What is the recommended treatment for a skin infection after a haircut?

Treatment of Skin Infections After a Haircut

For skin infections following a haircut, the recommended treatment is an antimicrobial agent active against both aerobic and anaerobic bacteria, such as amoxicillin-clavulanate. 1

Initial Assessment and Management

• Determine the type and severity of the infection (impetigo, folliculitis, abscess, or cellulitis) which commonly occur after haircuts due to minor trauma and bacterial contamination 1
• Evaluate for systemic signs of infection such as fever, tachycardia, or hypotension which may indicate more severe infection requiring aggressive treatment 1
• For localized superficial infections without systemic symptoms, topical therapy may be sufficient 1
• For more extensive infections or those with systemic symptoms, oral antibiotics are indicated 1

Treatment Options Based on Infection Type

Superficial Infections (Impetigo, Folliculitis)

• Topical therapy:

  • Mupirocin 2% ointment applied three times daily for 5-10 days 2
  • Clinical efficacy rates for mupirocin in impetigo are approximately 71-93%, significantly higher than placebo 2
  • Apply a small amount to affected area; may be covered with gauze if desired 2
  • Re-evaluate if no clinical response within 3-5 days 2

• Oral therapy (for more extensive infections):

  • First-line: Cephalexin 500 mg four times daily for 7-10 days 1
  • For suspected MRSA: Trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline based on local susceptibility patterns 1

Deeper Infections (Abscesses)

• Incision and drainage is the primary treatment for abscesses 1

• Culture of the drainage is recommended to guide antibiotic therapy 1

• Antibiotics should be added if:

  • Systemic inflammatory response syndrome (SIRS) is present
  • Multiple lesions exist
  • Rapid progression of infection
  • Associated cellulitis
  • Immunocompromised host 1

• Antibiotic options for abscesses:

  • For MSSA: Dicloxacillin or cephalexin 1
  • For suspected MRSA: TMP-SMX, doxycycline, or clindamycin based on local susceptibility 1

Cellulitis

• Mild cellulitis: Oral antibiotics active against streptococci (e.g., penicillin, amoxicillin, cephalexin) 1
• Moderate to severe cellulitis: Coverage for both streptococci and S. aureus 1
• Duration: 5-7 days, extended if infection has not improved 1

Special Considerations

• Immunocompromised patients require broader antimicrobial coverage and closer monitoring 1
• Tetanus prophylaxis should be administered if the patient has not received a tetanus toxoid vaccination within 10 years 1
• Wound care:
  • Copious irrigation of the wound 1
  • Keep the area clean and dry 1
  • Consider topical antiseptics like chlorhexidine for cleansing 1

Prevention of Recurrence

• For recurrent infections, consider a 5-day decolonization regimen consisting of:

  • Intranasal mupirocin twice daily
  • Daily chlorhexidine washes
  • Daily decontamination of personal items (towels, sheets, clothes) 1

• Preventive measures include:

  • Good personal hygiene
  • Avoiding sharing of personal items like towels and razors
  • Proper disinfection of barber tools 1

When to Seek Further Care

• If no improvement after 48-72 hours of treatment 1
• Development of systemic symptoms (fever, chills, hypotension) 1
• Rapid expansion of erythema or induration 1
• Appearance of bullae, skin sloughing, or necrosis which may indicate necrotizing infection 1