Does Prednisone Help Post-herpetic Neuralgia?
Corticosteroids did not reduce the incidence of post-herpetic neuralgia at 6 months or pain severity at 3, 6, or 12 months. However, the evidence for this review was fairly weak. Two trials indicated that steroids may reduce short-term pain and speed healing at one month.
Does Acyclovir Help Post-herpetic Neuralgia?
Acyclovir within 72-hours of onset of herpes zoster did not reduce pain from post-herpetic neuralgia better than placebo at 4 to 6-month follow up. But it likely helps with acute pain from zoster at 1-month.
LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?
In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive at best. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.
How to Sew Like a Pro
Suturing of facial lacerations by novice physicians resulted in less cosmetically favorable repair in follow up than experienced physicians.
Fluconazole Safety in Pregnancy
Oral fluconazole is safe to use in pregnancy.
Predicting Outpatient Failure for Cellulitis
Tachypnea, chronic ulcers, prior MRSA colonization, and prior cellulitis in the past 12 months were all associated with an increased risk of oral antibiotic failure for treatment of non-purulent cellulitis.
Is a Blood Culture Needed in Cellulitis?
Blood cultures were low yield in patients admitted with cellulitis, and should largely be avoided. Similarly, imaging was also low yield but changed management in a minority of cases.
Ultrasound For Abscess in Children – The MRSA Era
Sonographically occult perineal abscess in children was surprisingly common, 28% (61/217). More than half had I&D within 4 hours of a "negative" radiology-obtained ultrasound. Symptoms < 4 days, age < 4 years, and history of MRSA were all associated with false negative ultrasound.
TMP-SMX Better For Abscesses Across the Board
We can't draw firm conclusions from this paper, since it was not designed or powered to detect differences in subgroups with skin abscesses. But it was notable that patients who received TMP/SMX did better than those who received placebo across all subgroups, including those with larger abscesses; especially those with fever, history of MRSA, or MRSA positive culture.
Small Abscesses Do Better With Antibiotics
Even small abscesses, <5cm, benefitted from antibiotics. This is contrary to some prior studies' findings that I&D alone was adequate for small abscesses.