What is the treatment for an erupted lesion of the inner groin?

Treatment of Erupted Lesions in the Inner Groin

The treatment of an erupted lesion in the inner groin requires immediate surgical intervention if Fournier's gangrene is suspected, followed by broad-spectrum antibiotics covering gram-positive, gram-negative, aerobic, and anaerobic bacteria. 1

Assessment and Diagnosis

• Perform a focused medical history and complete physical examination to determine the etiology of the groin lesion 2
• Examine for signs of necrotizing infection including cutaneous manifestations, erythema, subcutaneous crepitations, patches of gangrene, foul smell, purulence, and tenderness 1
• Consider microscopic examination and culture of scrapings from the eruption to identify causative organisms 2
• Examine the eruption using Wood's light to help identify certain fungal infections 2
• For suspected Fournier's gangrene, consider Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score for early diagnosis 1

Treatment Algorithm for Erupted Groin Lesions

For Suspected Fournier's Gangrene (Necrotizing Infection)

1. Immediate Surgical Management:

   • Perform surgical debridement as soon as possible 1
   • Remove all necrotic tissue completely 1
   • Plan repeat surgical revisions (every 12-24 hours) until all necrotic tissue is removed 1
   • Consider a multidisciplinary approach involving general surgeons, urologists, and plastic surgeons 1

2. Antibiotic Therapy:

   • For stable patients: Piperacillin/tazobactam 4.5g IV every 6 hours plus clindamycin 600mg IV every 6 hours 1, 3
   • For unstable patients: Carbapenem (meropenem or imipenem) plus anti-MRSA agent (vancomycin or linezolid) plus clindamycin 1, 3
   • Obtain microbiological samples during initial debridement 1
   • Adjust antibiotics based on culture results and clinical improvement 1, 3

3. Wound Management:

   • Consider negative pressure wound therapy (NPWT) after initial debridement 1, 3
   • For wounds with fecal contamination, consider fecal diversion via colostomy or temporary fecal management system 1
   • For urinary tract involvement, consider urinary catheterization or suprapubic cystostomy 1

For Non-Necrotizing Infections

1. For Fungal Infections:

   • Apply topical antifungal agents such as clotrimazole twice daily for up to 7 days 4
   • Keep the area clean and dry to prevent maceration 5

2. For Bacterial Infections:

   • Apply topical antibiotics such as bacitracin 1-3 times daily 6
   • For deeper infections, culture-specific antibiotics may be required 7
   • Consider concentrated surfactant-based gel dressings for infected wounds 8

3. For Complex Wounds:

   • Vacuum-assisted closure therapy has shown success in managing complex groin wounds 9
   • Continue wound care until complete healing, which may take several weeks 9

Important Considerations

• Avoid prolonged use of high-potency topical corticosteroids in the groin area as this can be deleterious 2
• The groin is particularly susceptible to maceration due to heat, perspiration, and friction, which can exacerbate infections 5
• For vascular graft infections in the groin, more aggressive management with long-term antibiotics and possible graft removal may be necessary 7
• Maintain vigilance for signs of spreading infection, as the anatomical location of the groin allows for rapid spread to adjacent structures 1

Monitoring and Follow-up

• Monitor for clinical improvement including reduction in erythema, drainage, and pain 1
• For severe infections, follow inflammatory markers such as procalcitonin to assess treatment response 1, 3
• Continue antibiotics until further debridement is no longer necessary and the patient is afebrile for 48-72 hours 3
• Plan for management of surgical sequelae with a multidisciplinary team 1