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...

Just in case you missed @Theredjellybean’s post, I would call OOH for that.

Although it looks like it's healing a bit, it looks bigger to me too. I would definitely get seen again.

Thanks so much @theredjellybean - just been to the fridge and checked - it is flucloxacilin he's on, but this is how it is at day 5 of 7 day course which I'm guessing isn't great.

To be fair to the paramedic, it wasn't as raw as these photos when he was seen. But will get him reviewed asap.

Systemically he's fine otherwise - no temperature, eating and drinking well today, normal energetic self (after a slightly quieter day yesterday according to nursery), which is reassuring

Could also be ringworm? I had a graze on my leg as a teen which then got infected with ringworm - it spread and oozed at surface level exactly like that, didn't get deeper at all. An anti-fungal treatment cleared it up. It didn't present like normal ringworm because it got into a wound that was already there

hogweed or similar.looks very chemical burn-like?

Get that seem first thing, don't wait any longer, looks like impetigo to me but it's getting worse which isn't a good sign. I don't hold much faith in paramedic physicians after some frankly dangerous advice from 3 of them. They are amazing at saving lives and getting people to the hospital but things like this not so much in my experience.

My DD’s impetigo started appearing in other places on her body. The doctor said she might have to go to hospital if the third lot of oral antibiotics didn’t work, but thankfully they did. The antibiotic ointment we used first did nothing.

Thanks again everyone for the advice.

Saw GP first thing this morning - she wants to keep a close eye. I specifically mentioned impetigo and potential hogsweed related burn, but doesn't feel it's impetigo, and having given it a prod it doesn't seem to be puffy or inflamed under the skin, so hopefully the flucloxacilin is doing its job, and it's just a healing process now.

She wants to keep a close eye as she agreed it does look someone burnt or scolded so want to check it doesn't need further treatment, so we'll be back again on Monday, and have been given some emollient to try (if he lets me touch it... - very tender still)

It's definitely drying out little by little - more of a scabby crust coming through this morning

It does look a little better today than your previous pics. Good to hear GP is monitoring it.

Coming to update on this again to seek out any further thoughts!

His leg is certainly doing much, much better for the most part - the huge raw areas are healing, and now no longer seem sensitive or sore thankfully. It's still a very very odd colour but I'm hoping that will go down with time.

He is, however, getting new blister type bits that are scabbing and flaking just like the main area did.

Photo attached shows from top to bottom 1 week ago, yesterday, and today. You can see at the bottom that a new blister formed over the last few days, and has scabbed overnight and starting to flake already.

We've not been back to France, so it's not a new bite from the same insects. No one else has got any similar marks or issues so I'm confident it's not bedbugs thatve been brought back (DD and DS are always climbing on eachother and going into eachother's beds so she would have been bitten too if so)

He's also now got one exactly the same where his buttocks meets his thigh.

I'm slightly concerned whether this means there is a recurrent infection of some sort, or just a very, very delayed reaction to some teeny tiny bites we hadn't seen.

GP said to have a very low threshold for coming back for review, but are not open over the weekend so it'd be a 111/OoH job at the local hospital. If @theredjellybean or any other medics see this and can advise whether it's odd enough to go OoH or wait until Monday with our GP I'd be so grateful!

Bumping for anyone medically trained.

In the absence of that I would say if in doubt try 111 - better to call them needlessly than not call them and have it get much worse by Mon,

Bumping for you. Hope you get some answers soon. Your poor lad 😢

Thanks for the bumps - another under his armpit this morning now...

I think the answer is that the diagnosis is not insect bites, infected insect bites or anything else along those lines.

No idea what it is but given it isn't clearing up it's time he saw a specialist.

When my girl had impetigo it did look similar. Too two goes of oral antibiotics to clear it and she was left with marks for ages 😐

That has to be impetigo. If denial to what my daughter had years ago off the back of chicken pox. Perhaps needs a different antibiotic to start clearing it up properly

*it's identical

We were told it's resistant now to the creams

So we went back to the OoH primary care centre today. Have been given fucidin h cream as a combined antibiotic and steroid cream to try and deal with the new ones. She suggested that the new locations of the blisters/scabs might be down to him scratching the original source and then scratching elsewhere and spreading the bacteria maybe.

I'm not overly convinced. The paramedic physician had suggested the same cream last week but the GP disagreed in case it inflamed it more. Granted, the skin was incredibly red and sore then, which isn't necessarily the case now. But he hasn't been scratching much at all, either the original site or these new areas - certainly not under his armpit anyway.

Anyway, advice was give it 2 days and if it's not helped back to the GP again...

If you have the money, urgent referral to a consultant dermatologist. Probably £220 for an initial consultation. I think you need to stop fannying around with this and get a specialist to look at it.

A PP suggested getting it swabbed for the strain of bacteria - that would be a logical step at this point. Otherwise, when you consult, do you show the doctor all the photos? Poor little fellow!

If it's spreading it's impetigo, surely? Glad you went back and keep going back, I'm surprised they're not more concerned especially with it spreading.