Preventing Infections in Axillary Cysts: Is Povidone-Iodine Ointment Better?

Please advise on medications for preventing infection in axillary lipomas?

Hello Dr.
Ke, I discovered an axillary sebaceous cyst during my junior high school years and underwent surgical excision, but it has continued to recur, so I have since switched to conservative treatment (taking antibiotics occasionally when inflammation is severe).
Sometimes I can go for years without a flare-up, but there are times when I experience mild inflammation throughout the entire summer.
In recent years, due to weight gain, the incidence of axillary infections during the summer has become more frequent.
I later found that applying povidone-iodine solution has a preventive effect.
I researched online and found that antibiotics are not suitable for prophylactic use, and povidone-iodine solution seems to have a higher skin irritancy and can lead to pigmentation.
Would povidone-iodine ointment be more suitable for prevention compared to the solution? Or, given my situation, are there any recommended products available on the market? Thank you, doctor, and I wish you good health and all the best.

Niming, 30~39 year old female. Ask Date: 2020/09/14

Dr. Ke Fangxu reply Surgery

The active ingredients in povidone-iodine ointment and solution are the same; however, the ointment can remain on the skin for a longer duration.
Folliculitis in the axillary region is a challenging issue that is very prone to recurrence.
If the individual is overweight, sweat accumulation can further increase the risk of infection.
Over-the-counter antibiotic ointments or povidone-iodine can be used, but for a definitive cure, surgery is the only option.

Reply Date: 2020/09/14

More Info

When it comes to managing axillary cysts (also known as epidermoid cysts or sebaceous cysts), particularly in the context of preventing infections, it's essential to consider both the treatment options available and the underlying factors that may contribute to their recurrence. Your experience with recurrent cysts and the use of povidone-iodine (often referred to as Betadine) is quite common among individuals dealing with similar issues.

Understanding Axillary Cysts and Infections
Axillary cysts are benign lumps that can occur in the skin, often filled with keratin. They can become inflamed or infected, leading to discomfort and the need for treatment. The recurrence of these cysts can be influenced by several factors, including genetics, skin type, and hygiene practices. In your case, the increase in infections during the summer months may be related to increased sweating and friction in the axillary area, which can create an environment conducive to bacterial growth.

Povidone-Iodine: Ointment vs. Solution
Povidone-iodine is a broad-spectrum antiseptic that is effective against bacteria, viruses, and fungi. It is commonly used in surgical settings and for wound care. However, there are some considerations when choosing between povidone-iodine ointment and solution:
1. Skin Irritation: Povidone-iodine solution can be more irritating to the skin, especially with prolonged use. This irritation can lead to dryness and potential allergic reactions in some individuals. The ointment form may be less irritating due to its emollient properties, which can help soothe the skin while providing antimicrobial benefits.

2. Staining: Both forms can cause staining of the skin and clothing, but the solution is particularly notorious for this. If cosmetic appearance is a concern, the ointment may be a better choice as it tends to be less messy.

3. Moisture Retention: The ointment can help retain moisture in the skin, which may be beneficial in preventing the skin from becoming overly dry and cracked, a condition that can lead to further irritation and potential infection.

Recommendations for Your Situation
Given your history of recurrent infections and the use of povidone-iodine, here are some recommendations:
- Consider Switching to Ointment: If you find that the solution is causing irritation or discomfort, switching to povidone-iodine ointment may be beneficial. It can provide the antiseptic properties you need while being gentler on your skin.

- Maintain Good Hygiene: Regularly cleanse the area with a mild soap and water, especially after sweating or physical activity. This can help reduce the bacterial load and prevent infections.

- Avoid Tight Clothing: Wearing loose-fitting clothing can minimize friction in the axillary area, reducing the risk of irritation and subsequent infection.

- Monitor for Signs of Infection: Be vigilant for signs of infection, such as increased redness, swelling, warmth, or discharge from the cyst. If you notice these symptoms, it may be necessary to consult a healthcare provider for further evaluation and possible antibiotic treatment.

- Consult a Dermatologist: If you continue to experience recurrent infections or if the cysts become bothersome, consider consulting a dermatologist. They can provide tailored advice and may suggest other treatment options, including potential surgical removal if appropriate.

Conclusion
In summary, while povidone-iodine ointment may be a suitable option for preventing infections in your axillary cysts, it is essential to consider your skin's sensitivity and the potential for irritation. Maintaining good hygiene, monitoring for signs of infection, and consulting with a healthcare professional can help manage your condition effectively. Always prioritize your comfort and skin health when choosing topical treatments.

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