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Sept 2011: Dermatology

A 28 year old male deckhand presents to the clinic with the following:

The patient has a 3-day history of having a lump under his arm that is getting larger and more painful. He saw a “pimple” two days ago and tried to “pop the pimple” without success. The patient has not had anything like this in the past.

During examination you find a 2 cm area of erythema with induration and central fluctuance, warmth, and tenderness to palpation.

Diagnosis: Axillary Abscess

An abscess is a collection of pus that forms as a normal body response to infection and is commonly found on the skin surface.

Treatment: Incision and drainage (I&D)

 

Discussion

Working in a remote environment is not conducive to I&D due to the high risk of contamination. Patient should be isolated from common living areas and removed from the remote working environment as soon as possible for definitive treatment. Living quarters and lavatories must be decontaminated to prevent spread of the bacteria. Educate the patient to avoid squeezing the wound as this may spread bacteria to the surrounding tissue. Hot compresses applied directly to the area can assist in consolidation of the infection. Patients may be started on appropriate antibiotics in the interim until definitive treatment can be obtained. When selecting the antibiotic, be sure to select one with the appropriate spectrum of coverage for both regular bacteria as well as drug resistant bacteria, specifically MRSA. Some choices to consider include doxycycline, trimethoprim-sulfamethoxazole, or clindamycin. Tetanus prophylaxis should be administered if not all ready up to date. Appropriate pain control should be considered at this time to keep the patient comfortable.

Return to Work

The patient may return to the remote working environment once

  • Appropriate therapy has been completed
  • The wound is no longer draining and is completely healed
  • Pain medication is no longer required
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