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Cellulitis: How Long Does It Take To Heal?
Cellulitis is an infection of the deep layers of the skin.
It develops when bacteria enter through a cut, bite, or wound — including tiny breaks in cracked, dry skin. Common skin-dwelling bacteria, Staphylococcus or Streptococcus, are the usual culprits. Although cellulitis can occur anywhere on the body, the most common location is the lower leg.
Dr. Arash Mostaghimi, a dermatologist at Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, weighs in on new research that explores important questions about how long it takes to fully heal.
SymptomsThe body's natural immune response to this bacterial invasion triggers a painful rash that appears red on lighter skin and dark purple on darker skin. The affected area also may be swollen and feel warm.
TreatmentThe typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.
After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.
Does that mean the antibiotic treatment was ineffective? Not necessarily, according to a recent study of people with cellulitis in the lower leg that described the natural history of the healing stages following antibiotics.
"The healing process has two parts, which is why a full recovery takes longer than you might think," says Mostaghimi.
First, the antibiotics and your white blood cells work together to kill the bacteria. But your body's immune response against the bacteria may take a while to shut down. As a result, this second stage of the healing process may include some residual symptoms, he explains.
What did the study find?
The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:
Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.
A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.
Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.
This pattern of discomfort isn't unusual, especially with leg infections, says Mostaghimi. As people are recovering from leg cellulitis, they're often advised to elevate the leg, which helps to ease the swelling. (Putting a warm, moist washcloth on the area may also help.)
But after they feel better and start walking more, fluid shifts back down into the legs. So it's not surprising that the area might feel a little swollen and uncomfortable again once they're back on their feet, he says.
Who is at greatest risk for cellulitis?
Remember, cellulitis typically occurs when bacteria normally present on our skin manage to breach that shield to enter the body.
Some people who develop cellulitis have no obvious injury or skin damage to explain the infection, which can occur in people who are generally healthy. However, people with certain health problems are more prone to cellulitis. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation, or chronic edema (swollen limbs).
Additionally, skin conditions such as eczema and athlete's foot can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, Mostaghimi says. Scratching a bug bite until it bleeds is another possible entry point for bacteria.
What happens if untreated?Untreated cellulitis can be very serious. The rash may spread, be surrounded with blisters, and become increasingly painful. Nearby lymph nodes may become tender and swollen, followed by fever and chills.
It is important to seek medical care right away if you experience these symptoms.
The bottom line"It's important for people with leg cellulitis to realize that it may take a bit longer after finishing your antibiotics for all of your symptoms to completely resolve," says Mostaghimi.
You'll probably start to feel better within a few days, but always finish all the pills in your antibiotic prescription.
However, having residual symptoms once you're finished with the medication done does not mean you need another course of antibiotics or a different antibiotic, he says.
Pivya Approved To Treat Uncomplicated UTI In Women
The Food and Drug Administration (FDA) has approved Pivya (pivmecillinam) for the treatment of female patients 18 years of age and older with uncomplicated urinary tract infections (UTIs) caused by susceptible isolates of Escherichia coli, Proteus mirabilis and Staphylococcus saprophyticus.
Pivmecillinam is a prodrug of mecillinam, a beta-lactam antibacterial drug. The approval was based on data from 3 phase 3 trials, which compared the efficacy of different dosing regimens of pivmecillinam to placebo, to another oral antibacterial drug (cephalexin), and to ibuprofen (ClinicalTrials.Gov Identifier: NCT01849926).
The primary efficacy measure for all 3 trials was the composite response rate, which included clinical cure (defined as no persisting symptoms during and after therapy) and microbiological response (defined as a reduction in the number of bacteria to <103 CFU/mL). The composite response rate was assessed approximately 8 to 14 days after patients were enrolled into the studies.
Findings from the placebo-controlled clinical trial showed 62% (n=85/137) of patients in the pivmecillinam arm achieved the composite response vs 10% (n=14/134) of those in the placebo arm (treatment difference, 52% [95% CI, 41-62]).
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Uncomplicated UTIs are a very common condition impacting women and one of the most frequent reasons for antibiotic use.
In the cephalexin-controlled clinical trial, 72% (n=91/127) of patients in the pivmecillinam arm achieved the composite response vs 76% (n=100/132) of those in the cephalexin arm (treatment difference, -4% [95% CI, -16, 7]).
In the ibuprofen-controlled clinical trial, 66% (n=69/105) of patients in the pivmecillinam arm achieved the composite response vs 22% (n=26/119) of patients in the ibuprofen arm (treatment difference, 44% [95% CI, 31-57]).
Pivya is contraindicated in: patients with a known history of severe hypersensitivity to Pivya or other beta-lactam antibacterial drugs; patients with primary or secondary carnitine deficiency resulting from inherited disorders of mitochondrial fatty acid oxidation and carnitine metabolism, and other inborn errors of metabolism; and patients who are suffering from porphyria. The most common adverse reactions reported with Pivya were nausea and diarrhea.
"Uncomplicated UTIs are a very common condition impacting women and one of the most frequent reasons for antibiotic use," said Peter Kim, MD, MS, director of the Division of Anti-Infectives in the FDA's Center for Drug Evaluation and Research. "The FDA is committed to fostering new antibiotic availability when they prove to be safe and effective, and Pivya will provide an additional treatment option for uncomplicated UTIs."
Pivya is supplied as 185mg pivmecillinam tablets. The recommended dosage is one 185mg tablet orally three times a day for 3 to 7 days as clinically indicated.
This article originally appeared on MPR
What To Know About Finger Infection?
There are different types of finger infections which can range from mild to severe. Although many start out small and are easy to treat, complications can occur if a person does not receive treatment.
Hands are likely to come into contact with infectious bacteria and other germs, which can lead to infection. Prevention of finger infection is important, as well as knowing when to see a doctor.
This article covers the different types of finger infections, their causes and risk factors, and treatment options.
There are many different types of infections, each with their own causes and symptoms. Some types of finger infections include:
The causes of finger infections can vary depending on the type of infection.
Often, infections develop due to bacteria entering the body due to an injury, such as a cut on the finger. Other possible entry points for bacteria may be animal or insect bites, paper cuts, or puncture wounds.
Herpetic whitlow is caused by a virus instead of bacteria.
FelonA felon infection usually results from a wound penetrating the skin, such as:
These wounds allow bacteria to get into the deeper layers of the skin. Staphylococcus aureas is the most common source of the infection.
ParonychiaParonychia develops when bacteria, most commonly Staphylococcus aureus, enters the cuticle. This can happen when the cuticle or a hangnail becomes irritated, resulting in an open wound.
Bacteria can enter the cuticle via:
Herpes simplex virus I or II is the virus responsible for herpetic whitlow. It is the same virus that causes outbreaks of oral or genital herpes.
People who work with bodily fluids, such as doctors, dentists, and other medical workers, may be more at risk of contracting the infection. It is also possible for someone with herpes to infect their own finger.
Deep space infectionDeep space infections, including infectious flexor tenosynovitis, are caused by a deep puncture wound or very deep cut that allows bacteria to reach the deepest tissues in the hand and finger.
Infectious flexor tenosynovitisBacteria can enter the finger through a small cut or puncture wound. Although the wound can be anywhere on the hand, infectious flexor tenosynovitis is particularly likely to develop if the wound is near a joint in the palm side of the hand.
CellulitisA person can develop cellulitis when bacteria, most commonly Streptococcus, enters the skin through an opening in the skin, such as an injury.
The bacteria enter the lower layers of the skin through an open wound. The infection may spread to other parts of the hands and fingers via the bloodstream.
When a cut on the finger becomes infected, symptoms include:
Typical symptoms of a felon include a swollen and painful fingertip. It may be possible to see a pool of pus forming under the skin.
A person may first notice erythema at the fingertip. As the symptoms progress, the fingertip can become painful and swollen. The pain can start off as mild, but quickly progress to severe.
ParonychiaSymptoms of paronychia include skin discoloration and swelling next to the fingernail, which will be painful to touch.
Pus may develop under the nail or skin, which may leak out of the wound. The drainage is usually a white-yellow color.
Herpetic whitlowWhitlows present as blood-tinged blisters that are small, swollen, and painful. The following symptoms may also be present:
A whitlow may cause one or more open wounds in the area that often occur in clusters.
Deep space infectionCommon symptoms and signs of deep space infections include pain when moving certain parts of the hand.
The area may become discolored, very sensitive to touch, and spread along the tendon sheath. The center of the infection may have a soft spot, where a collection of pus is forming.
Infectious flexor tenosynovitisInfectious flexor tenosynovitis can present with the following symptoms:
Symptoms of cellulitis include erythema and skin that is sensitive and warm to the touch. The area may also swell.
If a person notices any signs of an infection in their finger, they should seek medical help. Without treatment, an infection can progress.
A doctor will be able to discuss the best treatment options.
Doctors will diagnose finger infections by thoroughly identifying symptoms and their potential causes. They will ask a series of questions to determine when the infection began.
The doctor may also ask more specific questions, such as if a person has a history of biting their nails or if they have the herpes virus. These questions help narrow the possibilities down for a proper diagnosis and treatment.
A doctor can treat some finger infections with antibiotics, wound care, and nonsurgical treatment. Other types of infection require surgery to remove the infected tissue.
To treat herpetic whitlows, a doctor may prescribe antiviral tablets.
Home remediesA person should seek medical attention to treat an infected finger. However, there are some steps a person can take at home.
These include ensuring the wound is clean and covered with a sterile dressing and taking painkillers to ease the pain.
Preventing finger infections begins with basic hygiene and following safety practices when handling dangerous materials or doing dangerous work.
If a person develops a wound on their hand or finger, they can take steps to care for it. These include:
A person's outlook is positive if a person receives prompt treatment for an infected finger. If treatment is delayed or infections are severe, there is the possibility of lasting damage.
It is essential to talk with a doctor at the first sign of infection to discuss treatment.
Finger infections can range from mild to severe. They often cause symptoms such as skin discoloration, swelling, and pain.
If a person notices any symptoms of a finger infection, they should contact a doctor. This is because infections can progress quickly and lead to permanent damage.
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