Periorbital Cellulitis

Periorbital cellulitis is inflammation and infection of one or both eyelids caused by bacteria. Periorbital cellulitis is most common in children younger than 5 years old.

Cellulitis of the Eye

DISCHARGE INSTRUCTIONS:

Call 911 for any of the following:

  • Your child has trouble breathing.
  • Your child has a seizure.
  • Your child is more sleepy than usual or is hard to wake.

Return to the emergency department if:

  • Your child says his or her neck feels stiff.
  • Your child has a headache and is vomiting.
  • Your child has blurred or double vision and cannot see well in bright light.
  • Your child’s infected eye bulges from his or her head.

Contact your child’s healthcare provider if:

  • Your child has a fever higher than 101.5°F (38.6°C) and chills.
  • You see red streaks on the skin of the infected area.
  • Your child’s eye is more red and swollen, or starts to drain pus.
  • You have questions or concerns about your child’s condition or care.

Medicines:

Your child may need any of the following:

  • Antibiotics help treat a bacterial infection.
  • Acetaminophen decreases pain and fever. It is available without a doctor’s order. Ask how much to give your child and how often to give it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him or her. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.
  • Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child’s medicine labels for aspirin, salicylates, or oil of wintergreen.
  • Give your child’s medicine as directed. Contact your child’s healthcare provider if you think the medicine is not working as expected. Tell him or her if your child is allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs your child takes. Include the amounts, and when, how, and why they are taken. Bring the list or the medicines in their containers to follow-up visits. Carry your child’s medicine list with you in case of an emergency.

Prevent periorbital cellulitis:

  • Have your child wear proper safety equipment. Protect his or her face from injury during sports and other activities.
  • Keep wounds clean and dry. Clean wounds on the face with soap and water. Cover wounds with a dry bandage. Use antibiotic ointment on skin breaks to help prevent infection. Do not let your child swim with a skin wound.
  • Ask your child’s healthcare provider about vaccines. The Hib and pneumococcal vaccines help prevent periorbital cellulitis.

Follow up with your child’s healthcare provider in 1 to 2 days:

Write down your questions so you remember to ask them during your visits.

Perirectal Abscess

Glands near the anus can become blocked. This can lead to infection. If the infection can’t drain, a collection of pus called an abscess may form. Symptoms of an abscess include anal or rectal pain, itching, swelling, and fever. Frequently the abscess results in a fistula, which is an abnormal connection between the abscess and the skin where pus drains. A fistula may sometimes be seen on exam and may require other testing and treatments.

Your healthcare provider will likely drain the abscess. In some cases, he or she will also prescribe antibiotics. People with artificial valves, diabetes, weak immune systems, and certain other conditions always need antibiotics.

Home care

  • Abscesses are almost always drained. Follow any instructions from your provider about care of the incision site. 
  • If you are prescribed antibiotics, take them exactly as prescribed. Take all of the antibiotic medicine as prescribed. Continue it even if you start feeling better. Finish all of the medicine unless your healthcare provider tells you to stop.
  • Try sitz baths. Sit in a tub filled with about 6 inches of hot water for 15 to 30 minutes. Test the water temperature before sitting down to ensure it will not burn you. Repeat this twice a day until pain is relieved.
  • Unless a pain medicine has been prescribed, you may take an over-the-counter medicine, such as ibuprofen, for pain. 
  • Passing stools may be painful. If so, ask your healthcare provider about using a stool-softener for a short time. Gradually adding fiber to your diet, or taking a fiber supplement, is also helpful.

Follow-up care

Follow up with your doctor, or as advised.

When to seek medical advice

Call your healthcare provider right away if any of the following occur:

  • Increasing pain, swelling, or redness
  • Pus draining from the abscess
  • Fever of 100.4ºF (38ºC) or higher that continues for a day after starting antibiotics, or as directed by your healthcare provider
  • Other symptoms such as rectal bleeding, abdominal pain, or chronic diarrhea. Your provider will evaluate whether the abscess may indicate other medical conditions.

Peritonitis

Peritonitis is an infection in the lining that covers your abdomen and organs, called the peritoneum. Spontaneous peritonitis happens when fluid in the peritoneum becomes infected. Secondary peritonitis happens after an injury or surgery in your abdomen. A peritonitis infection can become life-threatening.

DISCHARGE INSTRUCTIONS:

Seek care immediately if:

  • You have severe pain in your abdomen that keeps you from being comfortable.
  • You have severe tenderness in your abdomen.
  • You have severe abdominal pain after you have an accident or are injured.
  • You are receiving peritoneal dialysis and the dialysis fluid is cloudy or has flecks or clumps.

Contact your healthcare provider if:

  • You have a fever.
  • You have questions or concerns about your condition or care.

Medicines:

  • Medicines may be given to fight a bacterial infection or to reduce pain. Ask your healthcare provider how to take prescription pain medicine safely. You may also need medicines to relieve nausea or to stop vomiting.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Peritonsillar Abscess

Tonsils and uvula

Your Care Instructions

A peritonsillar abscess is a collection of pus that forms in tissues around the tonsils. It can occur as a result of strep throat or another infection. An abscess can cause severe pain and make it very hard to swallow.

You will need antibiotics. In some cases, your abscess will have been drained through a needle or small incision.

You may have had a sedative to help you relax. You may be unsteady after having sedation. It can take a few hours for the medicine’s effects to wear off. Common side effects of sedation include nausea, vomiting, and feeling sleepy or tired.

The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • If the doctor gave you a sedative:
    • For 24 hours, don’t do anything that requires attention to detail. This includes going to work, making important decisions, or signing any legal documents. It takes time for the medicine’s effects to completely wear off.
    • For your safety, do not drive or operate any machinery that could be dangerous. Wait until the medicine wears off and you can think clearly and react easily.
  • Take your antibiotics as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
    • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
  • Gargle with warm salt water once an hour to help reduce swelling and relieve discomfort. Use 1 teaspoon of salt mixed in 1 cup of warm water.
  • Get lots of rest.
  • Follow your doctor’s instructions if your abscess was drained through a needle or small incision.
  • While your throat is very sore, use liquid nourishment such as soup or high-protein drinks.
  • Prevent spreading an infection. Wash your hands often, do not sneeze or cough on others, and do not share toothbrushes, eating utensils, or drinking glasses.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You have trouble breathing.
  • You passed out (lost consciousness).
  • You have a lot of blood coming from the mouth.

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have symptoms of worsening infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks coming from the area.
    • Pus draining from the area.
    • A fever.
  • You are bleeding.
  • You have new or worse nausea or vomiting.
  • You have new or worse trouble swallowing.
  • You have a hard time drinking fluids.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

  • You do not get better as expected.

Paronychia

  • Paronychia, also called perionychia, is an infection and inflammation (redness, pain, and swelling) of your nail fold. The nail fold is the skin around your fingernails and toenails. Paronychia may be acute (sudden) or chronic (happen repeatedly over six weeks or longer). Injury to your nails or nail folds, such as from biting your nails may tear your skin. Germs such as bacteria and fungi may enter through the torn skin, causing an infection. Certain medicines and medical conditions may increase your risk of having paronychia. Skin allergies, certain soaps, chemicals, or repeated water soaking may also increase your risk.Nail anatomy
  • With paronychia, your nail fold may be painful. Pus may come out of your nail fold when you press against it. With chronic paronychia, your nail may change color or become thick. Your nail may also pull away from your nail fold, and fall off. Your caregiver may ask about your symptoms and do a digital pressure test. You may need medicine to treat your pain, swelling, and infection. You may also need surgery to drain pus or remove your nail and the tissue around it. Treatments for paronychia may decrease redness, pain, and swelling. Treatment may also help prevent the infection from spreading to nearby tissue.

AFTER YOU LEAVE:

Take your medicine as directed:

Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  • Antifungal medicine: This medicine helps kill fungus that may be causing your infection.
  • NSAIDs: Nonsteroidal anti-inflammatory (NSAID) medicine may decrease swelling and pain or fever. This medicine can be bought with or without a doctor’s order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
  • Pain medicine: You may need medicine to take away or decrease pain.
    • Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it.
    • Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.
  • Tetanus shot: This is medicine to keep you from getting tetanus. You may be at risk for tetanus if you have skin tears. It is given as a shot. You should have a tetanus shot if you have not had one in the past 5 to 10 years. Your arm can get red, swollen, and sore after getting this shot.
  • Topical medicine: This medicine is put on the skin around your nails. This may come as a cream or ointment. Topical medicine may decrease pain and swelling, and may also prevent infection.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Caring for myself at home:

  • Apply a warm compress on your infected finger or toe to decrease pain and swelling. You may also soak your finger or toe in warm water or a special solution. This solution may contain vinegar or medicine to decrease redness and prevent infection. Ask your caregiver for more information about warm compresses or soaks.
  • Keep your infected finger or toe clean and dry at all times.
  • Rub lotion into your nail folds, hands, and feet.
  • Wear proper footwear to keep your infected toe clean.

Preventing paronychia:

  • Rub moisturizing lotion into your hands after washing them.
  • Avoid chemicals that may harm your skin and nails. These may include soaps, laundry detergents, cuticle removers, primers, nail hardeners, or nail products containing acetone. Ask your caregiver for more information about other chemicals that may cause paronychia.
  • Avoid cutting or removing your nail fold when cleaning your fingernails or toenails.
  • Bring your own nail tools when having your fingernails or toenails cared for in nail salons.
  • If you have diabetes, keep your blood sugar at the level your caregiver suggests. Your infected nail fold may take longer to heal if you have diabetes. Ask your caregiver for more information about diabetes, and ways to control your blood sugar level.
  • Keep your nails short. Do not bite your nails, pick at your hangnails, suck your fingers, or wear fake nails.
  • Use cotton-lined rubber gloves or wear two rubber gloves when working with food or water. The gloves will help protect your nail folds.

CONTACT A CAREGIVER IF:

  • You have a fever.
  • You have pus draining from your infected finger or toe.
  • You have questions or concerns about your condition, treatment, or care.

SEEK CARE IMMEDIATELY IF:

  • Your swelling and pain worsens in your finger or toe.

Myringitis Bullosa

Bullous myringitis is an infection of the tympanic membrane (the eardrum). Small fluid-filled blisters form on the eardrum and cause severe pain.

More to Know

More children get bullous myringitis than adults. It’s spread by the same viruses and bacteria that cause middle ear infections (otitis media), so the two often happen together.

Pain comes on suddenly and lasts anywhere from 24 to 48 hours. Other symptoms may include drainage from the infected ear, temporary hearing loss, and fever.

Bullous myringitis is usually treated with antibiotics and pain killers. Sometimes the blisters need to be drained surgically.

Keep in Mind

Bullous myringitis is painful, but in most cases can be successfully treated with no lasting impact on hearing.

Balanitis

Balanitis is irritation of the head of the penis. It is more common in men who have not been circumcised. The area under the foreskin that covers the head of the penis is often warm and moist. This can cause the growth of bacteria or a fungus. This can make the penis sore, red, swollen, and itchy. You may also feel burning when you urinate, have pus come from your penis, or have chills and a fever.

Balanitis can also be caused by the chemicals in soap, condoms, or lubricants. Men with diabetes are more likely to get balanitis.

Your doctor may suggest a cream that usually clears up the problem within 2 weeks. You can prevent balanitis by keeping your penis clean. You also can help prevent it by not using products that cause irritation.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • Be safe with medicines. Take your medicine exactly as prescribed. If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • Keep your penis clean. If you have not been circumcised, gently pull the foreskin back to wash your penis with warm water. Make sure your penis is dry before you get dressed.
  • If latex condoms irritate your penis, try other condoms that are made for sensitive skin. Your doctor can help you make a good choice.
  • Wash your underwear with mild soap. Rinse it well.
  • If you work with harsh chemicals, wash your hands well before you go to the bathroom.

When should you call for help?

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the area.
    • Pus draining from the area.
    • A fever.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

  • You do not get better as expected.

Avascular Necrosis

Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and the bone’s eventual collapse.

A broken bone or dislocated joint can interrupt the blood flow to a section of bone. Avascular necrosis is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.

Anyone can be affected, but the condition is most common in people between the ages of 30 and 50.

Symptoms

Many people have no symptoms in the early stages of avascular necrosis. As the condition worsens, your affected joint might hurt only when you put weight on it. Eventually, you might feel the pain even when you’re lying down.

Pain can be mild or severe and usually develops gradually. Pain associated with avascular necrosis of the hip might center on the groin, thigh or buttock. Besides the hip, the areas likely to be affected are the shoulder, knee, hand and foot.

Some people develop avascular necrosis on both sides (bilaterally) — such as in both hips or in both knees.

When to see a doctor

See your doctor if you have persistent pain in any joint. Seek immediate medical attention if you believe you have a broken bone or a dislocated joint.

Causes

Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by:

  • Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken bone and harm blood vessels.
  • Fatty deposits in blood vessels. The fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones.
  • Certain diseases. Medical conditions, such as sickle cell anemia and Gaucher’s disease, also can cause diminished blood flow to bone.

For about 25 percent of people with avascular necrosis, the cause of interrupted blood flow is unknown.

Risk factors

Risk factors for developing avascular necrosis include:

  • Trauma. Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones.
  • Steroid use. Use of high-dose corticosteroids, such as prednisone, is a common cause of avascular necrosis. The reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow.
  • Excessive alcohol use. Consuming several alcoholic drinks a day for several years also can cause fatty deposits to form in your blood vessels.
  • Bisphosphonate use. Long-term use of medications to increase bone density might contribute to developing osteonecrosis of the jaw. This rare complication has occurred in some people treated with high doses of these medications for cancers, such as multiple myeloma and metastatic breast cancer.
  • Certain medical treatments. Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplant, also is associated with avascular necrosis.

Medical conditions associated with avascular necrosis include:

  • Pancreatitis
  • Diabetes
  • Gaucher’s disease
  • HIV/AIDS
  • Systemic lupus erythematosus
  • Sickle cell anemia

Complications

Untreated, avascular necrosis worsens with time. Eventually, the bone can collapse. Avascular necrosis also causes bone to lose its smooth shape, potentially leading to severe arthritis.

Prevention

To reduce your risk of avascular necrosis and improve your general health:

  • Limit alcohol. Heavy drinking is one of the top risk factors for developing avascular necrosis.
  • Keep cholesterol levels low. Tiny bits of fat are the most common substance blocking blood supply to bones.
  • Monitor steroid use. Make sure your doctor knows about your past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids.
  • Don’t smoke. Smoking increases the risk.

Animal Bite

After an animal bite, the biggest concern is infection. The chance of infection depends on the type of animal that bit you, where on your body you were bitten, and your general health. Many animal bites are not closed with stitches, because this can increase the chance of infection.

Your bite may take as little as 7 days or as long as several months to heal, depending on how bad it is. Taking good care of your wound at home will help it heal and reduce your chance of infection.

The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • If your doctor told you how to care for your wound, follow your doctor’s instructions. If you did not get instructions, follow this general advice:
    • After 24 to 48 hours, gently wash the wound with clean water 2 times a day. Do not scrub or soak the wound. Don’t use hydrogen peroxide or alcohol, which can slow healing.
    • You may cover the wound with a thin layer of petroleum jelly, such as Vaseline, and a non-stick bandage.
    • Apply more petroleum jelly and replace the bandage as needed.
  • After you shower, gently dry the wound with a clean towel.
  • If your doctor has closed the wound, cover the bandage with a plastic bag before you take a shower.
  • Your doctor may advise you to remove the bandage after 24 to 48 hours and then gently wash the wound to remove the crust. Do not scrub or soak the wound.
  • A small amount of skin redness and swelling around the wound edges and the stitches or staples is normal. Your wound may itch or feel irritated. Do not scratch or rub the wound.
  • Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
  • If your bite puts you at risk for rabies, you will get a series of shots over the next few weeks to prevent rabies. Your doctor will tell you when to get the shots. It is very important that you get the full cycle of shots. Follow your doctor’s instructions exactly.
  • You may need a tetanus shot if you have not received one in the last 5 years.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

When should you call for help?

Call your doctor or nurse call line now or seek immediate medical care if:

  • The skin near the bite turns cold or pale or it changes colour.
  • You lose feeling in the area near the bite, or it feels numb or tingly.
  • You have trouble moving a limb near the bite.
  • You have symptoms of infection, such as:
    • Increased pain, swelling, warmth, or redness near the wound.
    • Red streaks leading from the wound.
    • Pus draining from the wound.
    • A fever.
  • Blood soaks through the bandage. Oozing small amounts of blood is normal.
  • Your pain is getting worse.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if you are not getting better as expected.

Stork Bite

Salmon patch; Nevus flammeus

A stork bite is a common type of birthmark seen in a newborn. It is most often temporary.

The medical term for a stork bite is nevus simplex. A stork bite is also called a salmon patch.Stork bite

A stork bite is a vascular lesion quite common in newborns consisting of one or more pale red patches of skin. Most often stork bites appear on the forehead, eyelids, tip of the nose, upper lip or back of the neck. They are usually gone within 18 months of birth.

Causes

Stork bites occur in about one third of all newborns.

A stork bite is due to a stretching (dilation) of certain blood vessels. It may become darker when the child cries or the temperature changes. It may fade when pressure is put on it.

Symptoms

A stork bite usually looks pink and flat. A baby may be born with a stork bite. It may also appear in the first months of life. Stork bites may be found on the forehead, eyelids, nose, upper lip, or back of the neck. Stork bites are purely cosmetic and do not cause any symptoms.

Exams and Tests

A health care provider can diagnose a stork bite simply by looking at it. No tests are needed.

Treatment

No treatment is needed. If a stork bite lasts longer than 3 years, it may be removed with a laser to improve the person’s appearance.

Outlook (Prognosis)

Most stork bites on the face go away completely in about 18 months. Stork bites on the back of the neck usually do not go away.

When to Contact a Medical Professional

The provider should look at all birthmarks during a routine well-baby exam.

Prevention

There is no known prevention.