OpenHealth Q&A

From Impetigo to Potential MRSA: Seeking Guidance

Hello everyone, I am reaching out for assistance and to better understand how to advocate for my health needs. It feels as though my medical team isn't taking this situation seriously enough. **Personal Information:** - Age: 27 years - Gender: Female - Weight: 105 lbs - Height: 5'1" - Smoking Status: Non-smoker - Location: New York City - Medical History: Anemia, gastroparesis. I have been diligently disinfecting my surroundings and using Hibiclens soap throughout this ordeal. **Timeline of Events:** - Initially, an eczema rash appeared on the bridge and tip of my nose, and on the tops of both hands. This developed into an impetigo infection, characterized by yellowish, honey-colored drainage and crusting primarily on the tip of my nose. This area, along with my right hand, experienced the most severe effects. - My dermatologist prescribed a treatment regimen of Mupirocin (2%) and Hydrocortisone (2.5%). * *Day 6:* - Unfortunately, the situation deteriorated; the infection spread to the sides of my nose and expanded around my eyes, resembling a butterfly rash but stemming from the impetigo. The Mupirocin was causing a painful burning sensation and exacerbating itching. - My dermatologist advised discontinuing the ointment, and I consulted my primary care physician (PCP) who then prescribed oral Keflex. * *Day 9:* - The infection had progressed into small pustules, affecting my scalp, both arms, and two areas on my leg. Additionally, I developed intermittent neck soreness and a migraine. - I visited the emergency room where I discussed the possibility of MRSA. They recommended stopping my previous medication and initiated a course of Clindamycin (300 mg taken three times a day for ten days) with instructions to follow up with my PCP and dermatologist. * *Day 11:* - I had a follow-up appointment to discuss the new symptoms and adjustments to my antibiotic regimen. * *Day 17 (6 days into Clindamycin):* - Physical symptoms on my nose were beginning to improve. However, new pustules emerged on my neck, collarbone, shoulder, and chest. * *Day 20 (9 days on Clindamycin):* - The condition on my nose worsened, and other symptoms persisted, such as neck soreness and frequent migraines. * *Day 28:* - I completed my course of Clindamycin a week prior. Despite this, I still exhibited all previous symptoms and my sores continued to worsen. My dermatologist performed a biopsy of the sores and my PCP prescribed Doxycycline Hyclate (100 mg twice daily for seven days). **Current Situation:** * *Day 33 (5 days of Doxycycline):* - My nose remains unchanged or has worsened, with renewed spread under my eyes and another boil forming on my leg. I have endured a migraine for four consecutive days and have lost my appetite. Sleep quality has been poor, and I have noticed small amounts of fresh blood in my nasal mucus. Despite my ongoing struggles, both my PCP and dermatologist seem unconcerned about my condition. My PCP insists on waiting until the Doxycycline treatment is completed and for the biopsy results to come back. I feel incredibly unwell and am unsure how to advocate for myself. If I were to visit the ER again, I worry they would dismiss my concerns due to the absence of fever or other acute symptoms like vomiting or shortness of breath. I would greatly appreciate any advice or insights on how to navigate this difficult situation. Thank you for your help! 😭

Answers (1)

3/19/2025, 3:11:11 AM

OpenHealth AI

I'm sorry to hear about your difficult experience with your skin condition and the challenges you've faced in advocating for your health. It's understandable to feel frustrated, especially when you're not feeling well and things seem to be worsening. Let's look at your situation step by step, focusing on the most critical points and actionable guidance.

Main Points:

1. Current symptoms indicate ongoing infection and inflammation.
2. You may need to advocate more assertively for further assessment and treatment.
3. Possible follow-up actions to consider.

Explanation:

Your timeline reveals a progression from an initial eczema rash to a more complicated skin infection (impetigo), treated with multiple antibiotics. Despite initially seeming to improve, the emergence of new pustules, worsening symptoms, and the presence of blood in your nasal mucus are concerning signs. Your symptoms of migraines, neck soreness, and appetite loss also point toward a need for further investigation.

Given that two antibiotics (Clindamycin and Doxycycline) have not cleared your infection effectively, there may be resistance or an underlying issue that needs addressing. It's also important to consider the potential side effects or reactions to medications in your history.

Actionable Next Steps:

1. Document Everything: Keep a detailed symptom diary. Note any changes in your skin condition, how you feel daily (including new symptoms), the timeline of your medication regimen, and any side effects. This will help you present a clear case if you seek further medical attention.

2. Reach Out for Care: If symptoms continue to worsen or do not improve significantly after completing the Doxycycline, it’s crucial to seek further evaluation. You could do this by:

   • Follow Up with Your PCP: Call your PCP to express your concerns loudly. Mention the worsening symptoms and any new developments (e.g., blood in mucus). Reiterate that the current treatment is not yielding the expected results.
   • Consider a Second Opinion: If your doctor remains unsympathetic, it may be beneficial to seek an appointment with another dermatology specialist or an infectious disease doctor who has experience with resistant skin infections.
   • Emergency Room (if needed): If at any point you feel you may be developing systemic symptoms (like a fever, swelling, severe pain, or increased fatigue), visiting the ER could be justified even without acute symptoms. Be assertive about your ongoing issues and lack of improvement.

3. Improve Symptom Management: While awaiting further medical guidance:

   • Continue to keep the affected areas clean and moisturized, but avoid any products that might irritate your skin.
   • Ensure you are hydrating well and eating nutritious foods to support your immune system.
   • Consider over-the-counter pain relief for migraines and neck soreness, such as ibuprofen or acetaminophen, unless contraindicated.

4. Consider Support: It may be helpful to speak with a mental health professional or a support group to help you process the stress of living with these ongoing health issues.

Remember, self-advocacy can be challenging, but your health and well-being should always come first. Trust your instincts as you navigate this situation, and don't hesitate to seek the care you need. If you have more questions or need further assistance, feel free to ask.