Is erythematous (redness of the skin) surrounding skin considered non-infected and how should I prepare a wet dressing for a potentially infected wound?

Erythematous Surrounding Skin and Wet Dressing Preparation

Erythematous (red) skin surrounding a wound is NOT automatically considered non-infected—it is actually one of the cardinal signs of infection and must be evaluated in context with other clinical findings. 1

Understanding Erythema as a Sign of Infection

The presence of erythema alone requires careful clinical assessment:

• Infection is diagnosed when at least TWO of the following are present: erythema, warmth, pain/tenderness, swelling/induration, or purulent discharge 1
• Erythema >0.5 cm around the wound is specifically listed as one of the diagnostic criteria for diabetic foot infection 1
• The extent of erythema helps classify infection severity: erythema <2 cm indicates mild infection, while erythema ≥2 cm suggests moderate infection requiring more aggressive treatment 1

Critical Distinction: Infection vs. Non-Infectious Erythema

Not all erythema means infection. You must exclude:

• Trauma, gout, acute Charcot neuro-osteoarthropathy, fracture, thrombosis, and venous stasis can all cause inflammatory erythema without infection 1
• Tick bite hypersensitivity reactions typically cause erythema <5 cm that appears within 48 hours and resolves quickly, unlike infectious erythema which expands over days 1
• Flat erythematous changes in the first week after surgery without swelling or drainage often resolve without treatment 1

Wet Dressing Preparation for Potentially Infected Wounds

Conservative Wound Management Approach

For wounds with surrounding erythema suggesting possible infection, follow this systematic approach:

• Regularly cleanse wounds and intact skin by irrigating gently using warmed sterile water, saline, or an antimicrobial such as chlorhexidine (1:5000 dilution) 1
• Apply a greasy emollient (such as 50% white soft paraffin with 50% liquid paraffin) over the whole epidermis, including denuded areas 1
• Apply topical antimicrobial agents to sloughy areas only, with choice guided by local microbiological advice—consider silver-containing products/dressings 1

Specific Dressing Selection

The dressing type depends on wound characteristics:

• Apply nonadherent dressings to denuded dermis such as Mepitel™ or Telfa™ to prevent further trauma 1
• Use a secondary foam or burn dressing to collect exudate, such as Exu-Dry™ 1
• Covering denuded skin reduces fluid and protein loss, limits microbial colonization, helps pain control, and may accelerate re-epithelialization 1

Infection Surveillance

Take swabs for bacterial and candidal culture from three areas of lesional skin, particularly sloughy or crusted areas, on alternate days throughout the acute phase 1

When to Add Antibiotics

The decision to add systemic antibiotics depends on infection severity:

• If minimal surrounding invasive infection (<5 cm erythema) and minimal systemic signs (temperature <38.5°C, pulse <100 bpm), antibiotics are unnecessary after drainage 1, 2
• If extensive surrounding cellulitis (>5 cm of erythema and induration) or systemic signs present, antibiotic therapy is indicated 2, 3
• Administer systemic antibiotics only if there are clinical signs of infection, not prophylactically 1

Common Pitfalls to Avoid

• Do not assume all erythema equals infection—look for the presence of at least two inflammatory signs before diagnosing infection 1
• Do not treat clinically uninfected wounds with antimicrobials, as this has not been proven beneficial and contributes to antibiotic resistance 1
• Do not use adhesive dressings on fragile or inflamed skin, as this can cause further epidermal detachment 1
• Do not apply topical antimicrobials to all areas—reserve these for sloughy or heavily colonized areas only 1