Infected dermatitis of the hand is a surprisingly irritating and recalcitrant condition. It had an episode last May, and it literally appeared from nowhere.
Looking back, I obviously underestimated its tenacity and I should have got to my doctor far more quickly. I hope that by writing the experience up here others will know what to expect if it happens to them, what does and does not work, and hopefully will be able to use my method with micropore tape for this and other difficult skin infections.
In my right hand, a patch appeared just at the point in the palm where the end of the handle of an ordinary dinner knife sits as you use it. The patch was oval, about 3cm long and 2cm wide sitting on the protuberance at the base of the thumb and extending about half a centimetre into the flatter part of the palm. A skin fold crossed it and the bit between the skin fold and the edge on the flat part of the palm was redder and more inflamed than the rest. The long axis of the oval was in the direction leading up to my thumb.
The very top layer of the skin broke down with a number of very fine small patches, each about half a millimetre in diameter which looked raw and started to weep slightly. They also itched greatly, and this was aggravated by use of the hand and by moisture. Thick hand creams produced limited symptomatic relief by protecting from moisture and from friction.
I have some medical knowledge I thought the most likely cause was a fungus, probably tinea. Tinea is treatable with ointments available over the counter (without prescription). They are relatively free of side effects and no harm is done by putting on the ointment more frequently than recommended. I put it on about five times per day instead of the recommended two and the itching and weeping regressed, though not for long. I found that I could keep it under control by this intensive treatment, but this merely held it down rather than curing it.
This continued until I found myself accompanying a friend who had had a fall and needed their grazed knee cleaning and dressing. Since our doctor’s surgery was getting a new practice nurse after the previous one had left we were directed to the local walk-in centre to have the knee dressed. Since I was already there, and the hand was particularly itchy, I decided to take advantage of the walk-in service and a doctor looked at it. She prescribed Fucibet, a combination ointment with fusidic acid (an antibiotic) and betamethasone valerate (a steroid), and which is not available over the counter.
I am cautious about using steroids where infections are involved, because they inhibit the inflammatory process. The initial relief is impressive, but the inflammatory process is there for a very good reason, to confine the infection so suppression can be dangerous. That is why the fusidic acid is there, though since the infecting organism was unknown (and has remained so during the whole episode) I took the risk that it might not be the right antibiotic.
As it happened the treatment produced a lot more effect than did the over-the-counter ointments and the patch got the stage that whilst still visible, it had faded almost completely. But when the ointment came to an end I was disappointed that the patch rapidly returned, including the broken down skin and the itching.
I made an appointment to see my doctor. The patch had changed a bit by this time with some hard nodules around the skin fold which might have contained pus – it was hard to know as they were only a millimetre or so in diameter. My doctor noted these and said that in view of the fact that infections of the skin can be very persistent we would need two weeks of intensive treatment.
The treatment would be twofold – a course of strong antibiotics (flucloxacillin rather than the usual benzyl penicillin) and an ointment consisting of a steroid and an antifungal (neomycin – also quite powerful). Not only would I need to take these stronger-than-usual antibiotics, but I would also need to enhance the effect of the ointment by rubbing it in and putting cling film over my hand. That would stop it getting rubbed away and would “reflect” it back into the skin as the cling film would not absorb it. Efficacy would thus be all day rather than just the few minutes until an application of ointment gets rubbed away.
Whilst this worked, it was not very comfortable or socially acceptable. I rapidly found a very effective alternative to having a whole hand covered in cling film. I had a roll of Micropore tape, 5 cm wide, which could be cut to a square, and in the middle of that square I could put a 3 cm piece of cling film leaving a centimetre all round to stick to my hand. Micropore is also good for those allergic to sticking plaster.
It took a little time to master four things – one was not getting stuck to the tape when handling it, the second was getting an accurate 3 centimetre square of cling film (which has a mind of its own as you take a pair of scissors to it), the third was landing the square right in the middle of the sticky side of the tape, and the fourth was that I made the mistake of rubbing the ointment into my hand before sticking the tape over the infected patch. This last meant that the ointment stopped the tape sticking to my hand, which was made worse by the curved three-dimensional surface at the base of the thumb and the movement of my hand as I used it.
The solution was to prepare the tape with its cling-film and then put a small amount of ointment on to the infected patch without rubbing it in. I could thus stick the tape around it with the centre of the cling-film square directly over it. After sticking down the edges well the blob of ointment could be well massaged in under the cling-film, and the tape would stick there for many hours without the discomfort of having to wrap the whole hand in cling film (and having people ask why). The only thing I had to be careful about was getting it wet which sometimes happened, but in that case, all that was necessary was to replace the tape with another lot of tape and cling film when the hand was dry and a new dab of ointment had been placed on the infected patch.
The antibiotics finished in mid-December and although they had produced an effect the patch was not gone, so I went back to my doctor. He was satisfied with progress and said that the patch would slowly disappear, though it would take some time during which I should apply the ointment as before. I carried on with the tape/cling-film/ointment treatment for a couple of weeks and the infected patch started to subside. After that I have continued with the ointment applying it as one would normally apply an ointment.
Six weeks on with this, things are much better, but the area where the patch was is still visible, with the skin over it rougher than that of the rest of the hand and it still itches several times a day. This itching typically lasts less than a minute and disappears completely when hand cream is applied. It is still mildly annoying, but it is not ever-present as the original itch was.
The good news is that I am confident that it will continue to get better until it is completely gone – at last.