Managing Allergic Reactions in Cellulitis Wound Care: Key Concerns

Allergic reaction to cellulitis wound?

On December 20, I was hospitalized for cellulitis in my foot and was discharged on December 25.
I applied gentamicin ointment, but the wound did not heal and continued to produce serous fluid (similar to a burn wound), with redness and swelling spreading towards my toes.
In mid-January, I switched to another antibiotic ointment, but the serous fluid continued to drain, and the redness and swelling spread slightly to the dorsum of my foot.
On February 2, I started using Miconazole, and the wound stopped producing serous fluid; however, the next day, I began to develop papules and rashes all over my body.
Starting February 6, I began applying a corticosteroid ointment to the areas with rashes while continuing to use Miconazole on the wound.
On February 8, I started taking corticosteroids, also applying them to the wound.
The oral corticosteroid I am taking is Dexamethasone, six tablets a day, and I am using Tacrolimus ointment on the wound and areas of body allergy.
I would like to ask: 1.
Can taking and applying corticosteroids lead to toxic epidermal necrolysis or Stevens-Johnson syndrome? 2.
If the wound produces a little serous fluid after walking too much, is it still appropriate to apply corticosteroids? (It usually doesn't, and I have asked my doctor, who said the wound is basically healed.) 3.
Is taking six tablets of corticosteroids a day considered a high dose? 4.
After applying corticosteroids to my toes, I noticed they became wrinkled, but the dorsum of my foot did not; is this normal?

Han Zai, 20~29 year old female. Ask Date: 2021/02/10

Dr. Wu Yuxin reply Dermatology

1.
No.

2.
The treatment will depend on the underlying cause of the exudate to determine the appropriate ointment.

3.
The treatment will not be effective.

4.
Without observing the lesion, it is impossible to determine the specific issue.

Reply Date: 2021/02/10

More Info

Managing allergic reactions in the context of cellulitis wound care is a complex issue that requires careful consideration of both the underlying infection and the patient's response to treatment. In your case, it appears that you have been dealing with a challenging cellulitis infection that has not responded well to initial treatments, leading to the use of both topical and systemic corticosteroids. Let's address your concerns one by one.

1. Risk of Toxic Epidermal Necrolysis (TEN) or Stevens-Johnson Syndrome (SJS): The use of corticosteroids, whether topical or systemic, does carry some risk of adverse reactions, but the likelihood of developing severe conditions like TEN or SJS is relatively low, especially if you are not experiencing other systemic symptoms such as fever, widespread rash, or mucosal involvement. These conditions are more commonly associated with certain medications, particularly some antibiotics and anticonvulsants, rather than corticosteroids. However, if you notice any signs of severe allergic reactions, such as extensive skin peeling, blistering, or systemic symptoms, you should seek immediate medical attention.

2. Use of Corticosteroids with Ongoing Fluid Leakage: The presence of a small amount of tissue fluid (exudate) from a wound can be a normal part of the healing process, especially if the wound is still in the inflammatory phase. Corticosteroids can help reduce inflammation and promote healing, but they may also suppress the local immune response, which could potentially lead to increased risk of infection if the wound is not properly managed. If your healthcare provider has assessed that your wound is healing and has advised the use of corticosteroids, it is likely appropriate to continue. However, if you notice any signs of worsening infection (increased redness, warmth, swelling, or pus), you should consult your doctor.

3. Corticosteroid Dosage: Taking six tablets of a corticosteroid like prednisolone (康素龍錠) daily can be considered a moderate to high dose, depending on the specific formulation and your individual health circumstances. Long-term use of corticosteroids can lead to side effects, including immunosuppression, weight gain, osteoporosis, and adrenal suppression. It is crucial to have regular follow-ups with your healthcare provider to monitor for these potential side effects and to adjust the dosage as necessary.

4. Skin Changes After Corticosteroid Application: The appearance of wrinkling or thinning of the skin in areas where corticosteroids have been applied is not uncommon, especially with prolonged use. Corticosteroids can cause skin atrophy, leading to a thinner appearance and loss of elasticity. This effect may be more pronounced in areas where the skin is thinner or more sensitive, such as the toes. If you are concerned about these changes, it would be advisable to discuss them with your healthcare provider, who may recommend alternative treatments or strategies to mitigate these effects.

In summary, managing allergic reactions and wound care in the context of cellulitis requires a careful balance of treating the infection while minimizing the risk of adverse effects from medications. Regular communication with your healthcare provider is essential to ensure that your treatment plan is effective and safe. If you have any further concerns or notice any new symptoms, do not hesitate to reach out to your healthcare team for guidance.

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