Infected bits getting worse?

[ECPCR2]

Not sure whether to put this here or in children's health but given the photos to upload, will start with you guys!

DS (4) seems to have been feasted upon by insects whilst in France last week. Small rash/spots appeared Sunday 21st along his legs. Feared it was bed bugs as he slept in a room no one else was in (DH, DD and I all unaffected so thought it wasn't insects) so cleared out all bedding, hot washes etc. But they weren't raised, weren't tender and weren't itchy, so overall rather confused.

Over the next few days more appeared, and the redness was getting worse so went to a (French) pharmacy. She didn't seem concerned as no temperature, no itching, so said just keep an eye on it and if it starts itching she could give him a cream. Felt it was insects rather than bed bugs.

The spot behind his knee started blistering so put plaster on it to keep them a bit cleaner.

Saturday (27th) night after a bath back home, realised that there were now two big blister spots so decided to do OoH GP in the morning as it seemed to be infected. All other spots still very present, very red, starting to itch, but now scabbing over. Saw the GP, who agreed the knee ones were infected so got a course of antibiotics for a week, and some dressings to protect them.

He's been taking the antibiotics without issue and most of the spots do seem to be reducing in size and redness now, but behind the knee is still looking nasty.

I was away last night (Mon 29th) and after bath time today, have seen the back of his knee now has even more blisters, some have been oozing as there's some gunk on the dressing, and the whole area looks even worse than before.

Is this how these sorts of infections heal? Or could it be a more serious infection and need IV treatment? Or some sort of parasite nibbling away at him and spreading out further?!

I'm planning on calling our GP first thing to see him (fantastic practice thankfully, and they know us well!), but if the view of Sporner Corner is that this is a pretty standard healing process maybe I won't.

As further info - no temperature at any stage, absolutely fine in himself, no fatigue, appetite has been reduced but put that down to the heat. He is under paeds review for lymphadenopathy that's been ongoing since March with no obvious cause (last blood test done on Weds 16th with no concerning results).

Thanks for any thoughts! Hoping photos upload in chronological order, but if they don't it's pretty obvious how they get progressively more gruesome...

Hmm latest photo doesn't seem to have attached so trying again

Is he taking an antihistamine?

Infected insect bites are rare. Allergic reactions to bites are common - and look more or less exactly the same as an infection.

O those look sore! I think as they are not reducing I would probably go to the GP again.

We've given him piriton liquid most days since Saturday, but didn't seem to be having any effect and he's not itching much

I know, poor lad. He's coping with it so we'll and not complaining. Although has become very anxious about the dressing coming off as it "has to protect my wound"

That doesn't look right to me. I'd go back to the gp.

My dd had very similar to those pics and it turned out to be a Staph infection. Took a few months and multiple rounds of different Antibiotics until I finally persuaded a Dr to swab them, and then the antibiotics she was finally given worked. So if I was you, I would want a swab taken asap just to check

Oh poor thing. That's not the type of experience I was hoping to hear... No one has suggested doing a swab yet

I did go to the GP today but saw the paramedic physician instead of a doctor. His view was it looks like it's responding to antibiotics but skin around might be getting irritated by the dressing and moisture, so to try without dressing for a bit to see if that drys and helps it heal.

He disagreed that the new bits are blisters and thought more like dermatitis, which I'm not sure I agree with...

Said if still not improving by Friday to go back again. This photo is from tonight having been dressing free all day. It does seem to look so much worse in the evenings for some reason...

Oh, your poor DS - that looks so painful.

Are they starting to crust over - it looks like they might be around the edges but hard to tell from a picture.

If you're not confident of an improvement, I would try to see the doctor tomorrow rather than risk the difficulty of seeing someone over the weekend.

Just to add, is there any chance it could be a rash from Giant Hogweed? I had that as a child and it looked very similar to your DS's rash. It's basically a burn - toxins in the plant make your skin hyper-sensitive to sunlight so your skin blisters and burns where the plant toxins have touched it. The plant looks like this, if your DS was near anything like it on holiday.

Mine started as a red rash, then came up in blisters, which soon burst leaving a red patch like your DS has, which gradually healed. No specific treatment given but that was back in the 1970s.

Thanks @Sethera - I can't specifically remember a plant like that, but he was running around all over the place in shorts in a very rural area so it's a possibility. DD would have gone everywhere with him too, but she was in longer bottoms more of the time so would have had less sunlight exposure.

It's maybe starting to dry slightly now but very little change really. And of course without the dressing on, but wearing trousers to avoid sun because can't put suncream on it, there's now fluff and grub getting in so hard to tell what's a bit of muck and what is dark skin or scab. He said it was incredibly painful with water running over it in a quick shower (but it's hard to know if he was actually in pain or scared - he's undergoing an autism assessment and does struggle to properly explain how he's feeling)

Is there any possibility he has had an allergic reaction to amoxicillin? Mine did, but it was small red spots. Can apparently also blister.

I'd call 111 now and get seen again that looks horrendous and it look like it's getting worse.

Or GP first thing if you can get an appointment there.

Your poor son. Assuming he generally well and no fever. I'd he is feeling unwell and has fever A & E

My DD had really bad impetigo which looked very like that. It started off as a rash, then blisters, then very large scan which kept growing. It took about three doses of antibiotics to get rid of it.

Poor, poor child. Glad he's so got some oral antibiotics, but why haven't they given you an antibiotic ointment?? I'm horribly allergic to bites so my first call is antihistamine, then Savlon, then if needed Fusidic cream. You can get that OTC.

Correction. Need prescription in UK. I get mine in Italy. Sigh.

I'd say that's infected with impetigo tbh. My daughter had chicken pox that become infected with it and it looked very similar

Looks like something my DD had and she had an initial round of antibiotics but it just came back raging like your last pics. She had 3 months worth of antibiotics after that and thankfully it never came back.

If they are sore, look like open wounds then crust over it does sound similar.

I take a terrible reaction to bites and normally end up on antibiotics. Quite a few times I’ve needed to have IV antibiotics too. I find if I’m bitten on the inside of my elbows or the back of my knees they’re harder to heal, his trousers will probably be irritating the area. It does look like it’s drying out though.

I buy breathable dressings to let the air in called Mepore, you get them in a lot of sizes. Water really hurts the areas where I get bitten even for a week or so after it starts to heal.

It’s probably best to get that checked out again by a professional to be on the safe side as not all antibiotics work on skin infections.

GP here...sorry but that paramedic is wrong. That looks very much like staph // impetigo and needs antibiotics asap.
I'm not sure which antibiotics he has originally but he definitely needs flucloxacillin if he didn't have that first time.
Call NHS 111 now and see the oohs gp.

@KnittedCardi ... antibiotic ointment has big problems with antibiotic resistance and guidance is to use oral flucloxacillin

I don't think it's that - he's had the same medication before for a previous infection and didn't have any reaction, but it's a good thought to query with the doctor anyway

Thanks all for the reassurance I'm not just being a paranoid mother, and that this isn't looking nice. DH and I are in disagreement as to whether it's getting better, but I'll definitely call the GP again tomorrow first thing for a review before the weekend. This pic shows yesterday Vs today, and the middle raw section to me looks bigger, and whilst there might be the start of some crusting for a scab, it's not exactly an improvement. He's also in more discomfort now too.

A few others have mentioned impetigo and it is exactly like this - often forms in creases like elbows and knees and spreads like wild fire if not treated. Hope your ds gets better soon!