NOT A Spider Bite
Everyone reading this website probably has a good understand of what MRSA is and how it differs from other types of bugs. MRSA can infect other organ systems besides the skin but let’s keep it simple by talking about preventing skin infections. MRSA can cause cellulitis and all other sorts of skin infections but the most common are the boils, the abscesses that we see in the urgent care. These commonly present with what patients think to be bug bites (spiders for some reason have gotten a bad reputation for this) which almost never are bug bites of course. They almost never are spider bites or any other “bite”. They are usually small infections that develop at the hair follicles and spread from there.
They develop a “head” and become tender, red and slowly spread from there. They are aggressive, that’s almost always a good way to tell that it’s MRSA. Also often times it does occur on the lower extremities. They can ooze out puss, they can be fairly dry, there can sometimes be a black necrotic crust. The area tends to expand towards the heart (direction of lymphatic flow) but some of the redness is gravity dependent and can track further down. Streaks can develop, this is the lymphangitis that we see with such infections. Lymphangitis is the infection of the lymphatic tract. Usually these lines are tender themselves, not always a signs of a serious infection but certainly more commonly seen in the more aggressive infections. All bets are off in diabetics. Their immune response tends to be weaker so the area may not look impressive but might already have a very high bacterial load. Puss formation in these patients may be minimal but don’t underestimate the underlying infection. Remember, the redness and swelling and puss formation is mostly due to the body’s immune system, without it there would only be a benign looking tissue destruction until of course the blood gets infected and organ systems start shutting down.
So You Got Your Staph Treated…
Yes, sometimes MRSA is called staph. Staph aureus is the bacteria, the resistant strain that’s called MRSA just happens to be more virulent. Anyway, so you got started on bactrim/spetra or doxycycline or clindamycin… now what? Well, you take the antibiotics and hope for no side effects. This is the time where you have to really figure out why you are getting colonized (unless it’s your very first one in which case hopefully you’ll never get it again). Some patients get colonized because of poor health, poor hygiene, high stress levels, bad diet etc. Let’s address each of these individually and then we’ll talk about what you can ‘mechanically’ do to prevent future infections if you can’t navigate past the underlying cause.
Poor Health – You may have diabetes, you may be a smoker, you might not be very active with poor tissue circulation. You may be on immune suppressing medications. The ones you have control over start working on right away. Lower your blood sugars, increase your activity level and stop smoking.
Poor Hygiene – You may shower once every few days, you may use your same towel repeatedly well then you may not actually be getting past the biofilm on your skin. You may not be washing in all the crevices, you may not be pushing down hard enough to clean the skin well then you aren’t even getting past the dead skin. So, you gotta scrub, you have to get rid of dead skin and the invisible film on your body. You should be smelling fresh, you need to get the arm pits and groin and buttock area really well. You need to wash like that a few days in a row to really get started on a good routine and get rid of that biofilm and then it’s all about maintaining that. Shower several times a day (2 is a great start). Lot’s of dirty clothes? Then start doing more laundry, hot soapy water. Never wear the same clothes that directly come into contact with your skin twice in a row without washing them.
High Stress – Yeap, stress kills and it lowers your immune system. Get enough sleep, for most people 6-7 hours is NOT enough. The more you have on your mind and the more is going on in your life the more sleep you need. It’s important to meditate, to control those around you that stress you out. Stress is our response to external factors, we have a lot of control over this.
Bad Diet – This one is tough. Studies show that simple carbs or high carb diets can decrease your body’s immune system. So make sure you are eating mostly vegetables and fruits. Then cut back as much animal products and carbohydrates (simple carbs, rice and bread/pasta) as possible. You may need to do some experimenting here to see what works.
How To Decrease Your Body’s Bacterial Load
We discussed what lifestyle changes you can take on that will decrease the chance of these bacteria becoming virulent in your body. The next step is how to actually kill the bacteria on your skin. One method that for some reason is widely and excessively used is the ointment in your nose and butt, mupirocin. Hasn’t really been that effective, I don’t recommend that method. Your doc may also want you to do sample cultures to see if you are “colonized”. Well, if you are getting MRSA infections (more than once) then you are colonized, and even if you aren’t you should still be ramping up the things I have outlined here until you get no more infections. There are 3 basic things that you can do that will kill enough of the MRSA bacteria on your skin that will make an infection a lot less likely. I will list them from least effective to most effective.
Chlorhexidine gluconate, which is a soap that you wash with. There are numerous ways to use this product. You can use it as your stand-alone soap or you can use this after your regular soap. You can use it daily or every few days. I tell my patients to use this after their regular showering routine and I tell them to start using it daily and then cutting back to every other day or every 2 days and see if they will get new skin infections. It’s important to use this on your hair as well. It doesn’t leave a film on your body so it’s tolerated well by most patients.
Benzoyl Peroxide Soap
Not always easy to find but usually it comes in 5% or 10% formulations, patients can use the lowest percentage which is often easier on the skin. I have had great luck with the brand Oxy, comes in a black bottle, not cheap but you need very little of it in order for it to be effective. Use this after your regular soap/shampoo routine. It can bleach your hair and clothes so take caution to wash it off fully and to not use it on your hair. If you wash it off quickly from your hair then you should be fine using it on your scalp but I tell my patients to just wash their hair regularly and that’s often adequate. So, use this every day initially for 2 weeks, it can be harsh on the skin but usually your skin gets used to it. You quickly lather with it, leave it on for a few seconds and then wash it off. After the initial 2 weeks I tell my patients to use it 3x per week to maintain its potency. Again, use the lowest percentage you need.
This certainly should be the last resort because it’s just nasty. On the upside the bleach smell will evaporate quickly from your body. Best way to do this is to have access to a bath, I recommend filling your tub with warm water, add a 1-2 cups of bleach (that’s more than enough) and then soak in there for a good 30 minutes and even up to 1 hour if you can tolerate it. It’s hard to say how often you need to do this, there isn’t good data on this. I would start doing it 1x a week and increase it if you are still getting infections.
In summary, MRSA is a resilient and aggressive bug. You want to not give it a good place to live on your body. You want to have your immune system as strong as possible. These methods have worked very well for my patients. Try them and don’t give up if one method fails at first.