Editing Skin infections (section)

== '''Principles of management:''' ==

* Antibiotics
** Treat for cellulitis whenever you are uncertain whether it is cellulitis or erysipelas
** Indications for MRSA coverage
*** Systemic toxicity
*** Cellulitis with purulent wound drainage
*** Known MRSA colonisation or infection
*** Injection drug use
*** High-risk neutropaenia
** Regimens: 
*** No MRSA factors: cefazolin/cefalexin
*** MRSA factors: Bactrim OR Augmentin DF + doxycycline 100mg BD. Generally avoid clindamycin due to C diff risk and MRSA resistance.
*** MRSA and needs IV: vancomycin
*** Erysipelas can generally be managed as an outpatient: Augmentin DF, cefalexin, or as above if risk of MRSA
* Symptomatic improvement usually within 24-48 hours, but skin manifestations can take longer. Look for reductions in pain, fever, brightness of erythema, and WCC. Skin can begin to weep, blister, or crack as cellulitis evolves - not generally a marker of worsening infection
* Consider decolonisation for MRSA carriers
* Surgery
** Excision of boil/carbuncle and primary closure - be careful not to spill pus into the wound - incise an ellipse to the extent of the skin changes, then tunnel the subcutaneous resection slightly outwards to ensure you don't go into the cavity