Slow healing skin infection: Ecthyma??

[konyha]

developed a skin infection in the US since it appeared a day after I arrived in the UK.  There was no redness, sign of eruptions, itching or burning. One was on my lower left jaw, one on my neck & 2 remain on my sternum. At 1st lesions were size of a 50 cent piece. By day 3 lesions turned light grayish yellow colour, crust was adherent, looked like a fungus. Outer lesions light pink slightly puckered up. No leakage under crust it looked like a thousand little pin pricks & “gewy” & colour was marbled light yellow/pink. Click on my user name for more info. GP b/l source was one of my stuffed hand puppets. I use disinfection practices w/materials & children’s hands. GP easily removed lesions and prescribed Bactroban and 2 oral antibiotics. 1 was Flucloxacillin.Lesions on face/neck healed rapidly. Used  Baycuten-Nos scars w/topical heparin (MPS)/Retin-A on face/neck.8 wks lapse & still 2 quarter size crusts on sternum. Lesions flatter & the new crust is ugly-looks untreated-skin around lesions flatter & raised. Crusts not easy to remove=painful and impossible. Soaking crusts, moist compress, white vinegar & hydrogen peroxide not work. I no longer attempt to remove the crusts. The outer area of skin is unblemished but sometimes itches and burns.  Skin directly surrounding the 2 lesions is irritated (chemical burn?) b/c a few weeks ago I used hydrogen peroxide improperly to remove the crusts.  Infection is contained. Mupirocin ceased to be effective-Bacitration & Neosporin never were. Brulidine helped w/pain. No dx. 1st 2 lesions healed fast. Would like to be armed with information and ask the right questions if I have to see a specialist.Thx.;)  

[konyha]

Thank you for your timely response.

Eight weeks ago the GP removed the crusts and treated them. I used all medications until they ran out.

I only attempted to remove *one* of the remaining two crusts twice - over five weeks ago.
I no longer tried after those two failed attempts.

The one crust I did not tamper with does appear less irritated/aggravated on the outside, however, the surface of both crusts appears the same.

The crusts are not like scabs.  
Scabs are often easy to pick at and it sometimes hard to resist doing so without realising it.  In short, the crusts are simply too sensitive to "mess" with or even keep covered.

The tough, adhesive crusts barely absorb water after standing in a warm shower or soaking in a tub, It does not surprise the Neosporin and Bacitration merely sit on top of the crust.  

As frustrating as it is, I am beginning to accept that slow healing is simply the nature of some skin infections.  Still, I admit I am perplexed (and grateful) the face and neck crusts healed rapidly (during the first three weeks of now an eight week period).  

The healing process would be more bearable if there were a way to minimise the sting,  sensitivity and occasional itch.

Thank you once again for your time and consideration,
Konyha

[Alan Rockoff, MD]

The best explanation I can come up with based on your description is that you had a skin infection, whose crusts you delayed by messing with them.  You don't need to arm yourself with information before seeing a specialist.  Just leave the crusts alone and show it to him or her.  A bacterial culture can be obtained from under the crust if necessary.  or it may just be a question of time before the crusts heal.  If crusts are just taking their time to go away, you cannot conclude that bacitracin and the other creams were "not effective."  You may just not have given them enough time.  Crusts do look ugly until they heal, but they do--if you leave them alone.

Best.

Dr. Rockoff