What is the treatment for MRSA infected sebaceous cyst?

A sebaceous cyst or an epidermal cyst is a skin growth that contains sebum and skin proteins. It is a slow-growing, freely movable and painless lump under the skin. It arises mostly from swollen hair cavities.

If an infection begins in a sebaceous cyst then the surrounding area becomes red, swollen and tender. An abscess may develop due to a bacterial infection.

However, a sebaceous cyst rarely develops a bacterial infection. Sometimes if it gets ruptured then keratin gets released into the dermis. This may lead to an inflammatory reaction that clinically resembles an infection. The cultures of such ruptured cysts rarely reveal the staph bacteria.

The treatment of the sebaceous cyst includes the following:

• Incision and drainage.
• Antibiotics in some cases.

Drainage is the only option in case of rather large sebaceous cysts. This can be done in the following way:

• The cyst and the nearby area is wiped with beta dine swabs.
• 1% lidocaine with epinephrine is injected before the lancing begins in order to numb the area.
• A scalpel is used to cut distally starting from the proximal end of the cyst.
• With sterile gauze the contents of the sebaceous cyst are squeezed.
• When the cyst gets drained completely the cavity is directly explored with a curette or a gloved finger to clear loculations. Thereafter it is irrigated with 0.9% saline solution and lastly, it is packed with gauze.

Antibiotic therapy is required only if there are multiple abscesses. In such a case an empiric treatment should begin with a drug that is active against the MRSA such as:

• Trimethoprim-sulfamethoxazole
• Clindamycin
• Tetracycline
• Vancomycin
• Linezolid
• Daptomycin
• Doxycycline
• Minocycline

It is quite essential to complete the course of antibiotics that the doctor prescribes, even if one feels relieved before the last dose. One should avoid skipping doses as well. This is because the severe antibiotic infections are becoming hard to treat because of the bacteria that develop resistance to it. Most of the bacteria have become stronger and less responsive to antibiotic treatment. Stopping the antibiotic course half-way makes the bacteria more resistant.

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