Infected Acute Cutaneous Injury

May 1, 2012

A 32-year-old woman presents with a swollen, painful fourth digit on the right hand. While housecleaning, a traumatic erosion developed on the ipsilateral hyponychium.

A 32-year-old woman presents with a swollen, painful fourth digit on the right hand. While housecleaning, a traumatic erosion developed on the ipsilateral hyponychium. Despite the injury, she continued her chores, necessitating putting the affected finger into dirty environments.

Key point: There is clearly a degree of cellulitis present: well-demarcated erythema and swelling with subjective pain. Despite the patient’s best intentions, continuing to clean in spite of a fresh, open wound was not a good decision.

Treatment: Oral doxycycline, 100 mg twice daily, was started promptly. After 14 days, all signs and symptoms had abated.

Note: Infected acute cutaneous injuries should be presumed to be caused by Staphylococcus aureus. MRSA may also be suspected in communities with a high prevalence of this organism as a pathogen.