From episode 165 on the medicine feed. With Dr Nellie Choi.
Our dermatology lecturer at uni tried hard to encourage us not just to reach for the pred for every skin case. And if bacteria was involved, then the preference was definitely to go with antibiotics, and hold off on the steroids. In my head, a wet smelly hot spot is the epitome of a bacterial skin disease that needs antibiotics. But dermatologist Dr Nellie Choi had this to say:
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The accurate name for a 'hotspot' is acute pyo-traumatic dermatitis. They happen because of self-trauma, which is the real cause for all of that sticky grossness.
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In most cases, all you need is something to stop the discomfort, and steroids are best for this.
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Systemic antibiotics are usually NOT indicated initially, unless it’s a very large area with very severe signs.
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Plan: steroids, topical antibacterial, like chlorhexidine. Follow up in 2 - 3 days. If it’s not much better, THEN start the systemic antibiotics.
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“In my experience, 80% of patients will improve with steroids alone.”
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