From the Guidelines
I strongly recommend proceeding with the ultrasound of the neck to address the patient's concerns about the subcutaneous mass, while also emphasizing the importance of proper hygiene practices to prevent future skin issues. The small mass observed is likely benign scar tissue resulting from previous folliculitis or skin infection, commonly associated with poor shaving hygiene, as suggested by the patient's history 1. Selenium sulfide can be prescribed for topical use to help treat fungal skin conditions and reduce inflammation, but it is crucial to follow the product label instructions for application and rinsing.
The patient's insistence on having an ultrasound is understandable given their concerns, and it will provide an opportunity to confirm the diagnosis and alleviate anxiety. It is also essential to discuss the results of the ultrasound during the follow-up appointment and address any further questions the patient may have.
Given the potential for skin and soft tissue infections to be caused by resistant microbes, yeast, or molds, as outlined in the practice guidelines for the diagnosis and management of skin and soft tissue infections 1, aggressive evaluation and treatment are necessary if such infections are suspected. However, in this case, the clinical presentation suggests a benign condition, and the approach should focus on confirming this diagnosis while emphasizing preventive measures.
Proper hygiene practices, including using clean razors, changing blades regularly, and applying antiseptic after shaving, are crucial for preventing future skin issues, as poor hygiene can lead to infections, which may result in similar subcutaneous masses or more severe conditions 1. By combining diagnostic confirmation with preventive advice, the patient can be reassured and empowered to manage their skin health effectively.
From the Research
Patient Assessment and Diagnosis
- The patient presented with complaints of knots or bumps under the skin, which was assessed as a small mass under the skin, likely scar tissue 2.
- The patient's insistence on having an ultrasound was noted, and an ultrasound of the neck was prescribed to evaluate the neck mass.
- The patient was also prescribed selenium sulfide, which may be related to the treatment of fungal infections, as selenium nanoparticles have been shown to have antifungal activity against Aspergillus fumigatus and Candida albicans 3.
Fungal Infections and Treatment
- Fungal infections can be caused by various organisms, including Candida and Aspergillus, and can affect different parts of the body 4, 5.
- The incidence of fungal infections is increasing, and treatment can be challenging due to the development of resistance to antifungal drugs 5, 6.
- Novel approaches, such as the use of selenium nanoparticles, are being explored for the treatment of fungal infections 3.
Role of Ultrasound in Evaluation and Management
- Ultrasound can play a useful role in the initial evaluation and management of adults presenting with a neck mass, as it can help identify benign features and avoid unnecessary cross-sectional imaging and tissue sampling 2.
- The study found that approximately one third of patients presenting with a visible or palpable neck mass were able to safely avoid cross-sectional imaging and/or tissue sampling when ultrasound demonstrated features consistent with benign pathology 2.