as seen in 2nd ultrasound scan and its unlikely to be foreign body.
Both Clinically and radiologically the features are suggestive of subcutaneous abscess , there is absolutely no cause for concern. Children closely follow the emotions of parents , as he would have seen you being tensed he would be tensed too.
Rest be assured there is absolutely no cause for concern, the scar tissue will undergo remodelling and the final outcome will be much better.
Take Care
Regards
Deepak
Clinco-radiologically its an abscess
Detailed Answer:
Dear Sir
Increased vascularity in the wall is due to inflammation in the surrounding region , in no way does it denote malignancy.
I have already seen the scan reports. Internal echoes suggests pus. In case of abscess all the contents may not be liquid, there may be some component which could appear as echogenic foci in the ultrasound as seen in 2nd ultrasound scan and its unlikely to be foreign body.
Both Clinically and radiologically the features are suggestive of subcutaneous abscess , there is absolutely no cause for concern. Children closely follow the emotions of parents , as he would have seen you being tensed he would be tensed too.
Rest be assured there is absolutely no cause for concern, the scar tissue will undergo remodelling and the final outcome will be much better.
Take Care
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Yogesh D
sir
wish you a very happy doctors day first of all !
Yesterday we went to the surgeon for review of my sons wound and he said it will take time to completely heal ...it has been 13 days now .....he asked us to come again next week and asked not to cover with bandaid but wash it and put mupin ointment as far as i remember the name correctly.
for our satisfaction we got a mri done which i am sending herewith please see it and reply
regards
XXXX
wish you a very happy doctors day first of all !
Yesterday we went to the surgeon for review of my sons wound and he said it will take time to completely heal ...it has been 13 days now .....he asked us to come again next week and asked not to cover with bandaid but wash it and put mupin ointment as far as i remember the name correctly.
for our satisfaction we got a mri done which i am sending herewith please see it and reply
regards
XXXX
Brief Answer:
MRI is suggestive of inflammation
Detailed Answer:
Dear Sir
Thank you very much for the wishes. Its good to know that you had been to follow up and everything seems fine. I can understand your concern why you would have went ahead with MRI scan. Rest be assured there is no cause for concern, the MRI scan is suggestive of inflammatory lesion : As the abscess has been of long duration there could be residual persistent inflammatory changes which have been picked up by MRI. There is definitely no suspicion of any malignancy or other pathology.
After this MRI , i assume now you will be very much relaxed and stop worrying. Being a parent myself I can understand your apprehensions.
Wishing you good luck in all your endeavours .
Regards
Deepak
MRI is suggestive of inflammation
Detailed Answer:
Dear Sir
Thank you very much for the wishes. Its good to know that you had been to follow up and everything seems fine. I can understand your concern why you would have went ahead with MRI scan. Rest be assured there is no cause for concern, the MRI scan is suggestive of inflammatory lesion : As the abscess has been of long duration there could be residual persistent inflammatory changes which have been picked up by MRI. There is definitely no suspicion of any malignancy or other pathology.
After this MRI , i assume now you will be very much relaxed and stop worrying. Being a parent myself I can understand your apprehensions.
Wishing you good luck in all your endeavours .
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Raju A.T
sir
this may be there for weeks or months or remain as permanent fibrosis ?? and also one more thing since the last 2 days the wound has been advised not be covered and wash with dermaldew soap and mupi ointment applied...is there no chance of germs entering if we keep it open. Today it will be 2 weeks since the drainage .....how many more weeks will it take for the healing completely and for the induration to go and induration can remain permanentlly too ?
one more thing mri is fully okay na ? and if there is recurrence of infection then should we worried of any uncurable diseases as they cyst was not found or removed which you had said is the preferred treatment
this may be there for weeks or months or remain as permanent fibrosis ?? and also one more thing since the last 2 days the wound has been advised not be covered and wash with dermaldew soap and mupi ointment applied...is there no chance of germs entering if we keep it open. Today it will be 2 weeks since the drainage .....how many more weeks will it take for the healing completely and for the induration to go and induration can remain permanentlly too ?
one more thing mri is fully okay na ? and if there is recurrence of infection then should we worried of any uncurable diseases as they cyst was not found or removed which you had said is the preferred treatment
Brief Answer:
MRI is fine
Detailed Answer:
Dear Sir
Many time we surgeons advise wound to be left open , this promotes faster healing. Continuously covering the wound increases the local temperature ( it acts like incubator) and this promotes growth of pathogenic organism ( High temperature promotes growth). Leaving the wound open is beneficial to some extent and washing it will also help clean it. Mupirocin is ant staphylococcal antibiotic.
Any wound healing is associated with fibrosis, as he is a child the final outcome will be much better. It may take another 10-12 days for complete healing to occur. Induration is result of active infection and inflammation, once it subsides its unlikely to remain.
MRI is perfectly fine and there is absolutely no cause for concern. As the curettage has been done which is almost like removing the whole of infected cyst , its unlikely to recur .
Rest be assured there is no cause for concern.
Regards
Deepak
MRI is fine
Detailed Answer:
Dear Sir
Many time we surgeons advise wound to be left open , this promotes faster healing. Continuously covering the wound increases the local temperature ( it acts like incubator) and this promotes growth of pathogenic organism ( High temperature promotes growth). Leaving the wound open is beneficial to some extent and washing it will also help clean it. Mupirocin is ant staphylococcal antibiotic.
Any wound healing is associated with fibrosis, as he is a child the final outcome will be much better. It may take another 10-12 days for complete healing to occur. Induration is result of active infection and inflammation, once it subsides its unlikely to remain.
MRI is perfectly fine and there is absolutely no cause for concern. As the curettage has been done which is almost like removing the whole of infected cyst , its unlikely to recur .
Rest be assured there is no cause for concern.
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Sonia Raina
sir
today i took some close up pics and sending you if you could plese enlarge them and see......the area immediately around the pink area is a bit swollen like it is encircled by a tube of skin.......it is just skin or fluid filled skin i cant make out......tried a lot to see and make out but i cant decide.........i hope u understand my doubt it is like a 2-3mm pipe type skin encircling the wound pink area if u look very carefully.....is it a sign of re infection or normal skin because it appears thick....pls see and let me know
today i took some close up pics and sending you if you could plese enlarge them and see......the area immediately around the pink area is a bit swollen like it is encircled by a tube of skin.......it is just skin or fluid filled skin i cant make out......tried a lot to see and make out but i cant decide.........i hope u understand my doubt it is like a 2-3mm pipe type skin encircling the wound pink area if u look very carefully.....is it a sign of re infection or normal skin because it appears thick....pls see and let me know
Brief Answer:
Kindly send the photograph
Detailed Answer:
Dear Sir
I have not received any fresh clinical photograph, requesting you to resend.
Awaiting your response
Regards
Deepak
Kindly send the photograph
Detailed Answer:
Dear Sir
I have not received any fresh clinical photograph, requesting you to resend.
Awaiting your response
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Prasad
i have attatched one pic here
Brief Answer:
There is no active infection
Detailed Answer:
Dear Sir
Thanks for the pictures. The area is definitely not angry looking and there is no evidence of re-infection or recurrence. As the wound had healed by secondary intention ( There was curettage done and wound was allowed to heal from the bottom without approximation of the skin which the ideal treatment ) there will be some amount of discolouration and hardness felt due to induration from associated fibrosis and slight scarring . Its definitely not a recurrence . As the skin has approximated, i would suggest you to apply small amount of coconut oil over it ( it may sound orthodox but it prevents itching occurring in healing phase : itching may and scratching may lead to breakdown of the skin)
Your child seems perfectly fine , do not appear about the appearance .
take Care
Regards
Deepak
There is no active infection
Detailed Answer:
Dear Sir
Thanks for the pictures. The area is definitely not angry looking and there is no evidence of re-infection or recurrence. As the wound had healed by secondary intention ( There was curettage done and wound was allowed to heal from the bottom without approximation of the skin which the ideal treatment ) there will be some amount of discolouration and hardness felt due to induration from associated fibrosis and slight scarring . Its definitely not a recurrence . As the skin has approximated, i would suggest you to apply small amount of coconut oil over it ( it may sound orthodox but it prevents itching occurring in healing phase : itching may and scratching may lead to breakdown of the skin)
Your child seems perfectly fine , do not appear about the appearance .
take Care
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Sir
I have a few doubts which you are requested to please clear
You had previously said and i quote for your reference "Induration is result of active infection and inflammation, once it subsides its unlikely to remain"
How will we get to know sir when induration is completely gone and does it mean that if induration is not gone infection will remain
Secondly
What are the chances of recurrence of infection like it happened after the pediatrician had drained the puss without incision ....like for how many days we need to worry or it can happen or not happen without any time limit like weeks or months or probably years.......i hope u understand my question
Thirdly
Sir what you make out of the entire events like i have sent you the history along with all details and pics what is your conclusion ...... a superficial abscess or something else
Area of wound is still red and brown ....you had also said it will take time and today its 3 weeks of the curetage and draining . The skin above is changed a bit in some area with thick dot like pin head in one place too which maybe because of incision
Thanks in advance
XXXX
I have a few doubts which you are requested to please clear
You had previously said and i quote for your reference "Induration is result of active infection and inflammation, once it subsides its unlikely to remain"
How will we get to know sir when induration is completely gone and does it mean that if induration is not gone infection will remain
Secondly
What are the chances of recurrence of infection like it happened after the pediatrician had drained the puss without incision ....like for how many days we need to worry or it can happen or not happen without any time limit like weeks or months or probably years.......i hope u understand my question
Thirdly
Sir what you make out of the entire events like i have sent you the history along with all details and pics what is your conclusion ...... a superficial abscess or something else
Area of wound is still red and brown ....you had also said it will take time and today its 3 weeks of the curetage and draining . The skin above is changed a bit in some area with thick dot like pin head in one place too which maybe because of incision
Thanks in advance
XXXX
Brief Answer:
Clinic radiologically its only superficial abscess
Detailed Answer:
Dear Sir
Induration is result of inflammatory cells accumulating at site of inflammation and associated fibrosis ( occurs during healing of wound ). induration is mad out by feeling of harness at the site of swelling. This will slowly resolve and there is nothing to be concerned about it. Slight harness at the site could be there that is due to fibrosis and does not necessarily denote active infection/inflammation . It is just a sequelae of long duration of inflammation in resolving phase.
As the infection has been thoroughly drained by qualified experienced Surgeon who would have taken care to remove the lining completely it is unlikely to recur. If you want a figure it is less than 2 % .
Going by complete description of event , clinics radiologically it is definitely and only superficial abscess. I would suggest you to remove the fear of any other pathology lurking in your mind.
Even if the infection has subsided there could be discolouration and slight scaring due to incision taken for drainage of abscess . The presence of which alone does not warrant cause for any concern. the wound is remodelling phase and likely to undergo changes. I had looks again at the latest picture , there is definitely nothing to be worried about.
Wishing you and your family a very happy and healthy life
Regards
Deepak
Clinic radiologically its only superficial abscess
Detailed Answer:
Dear Sir
Induration is result of inflammatory cells accumulating at site of inflammation and associated fibrosis ( occurs during healing of wound ). induration is mad out by feeling of harness at the site of swelling. This will slowly resolve and there is nothing to be concerned about it. Slight harness at the site could be there that is due to fibrosis and does not necessarily denote active infection/inflammation . It is just a sequelae of long duration of inflammation in resolving phase.
As the infection has been thoroughly drained by qualified experienced Surgeon who would have taken care to remove the lining completely it is unlikely to recur. If you want a figure it is less than 2 % .
Going by complete description of event , clinics radiologically it is definitely and only superficial abscess. I would suggest you to remove the fear of any other pathology lurking in your mind.
Even if the infection has subsided there could be discolouration and slight scaring due to incision taken for drainage of abscess . The presence of which alone does not warrant cause for any concern. the wound is remodelling phase and likely to undergo changes. I had looks again at the latest picture , there is definitely nothing to be worried about.
Wishing you and your family a very happy and healthy life
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
sir
i just now washed the wound area and took pics just to show you. sir also 2 pics of his hip area where he had a mosquito bite which he scratched and he usually scratches a lot when mosquitoes bite him. can we apply desowen lotion or linical lotion is enough. actually his original abscess was also a insect bite thing earlier so i get more afraid seeing these things. the area is red and as its on waist so he wears the pants there and it makes it more prone to sweat and itchiness.
i just now washed the wound area and took pics just to show you. sir also 2 pics of his hip area where he had a mosquito bite which he scratched and he usually scratches a lot when mosquitoes bite him. can we apply desowen lotion or linical lotion is enough. actually his original abscess was also a insect bite thing earlier so i get more afraid seeing these things. the area is red and as its on waist so he wears the pants there and it makes it more prone to sweat and itchiness.
Brief Answer:
Do not apply disowen
Detailed Answer:
Dear Sir
The area of abscess looks normal and there is no cause for concern. Mosquito bites heal on their own , sometimes it associated with itching. Intense itching XXXXXXX cause breakdown of skin and predispose to infection. So to prevent it local application of coconut oil or olive oil is sufficient. Application of Disown is not recommended, it contains steroid which causes thinning of skin and also reduces local immunity predisposing to infection. Its use is basically recommended for dermatitis especially allergic in nature or any allergic skin reaction .
Local application of calamine lotion( Linical lotion) over mosquito bite will be soothing and reduce itching . The picture provided at area of hip is normal mosquito bite without any complication and there is no cause for concern
Take Care
Regards
Deepak
Do not apply disowen
Detailed Answer:
Dear Sir
The area of abscess looks normal and there is no cause for concern. Mosquito bites heal on their own , sometimes it associated with itching. Intense itching XXXXXXX cause breakdown of skin and predispose to infection. So to prevent it local application of coconut oil or olive oil is sufficient. Application of Disown is not recommended, it contains steroid which causes thinning of skin and also reduces local immunity predisposing to infection. Its use is basically recommended for dermatitis especially allergic in nature or any allergic skin reaction .
Local application of calamine lotion( Linical lotion) over mosquito bite will be soothing and reduce itching . The picture provided at area of hip is normal mosquito bite without any complication and there is no cause for concern
Take Care
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Sonia Raina
sir
as yesterday i had sent the pic after washing the area with soap water you must have seen pink red colour exactly where the incision was done. It has been 23 days since it was done so there should have been covered with normal skin but still its showing the raw area.....sorry i didnt knew what word to use
also today when i applied mupi i just felt the area and below hardening is considerably there and i do not know if it has increased or decreased or the same....i mean the hardening below the incision ......in the inside
as yesterday i had sent the pic after washing the area with soap water you must have seen pink red colour exactly where the incision was done. It has been 23 days since it was done so there should have been covered with normal skin but still its showing the raw area.....sorry i didnt knew what word to use
also today when i applied mupi i just felt the area and below hardening is considerably there and i do not know if it has increased or decreased or the same....i mean the hardening below the incision ......in the inside
Brief Answer:
Induration is subjective
Detailed Answer:
Dear Sir
As i mentioned in earlier response that the area of incision and drainage heals with secondary intention ( normally when there is clean cut in skin and wound is approximated by suture it heals with primary intention with formation of bridge tissue ). But in this case as it has healed with secondary intention , it heals with formation of fibrosis and shrinkage of wound size , there is usually no overlying true cover with skin . As you mentioned the area has been same in 23 days , there is definitely no cause for concern. Induration and level of hardness are all subjective things, better to be decided by expert. I would suggest you to stop feeling the area . As it has not grown significantly , it implies no active inflammation / infection .
Rest be assured
Take Care
Regards
Deepak
Induration is subjective
Detailed Answer:
Dear Sir
As i mentioned in earlier response that the area of incision and drainage heals with secondary intention ( normally when there is clean cut in skin and wound is approximated by suture it heals with primary intention with formation of bridge tissue ). But in this case as it has healed with secondary intention , it heals with formation of fibrosis and shrinkage of wound size , there is usually no overlying true cover with skin . As you mentioned the area has been same in 23 days , there is definitely no cause for concern. Induration and level of hardness are all subjective things, better to be decided by expert. I would suggest you to stop feeling the area . As it has not grown significantly , it implies no active inflammation / infection .
Rest be assured
Take Care
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Nagamani Ng
sir
u used subjective word but i didnt understand.....there is no harm if hardness remains forever or does the doc has to intervene again if induration doesnt go. i am not known to subject so im asking you as we r nt experts.......is any concern for life long hardness or induration or fibrosis indont know whichbwords use
u used subjective word but i didnt understand.....there is no harm if hardness remains forever or does the doc has to intervene again if induration doesnt go. i am not known to subject so im asking you as we r nt experts.......is any concern for life long hardness or induration or fibrosis indont know whichbwords use
Brief Answer:
There is no cause for concern
Detailed Answer:
Dear Sir
Subjective means , the feeling of subjective varies from one person to other , put it in simple term if its very hard for someone to feel , for another person it may not be that hard. There is definitely no concern regarding hardness/ fibrosis. Fibrosis is inevitable during any wound healing . As i mentioned to you earlier , the final outcome of any wound in children is much better than adults ( children have miraculous healing )
Do write to me anytime regarding any query .
Take care Sir
Regards
Deepak
There is no cause for concern
Detailed Answer:
Dear Sir
Subjective means , the feeling of subjective varies from one person to other , put it in simple term if its very hard for someone to feel , for another person it may not be that hard. There is definitely no concern regarding hardness/ fibrosis. Fibrosis is inevitable during any wound healing . As i mentioned to you earlier , the final outcome of any wound in children is much better than adults ( children have miraculous healing )
Do write to me anytime regarding any query .
Take care Sir
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Sir
I am writing to you again as the wound is healing and the surgeon who we have been showing said that the hardness might take months to go and he indicated that maybe it remains also.
I have many things in my mind which are disturbing me sir hence i am very much confused so i am writing down whatever i remember so that i can get an expert opinion from you.
01. First of all sir what i gathered from various sources and also searching on the internet that a dermal cyst in children is usually from birth - so was this cyst from birth and is it abnormal for such a small child to have a cyst and at this place - the forearm. In my life of 37 years i havent come across a cyst in anyone of my family or friends so i am really really confused and worried.
02. Secondly i am quoting your explanation given in one of the answers above
"These dermal cyst are usually non infective , but when they undergo infection , its difficult to distinguish them from abscess. Any infection in cyst distorts the normal anatomy and complete removal is not possible which is the preferred treatment. Previous incomplete drainage leads to distortion of anatomy , and also infection leads to destruction of lining which can't be picked up by ultrasound scan.
When complete excision is not possible , curettage ( Its like scopping out the abscess cavity ) ensures complete removal of the lining. Rest be assured as curettage has been done its unlikely to recur. " Again something unusual happened as my childs cyst got infected which doesnt happen usually as indicated above by you . And also you mentioned complete excision is the preferred treatment and that was also not possible as the surgeon didnt find the cyst for which also you gave an explanation.
03. You maybe thinking i am asking the same things again and again but i am unable to solve the above mystery. The above comes to my mind everyday and as i am not a doctor or a surgeon so i cant tell myself that i need not worry about a cyst forming again as i dont know how it forms and why it forms . But due to all unusual hapennings as per me that has had happened i am worried and this is the reason why i keep asking about any uncurable disease due to cyst again forming and do these cysts carry some risks with it and all.
Sir i hope you understand my concerns and explain to me in detail what i have written above
I am writing to you again as the wound is healing and the surgeon who we have been showing said that the hardness might take months to go and he indicated that maybe it remains also.
I have many things in my mind which are disturbing me sir hence i am very much confused so i am writing down whatever i remember so that i can get an expert opinion from you.
01. First of all sir what i gathered from various sources and also searching on the internet that a dermal cyst in children is usually from birth - so was this cyst from birth and is it abnormal for such a small child to have a cyst and at this place - the forearm. In my life of 37 years i havent come across a cyst in anyone of my family or friends so i am really really confused and worried.
02. Secondly i am quoting your explanation given in one of the answers above
"These dermal cyst are usually non infective , but when they undergo infection , its difficult to distinguish them from abscess. Any infection in cyst distorts the normal anatomy and complete removal is not possible which is the preferred treatment. Previous incomplete drainage leads to distortion of anatomy , and also infection leads to destruction of lining which can't be picked up by ultrasound scan.
When complete excision is not possible , curettage ( Its like scopping out the abscess cavity ) ensures complete removal of the lining. Rest be assured as curettage has been done its unlikely to recur. " Again something unusual happened as my childs cyst got infected which doesnt happen usually as indicated above by you . And also you mentioned complete excision is the preferred treatment and that was also not possible as the surgeon didnt find the cyst for which also you gave an explanation.
03. You maybe thinking i am asking the same things again and again but i am unable to solve the above mystery. The above comes to my mind everyday and as i am not a doctor or a surgeon so i cant tell myself that i need not worry about a cyst forming again as i dont know how it forms and why it forms . But due to all unusual hapennings as per me that has had happened i am worried and this is the reason why i keep asking about any uncurable disease due to cyst again forming and do these cysts carry some risks with it and all.
Sir i hope you understand my concerns and explain to me in detail what i have written above
Brief Answer:
There is no cause for concern
Detailed Answer:
Dear Sir
Dermoid cyst could be of various types, congenital cyst usually occur in the midline or at site of fusion of embryonic line. There are other dermoid cyst which are acquired , they may be implantation dermoid, it usually result from epithelial lining getting entrapped below the skin surface. You would not have come across , as you are only dealing with your family or acquaintance . Surgeon/Doctor deal with various families known to them or unknown to them.
If Dermoid cyst gets infected . its difficult to distinguish the boundary between normal tissue and cyst. The only way is to scoop off the whole lining until there is bleeding. Rest be assured curettage has been done which is adequate treatment for infected cyst.
I do understand your concern and you are free to ask any questions any time.
Rest be assured there is no cause
Take Care
Regards
Deepak
There is no cause for concern
Detailed Answer:
Dear Sir
Dermoid cyst could be of various types, congenital cyst usually occur in the midline or at site of fusion of embryonic line. There are other dermoid cyst which are acquired , they may be implantation dermoid, it usually result from epithelial lining getting entrapped below the skin surface. You would not have come across , as you are only dealing with your family or acquaintance . Surgeon/Doctor deal with various families known to them or unknown to them.
If Dermoid cyst gets infected . its difficult to distinguish the boundary between normal tissue and cyst. The only way is to scoop off the whole lining until there is bleeding. Rest be assured curettage has been done which is adequate treatment for infected cyst.
I do understand your concern and you are free to ask any questions any time.
Rest be assured there is no cause
Take Care
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Yogesh D
sir
we had last visited our surgeon after almost 3 weeks and a few days from the process of incision curetage and he checked the wound and asked to continue limcee and bevon for 10 days and when i asked him when to come back for review he said you need not come back for general check up or review.
according to him the treatment was finished and closed as i understood because he said not to come for review.
How will we assess the hardness inside without showing to him and how can he be so confident not to review as it has been only 4 weeks now
we had last visited our surgeon after almost 3 weeks and a few days from the process of incision curetage and he checked the wound and asked to continue limcee and bevon for 10 days and when i asked him when to come back for review he said you need not come back for general check up or review.
according to him the treatment was finished and closed as i understood because he said not to come for review.
How will we assess the hardness inside without showing to him and how can he be so confident not to review as it has been only 4 weeks now
Brief Answer:
There is no cause for concern
Detailed Answer:
Dear Sir
I would suggest you not to give much weightage to induration/hardness. It will take its own time to settle down. Clinical assessment is the the best assessment, as he has been seen by Paediatric Surgeon again , there seems to be no cause for concern.
I would not suggest you to keep bothering about the hardness, the surgeon was confident based on his experience . Evidence of reinfection is noted by increase in size, redness and appearance of pain.
Rest ba assured there is no cause for concern.
Take Care
Best regards
Deepak
There is no cause for concern
Detailed Answer:
Dear Sir
I would suggest you not to give much weightage to induration/hardness. It will take its own time to settle down. Clinical assessment is the the best assessment, as he has been seen by Paediatric Surgeon again , there seems to be no cause for concern.
I would not suggest you to keep bothering about the hardness, the surgeon was confident based on his experience . Evidence of reinfection is noted by increase in size, redness and appearance of pain.
Rest ba assured there is no cause for concern.
Take Care
Best regards
Deepak
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
No cause for concern
Detailed Answer:
Dear Sir
You can definitely forget this incident. Unlikely for it to recur. Do not subject the child to repeated examination and tests.
Rest be assured there is no cause for concern.
Wishing you and your family a very happy and healthy life
Take Care
Best Regards
Deepak
No cause for concern
Detailed Answer:
Dear Sir
You can definitely forget this incident. Unlikely for it to recur. Do not subject the child to repeated examination and tests.
Rest be assured there is no cause for concern.
Wishing you and your family a very happy and healthy life
Take Care
Best Regards
Deepak
Above answer was peer-reviewed by :
Dr. Nagamani Ng
sir
cysts of these nature are always benign ?
like my surgeon hasnt called us for any follow up now so should we go on our own and when shud we go or no need . now it has almost been 5 weeks and he saw last tuesday
cysts of these nature are always benign ?
like my surgeon hasnt called us for any follow up now so should we go on our own and when shud we go or no need . now it has almost been 5 weeks and he saw last tuesday
Brief Answer:
The cyst is always benign
Detailed Answer:
Dear Sir
Such cyst are always benign. There is definitely no need for follow up sir.
Just forget this health ailment and carry forward.
Wishing your kid all the happiness and success.
Regards
Deepak
The cyst is always benign
Detailed Answer:
Dear Sir
Such cyst are always benign. There is definitely no need for follow up sir.
Just forget this health ailment and carry forward.
Wishing your kid all the happiness and success.
Regards
Deepak
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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