Foreskin infected - red and white and swollen

[Galatea]

A few weeks ago ds (11 months) got some pimply rash on his penis and diaper area. The doctor diagnosed impetigo and gave us some Mupirocin antibiotic ointment. It cleared it up, but since one of the sores was on the tip of his foreskin, I was concerned that maybe there was one inside the foreskin that I couldn't see and took him back to be rechecked. The doctor said it was fine.

Well yesterday I noticed that the tip had a red spot again, but nothing else. This morning, however, the entire end of his foreskin, all the part that hangs off, is red and poofy and swollen and springy to the touch. The center of it is whitish. I do not see any pimples, per se, but it is very white and infected-looking. I read the sticky and none of it applies. He is only 11 months and can't retract at all, and it is in the same spots as the impetigo.

It is Sunday. I left a message for the doctor. He is a good guy and anti-circ. Should I take ds to the emergency room, or is that a bad idea? I think at this point he needs some oral antibiotics.

[feebeeglee]

I wouldn't go to the ER unless your DS can't pee or is in severe pain. My DD has on again-off again impetigo as well, I think some kids are just more prone to it. We can be clear for months and she'll get it again, even with a culture and specific abx.

[Galatea]

The doctor called me back and said to start with the antibiotic ointment again for 2 weeks. Argh! I am going to have to use sposies!

His foreskin looks so bad. It is red and sort of wrinkly, or channeled, I don't know how to describe it, like an elephant's skin, maybe.

[Charmie981]

We had issues with impetaigo with DS1 as well. The tip of the foreskin seemed especially prone to it, but I was always glad he had the foreskin b/c I couldn't imagine that sores like that on the glans itself would feel very good.

If your son isn't retractile, I wouldn't worry about an infection under the foreskin. It's very unlikely that the bacteria traveled into there w/o the skin retracting. Impetaigo is a colonization of strep and staph infection on the skin, and it's flesh-eating :P. It takes MAJOR antibiotics and a minimum of two weeks of cream to get rid of it. Please be sure to use the cream for the entire two weeks, whether the sores disappear or not, to prevent developing a resistant strain of the bacteria.

It also spreads through contact, so be sure to wash your hands and DS's hands after every diaper change and try to discourage him from touching the sores and touching another part of his body. If the sores do spread, he'll need a 10-14 day course of an oral antibiotic, which will not be any fun for either of you.

Most of the time impetigo in the diaper area is caused by yeast (the pimply rash) that breaks open and gets a secondary bacterial infection (the impetaigo). Next time you see that yeast rash pop up, treat it ASAP with an antifungal cream or with Burts Bees diaper ointment (it has knocked out yeast for us before) and hopefully the impetaigo can be avoided.

[Galatea]

Flesh-eating?! That is horrible! The doctor just acted like it was no big deal. My concern is that I am using the same antibiotic cream I used the 1st time. If it didn't knock it out then, why would it work now? Should I be getting something stronger?

[feebeeglee]

http://www.cdc.gov/ncidod/dbmd/disea...tococcal_g.htm that's the CDC lowdown on Group A Strep, which can cause strep throat, impetigo and necrotizing fasciitis - flesh eating bacteria. It's the same (very very common) bug but it's rare for it to go to that stage. Most of the time it is no big deal.

I dunno about the same meds for the second round of treatment, but I'd think you have a point there.. they should maybe culture it and find out exactly what strain it is?

[Frankly Speaking]

Originally Posted by Galatea

Flesh-eating?! That is horrible! The doctor just acted like it was no big deal.

It probably isn't any big deal. These bacteria are omnipresent in our environment and our immune systems keep them at bay. You've got them crawling all over your body right now as do I and everyone else. It's only when we get a massive exposure to them that overwhelms our immune system or when our immune system is compromised that they become a problem. It's only in a very rare instance and special set of circumstances that it gets to the "flesh eating" stage. How many people have you ever known in real life who had "Flesh eating" staph infections? I have never heard of anyone in my circle of family and friends or anyone they know. It is highly doubtful that I ever will know anyone. There have only been several documented cases of this in all of the United States.

My concern is that I am using the same antibiotic cream I used the 1st time. If it didn't knock it out then, why would it work now? Should I be getting something stronger?

That's a valid concern if you followed a 10 to 14 day regimen of antibiotic treatment combined with a program to eliminate the source from your home, daycare center or other source of infection. If you have not done this, let us know if you need information about it.



Frank

[Galatea]

Originally Posted by Frankly Speaking

That's a valid concern if you followed a 10 to 14 day regimen of antibiotic treatment combined with a program to eliminate the source from your home, daycare center or other source of infection. If you have not done this, let us know if you need information about it.



Frank

I did no such regimen. We have our water heater set at 150 and I asked the doctor if that was hot enough for the diapers, and she said yes. So I didn't do anything special.

The treatment the 1st time was 10 days of Mupirocin ointment, 3 times a day. I think I only did 8 days, though, and feel terrible about that.

[Frankly Speaking]

Every time I write about this, I'm reminded of a segment on one of the news magazine shows like 20/20. They were talking about salmonella food poisioning and the importance of proper sanitary procedures to avoid it. They took some chicken and coated it with an invisible dye that would glow under black light. They gave it to a woman to prepare for dinner and then traced the dye to show how easily it could spread to other areas.

The woman prepared the chicken and promptly returned it to the refrigerator and washed her hands. She then prepared the rest of the meal. When she was finished, they checked the kitchen for cross contamination of the dye which would show how bacteria could spread.

The first place was the handle on the refrigerator door and next was the handles on the faucet on the sink that was contaminated when she washed her hands. Of course, when she turned the water off, she re-contaminated herself and then spread the contamination to the hand towel she used to dry her hands. She had also contaminated the spice jars holding the spice used on the chicken, the cooking oil bottle, the knife handle, etc. They showed that the proper way to do it was to put the chicken in a container, wash her hands, put the lid on the container and then put it into the refrigerator. That stopped the contamination dead in it's tracks until she was ready to cook it when she dumped it in the pan and moved it around with a fork. Stopped again! Doing it the proper way stopped the contamination in it's tracks and the cooking process killed any bacteria on the chicken.

You have to think this way when you are battling one of these easily transported bacterial infections. First, look for the original source of the infection. Prime candidates are other family members and pets. Even though they may not be showing any symptoms, they can be carriers of the infection and mostly, proper hand washing procedures are the easiest and best way to stop the infection. Other candidates are day care and doctor's offices and places where your son may visit. Think about how the infection can spread around your home and get to your son. Frequent changes of bed linens, wash cloths towels and clothing is a must. Wash them in hot water and use regular or color bleach. (Especially diapers!) Also wipe all surfaces your son will touch every day. Spray cleaners are good but a mix of bleach and water is even better. You can mix about 4 parts water with one part bleach and keep it handy in a spray bottle. Especially clean toys, cribs, playpens, strollers and such often. This should be continued for at least a few days longer than a prescription for antibiotics which in most cases would mean 2-2 2/2 weeks.

Following this routine, you will eliminate the vast majority of the bacteria so that your son's immune system will not get a massive dose that will overwhelm it. Eventually, his immune system will develop to the point that he will resist these infections quite easily in the vast majority of cases.

Good luck in getting rid of these critters!





Frank

[hummingbear]

Originally Posted by Galatea

We have our water heater set at 150 and I asked the doctor if that was hot enough for the diapers, and she said yes.

The following is heresay:
I have heard that a hot dryer is more effective than a how water wash at eliminating yeast and this may be for bacteria as well??

Anyone else?

[Frankly Speaking]

For boiling water sterilization, the recommended boiling time is 6 minutes and that is at 212 degrees fahrenheit. On the other hand, there are many bacteria that will only tolerate life outside the body for a few minutes. It's either too hot or too cold for them at much more or less than 98.6. That's why HIV/Aids is not easily transmitted via non-intimate contact.




Frank

[Galatea]

Well, I can't boil my diapers, as it would destroy the elastic and waterproofing. But I have been using oxiclean bleach.

I have been putting on the antibiotic at every diaper change on Sunday and Monday, and today I will put it on 3 times, then twice a day for the next two weeks. It is looking better already.

Thanks for all your help!