What is the treatment for an infected lipoma?

Treatment of Infected Lipoma

Surgical excision combined with appropriate antibiotic therapy is the definitive treatment for infected lipomas. While the provided evidence doesn't specifically address infected lipomas, we can apply general principles of managing soft tissue infections and lipomatous tumors to develop a treatment approach.

Diagnostic Approach

• Infected lipomas typically present with pain, erythema, warmth, and swelling at the site of a previously asymptomatic lipoma 1
• MRI is the preferred imaging method for assessing lipomatous lesions and can help differentiate between simple infection and more complex conditions 2
• In cases of diagnostic uncertainty, a percutaneous core biopsy may be performed to confirm the diagnosis and rule out malignancy 2

Treatment Algorithm

First-Line Treatment

• Complete surgical excision of the infected lipoma is the primary treatment approach 2, 1
• The procedure should include:
  • Thorough debridement of all infected tissue 3
  • Collection of specimens for culture and sensitivity testing 3
  • Irrigation of the surgical site 2

Antibiotic Therapy

• Empiric broad-spectrum antibiotics should be started immediately while awaiting culture results 3
• Initial antibiotic coverage should target common skin and soft tissue pathogens including:
  • Staphylococcus aureus (including MRSA consideration)
  • Streptococcus species
  • Anaerobic organisms 3
• Antibiotic therapy should be adjusted based on culture results and continued for 5-7 days post-procedure 3

Management of Severe Infections

• For severe infections with signs of systemic involvement (high fever, hypotension, extensive surrounding cellulitis):
  • Hospitalization may be required 3
  • Intravenous antibiotics should be administered 3
  • More extensive surgical debridement may be necessary 3
  • Consider negative pressure wound therapy for large surgical defects 3

Special Considerations

Differentiation from Malignancy

• Rapid growth, pain, or atypical features in a lipomatous mass should raise suspicion for liposarcoma 4, 5
• Lipomas that are deep to fascia or >5 cm in subcutaneous tissue warrant MRI evaluation prior to excision 4
• Masses that lack isointense signal to subcutaneous fat on MRI may represent a sarcoma and require biopsy before definitive treatment 4

Prevention of Recurrence

• Complete excision with removal of the capsule helps prevent recurrence 1
• Regular follow-up is recommended to monitor for recurrence or development of new lipomas 1

Potential Complications

• Necrotizing soft tissue infection is a rare but serious potential complication that requires immediate aggressive surgical debridement and broad-spectrum antibiotics 3
• Signs of necrotizing infection include:
  • Rapidly spreading erythema
  • Severe pain disproportionate to physical findings
  • Bullae formation
  • Skin necrosis or ecchymosis
  • Crepitus
  • Systemic toxicity 3

Remember that while most lipomas are benign and can be left alone, infected lipomas require prompt intervention to prevent progression of infection and potential complications 1.