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Daily Dose

Bug Bite or Staph Infection?

I received another e-mail with an attached picture (you can take a look too) asking me my thoughts on what to do about this child’s bite. My first thoughts are, “is this really a bite, or is it an early staph infection?”I received another e-mail  asking me my thoughts on what to do about this child’s bite. My first thoughts are, “is this really a bite, or is it an early staph infection?”

This is often a common problem even in the office setting. A parent brings in a child and there is no history of a known bite, and at this time of year there really are not that many bugs creeping around biting our arms and legs. At the same time, the lesion looks fairly benign, it is not warm to the touch, or tender, and the patient or parents aren’t sure how long it has been there. When faced with this dilemma, I often take a “sharpie” marker and draw a circle around the area and instruct the parent to keep the area clean with an antibacterial soap (don’t worry, “sharpie” does not wash off that fast). I also have them give the child a dose of an antihistamine, like Benadryl (diphenhydramine), which might help if it is indeed a bite. Then we wait and watch. If it is a bite, in most cases it will look a little better by the following day, or at a minimum unchanged. In the case of a staph skin infection the area typically appears larger than the original “sharpie” mark. It is also usually hot, red and tender by now. It may have “declared” itself to be a bacterial infection as it has a purulent center that can be drained. When I say drained, I mean at the doctor’s office so it can be done in a sterile manner and also the purulent material may be sent for culture and sensitivity. DO NOT poke, squeeze, take a needle or anything to drain the lesion at home. Remember NO PICKING!! By doing this at home you may take a completely benign lesion that will go away on its own in several days, and actually break the skin and cause a secondary infection. This is hard for many to resist, but resist! If the said “bite” turns out to be an actual skin infection, then by culturing the drainage, the organism which is often staph, may be identified as a “staph” that is susceptible to many antibiotics, or it may indeed be the unfortunately more and more common MRSA. MRSA or methicillin resistant staph is causing frequent skin infections within the community rather what we previously thought of as a hospital infection. The most important thing is to pay attention to the “bite” and if is worsens make sure you go see the doctor. We should get up follow up in the next several days!! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Summer Series: Best Ways To Use Bug Spray

The right ways to use bug sprayNow that you know all about the options for bugs sprays this summer, let’s discuss the guidelines for using these products.

The American Academy of Pediatrics (AAP) and the Environmental Protection Agency (EPA) have issued recommendations for the application of insect repellents in children. These include the following: -Do not apply bug spray to children under 2 months of age -Use up to 30% DEET in children, depending on duration of outdoor activities. Avoid the use of higher concentrations in children. -Apply insect repellent only to exposed areas of skin and/or clothing. Do not use repellents under a child’s clothing.  Certain repellents may damage synthetics, leather or plastics. -Do not apply insect repellent to eyes or mouth, and apply sparingly around the ears. Do not spray directly on the face, spray on your hands first and then apply to the child’s face -Do not apply bug spray over cuts, eczema or breaks in the skin. -Have a parent or caregiver apply the bug spray as a child may inadvertently ingest the spray.  Do not allow children to handle the repellents without supervision. -Wash repellents off with soap and water at the end of the day. This is especially important when repellents are used repeatedly in a day or on consecutive days. Also wash treated clothing before wearing again. -Combination products containing DEET and sunscreen are not recommended, as sunscreen should be reapplied frequently (every 2 hours) and in contrast bug repellents should be applies as infrequently as possible.  It is also thought that DEET may decrease the effectiveness of sunscreen. -Do not use spray in enclosed areas or near food. Avoid breathing the repellent spray. -There are other ways to beat the bugs too.  Try to avoid go outside when the bugs are most active, dawn and dusk. - When your child does go out cover as much of the skin as you possibly can. Use lightweight, long sleeved clothing and pants.   Do not dress your child in bright colors or flowery clothing.  For young children use mosquito netting over their strollers etc. -The use of citronella candles or bug zappers have not been shown to help . -Eliminating standing water in yards and areas around the house and yard will help eliminate mosquito breeding. Fans do seem to help as mosquitoes have trouble maneuvering in the wind, so buying a fan to use around the picnic table may be useful. There are many ways to try and avoid the dreaded insect bites, the “battle” is just beginning. So, gather information and your favorite repellents and enjoy the outdoors. That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue right now! Check the UV Index in your neighborhood here

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Daily Dose

The Truth About Bedbugs

With everyone finishing out summer vacation and trips to near and far, and away from one’s own bed, I wondered if any one had been unfortunate enough to develop bites secondary to bed bugs? Bed bugs, also known as Cimex Lectularis have been a known human parasite (remember the lovely louse in hair) for centuries. It is only recently that there has been a resurgence of this blood-sucking insect in all parts of this country and the developed world. YUCK!

Bed bugs are flat, oval shaped and about 5mm long. They seek warmth and that helps them locate warm-blooded bodies. They usually avoid the light, and hide in mattresses, crevices of box springs, headboards, and even behind hanging pictures. Did you know that they can survive a year without feeding? No wonder we are loosing the bed bug fight. We humans also help to move them from location to location via clothing, suitcases, personal possessions and bedding. Now I am really thinking about moving my son into that dorm next week!! Looking at the literature (JAMA, April 2009) it seems that more than 40 diseases have been attributed to bed bugs, but there is little evidence that such transmission has ever occurred. It is the reaction to the bite that it most bothersome as well as the mental anguish associated with it. The usual response to a bed bug bite is to little to no reaction at the site of the bite. About 30 percent of people will develop more significant reactions with larger local reactions that are more bothersome. These bites may be treated with oral anti-histamines and topical steroid cream, and seem to resolve over several weeks. An antibacterial cream may be used if the bites become locally infected due to scratching. With all of that being said, there are currently no repellents that have been shown to be effective. Mosquito repellant and oil of lemon eucalyptus may be of some help, but wearing these to bed every night doesn’t sound wise. Pesticides for spraying mattresses are also a cause of health concerns and are not routinely recommended. Let’s just hope we are all in the 70 percent that don’t know if we have been exposed and leave it at that! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Summer Series: Best Ways To Use Bug Spray

1.00 to read

Now that you know all about the options for bugs sprays this summer, let’s discuss the guidelines for using these products.

The American Academy of Pediatrics (AAP) and the Environmental Protection Agency (EPA) have issued recommendations for the application of insect repellents in children. These include the following:

-Do not apply bug spray to children under 2 months of age

-Use up to 30% DEET in children, depending on duration of outdoor activities. Avoid the use of higher concentrations in children.

-Apply insect repellent only to exposed areas of skin and/or clothing. Do not use repellents under a child’s clothing.  Certain repellents may damage synthetics, leather or plastics.

-Do not apply insect repellent to eyes or mouth, and apply sparingly around the ears. Do not spray directly on the face, spray on your hands first and then apply to the child’s face

-Do not apply bug spray over cuts, eczema or breaks in the skin.

-Have a parent or caregiver apply the bug spray as a child may inadvertently ingest the spray.  Do not allow children to handle the repellents without supervision.

-Wash repellents off with soap and water at the end of the day. This is especially important when repellents are used repeatedly in a day or on consecutive days. Also wash treated clothing before wearing again.

-Combination products containing DEET and sunscreen are not recommended, as sunscreen should be reapplied frequently (every 2 hours) and in contrast bug repellents should be applies as infrequently as possible.  It is also thought that DEET may decrease the effectiveness of sunscreen.

-Do not use spray in enclosed areas or near food. Avoid breathing the repellent spray.

-There are other ways to beat the bugs too.  Try to avoid go outside when the bugs are most active, dawn and dusk.

-When your child does go out cover as much of the skin as you possibly can. Use lightweight, long sleeved clothing and pants.   Do not dress your child in bright colors or flowery clothing.  For young children use mosquito netting over their strollers etc.

-The use of citronella candles or bug zappers have not been shown to help .

-Eliminating standing water in yards and areas around the house and yard will help eliminate mosquito breeding. Fans do seem to help as mosquitoes have trouble maneuvering in the wind, so buying a fan to use around the picnic table may be useful. There are many ways to try and avoid the dreaded insect bites, the “battle” is just beginning.

So, gather information and your favorite repellents and enjoy the outdoors. That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue right now! Check the UV Index in your neighborhood here

Daily Dose

Summer Series: How to Treat Common Insect Bites

From May/June until fall I consistently see children who are brought to my office for me to look at their insect bites.As we continue our summer series, it’s time to talk about pesky insect bites.  From May/June until Fall, I consistently see children who are brought to my office for me to look at their insect bites.  Just last week a mother brought in a 7 year old that she thought had chickenpox, but in reality it was numerous bug bites, which were located on the child’s arms and legs (exposed skin) rather than on the trunk which is seen with early chickenpox.  

In many cases, the offending biting insect is not accurately identified, as it could be the ubiquitous mosquito, or biting flies, gnats or fleas. Systemic reactions from insect bites are much less common that systemic reactions to insect stings. The immediate reaction to the insect bite usually occurs in 10–15 minutes with local swelling and itching, and may disappear in an hour or less.  The delayed reaction may appear in 12–24 hours with the development of an itchy red papule (bump) which may persist for days to even weeks. This is the reason that some people do not remember being bitten while they were outside, but the following day may present with the bites all over their arms and legs or chest, depending on what part of the body was exposed. Large local reactions to mosquito bites are common in children. For some reason it seems to me that “baby fat”  reacts more to the bite of the mosquito. (No science here).  The toddler set will often have itchy, red, are warm swellings appearing within minutes of the bites and they may even go on to develop bruising, and spontaneous blistering in 2–6 hours after being bitten. These bites then may persist for days or weeks, so in theory their little legs will be affected for most of the summer.  Severe local reactions are called “sweeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or extremity.  These are often misdiagnosed as cellulitis, but with a good history, the rapidity with which the area developed redness, swelling, warmth to touch and tenderness,  would be uncommon for a bacterial infection. Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins but are extremely rare. The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion,  Sarna lotion, Dommeboro soaks etc.  This may be supplemented by topical steroid creams (either over the counter or prescription) which may be used several times a day for a week or so to minimize scarring. An oral antihistamine (Benadryl)  may also reduce some of the swelling and itching.  Do not use topical antihistamines.  It is also important to try and prevent secondary infection (by scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream like Polysporin to open bites. The best treatment is actually prevention. Using a DEET preparation before going outside (lowest concentration that is effective) may be used in children over the age of 6 months.  Mosquito netting may be used for infants. Try to avoid going outside at dawn and dusk and make sure that you check pots etc for standing water that may be breeding areas for mosquitoes. Wearing long sleeves and long pants will also help (can’t imagine when it is 105 degrees !) That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue right now!

Daily Dose

Treating Summer Insect Stings

1:30 to read

I am sure there is a purpose for stinging insects in the animal kingdom, but they are quite a nuisance in the human kingdom during the summer months.Staying with the subject of summer ills, I thought it was also appropriate to discuss stinging insects. Stinging insects belong to the order Hymenoptera that includes honeybees, bumble bees, yellow jackets, hornets, wasps and fire ants. I am sure there is a purpose for these insects in the animal kingdom, but they are quite a nuisance in the human kingdom during the summer months.

The stinger of the insects delivers their venom to the victim. A honeybee can only sting one time and then dies, while wasps, hornets and yellow jackets may sting multiple times. Bees are actually docile, not very aggressive and typically do not sting, while yellow jackets and hornets are very aggressive (kind of like different types of people). Fire ants, which are so common in the southern and central U.S., also deliver multiple stings by anchoring their little jaws and actually pivoting while they are biting you. Again, the most common reactions to insect stings are local reactions with pain, redness, and swelling at the sting site. These symptoms usually resolve within several hours and require treatment with the local application of cold compresses, a paste of baking powder or meat tenderizer and analgesia with acetaminophen or ibuprofen.

There are also cases of marked local swelling and redness that develops over 12 -24 hours and may be quite large. Again, if this occurs within in the first one to two days following an insect sting, it is unlikely to be due to a bacterial infection. It may take up to five to 10 days to totally resolve and is not dangerous, but may be quite uncomfortable. In some cases a short burst of oral steroids may be required to reduce the inflammation. A systemic allergic reaction “anaphylaxis” to an insect sting is defined as “causing signs and symptoms in at least two organ systems distant from the site of the sting”. These symptoms may be cutaneous such as generalized, hives, swelling of lips, mouth or tongue and itching, or involve respiratory tract with difficulty breathing, hoarseness and difficulty swallowing. The symptoms may also involve GI tract with vomiting, nausea and abdominal pain, or circulatory system with dizziness, decrease in BP and loss of consciousness. Although children have a lower frequency of anaphylactic reactions to insect stings than adults, the above symptoms are a medical emergency and require immediate intervention.

If your child has ever had a systemic, anaphylactic reaction to an insect sting they should be prescribed an autoinjectable epinephrine device (Twinject/Epipen) and an anaphylaxis treatment plan for its use. Recent evidence also supports prescribing these devices for children who have experienced a generalized acute hive like rash after a sting because of the 10% risk of a more severe reaction from a future sting. It should be emphasized that multiple doses of epinephrine may be needed (in one study 16 -35%) in treating an anaphylactic reaction after a sting and therefore anyone who has used their own epinephrine should seek immediate medical care as they may require more doses. Children should also have action plans for school, camp etc and should wear a medical identification bracelet.

That’s your daily dose, we’ll chat again tomorrow.

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