Ask the Doctor: skin infections, swelling and sinuses

Dr. Rob Riley joins us each week from the South Bend Clinic. Here are his responses from April 16.

Bill: I have bumps in my armpit and they are sore. They look like pimples or cysts only deeper.

This is an area of the body that’s particularly prone to skin infections. There are a lot of hair follicles and sweat glands in that area and the skin is rubbing against itself just with normal activity so the skin barrier can break down. Sometimes these are just small pimples that will resolve on their own with soap and water and keeping the area dry, but deeper infections may not respond to that. Sometimes we need to use antibiotics and sometimes the larger, deeper infections need to be opened up and drained in the office. So if these areas are getting larger, more red, or more painful, your physician’s attention may be needed.

Ryan: I’m 32 years old. For the past few months I wake up in the mornings with hands so swollen I can barely move them. But after an hour or so the swelling goes down. What could cause that?

Morning swelling and stiffness that resolves as the day goes on can be a sign of arthritis. Some people have this with common wear and tear arthritis or osteoarthritis, but it’s more classic for a condition called rheumatoid arthritis. Rheumatoid arthritis can cause destruction and deformity of the joints over time if left untreated so making that diagnosis is important as good treatment is available to avoid that outcome. Other causes of morning swelling include more benign conditions like carpal tunnel syndrome, excessive salt intake, or even just an odd sleeping position. But in a 32 year old, if this is a persistent problem, seeing a physician to delve more into the history, do a physical exam, and perhaps perform some blood tests to look into this further could be really important.

Helen: I have this problem with my sinuses. I’ve been taking Claritin but now it’s turned really green. What can I take to help with that?

One of the challenges for patients and doctors alike is to sort out the difference between colds, which are caused by viruses and just have to run their course, and sinus infections caused by bacteria which often respond to antibiotics. We used to think the color of the discharge was helpful in sorting this out, but newer studies have shown that the color has more to do with the body’s efforts to fight the infection rather than the infection itself, so the color probably doesn’t help us much. One of the best determinants turns out to be time. Viral illnesses typically start to get better in a few days and usually resolve in about 7-10 days. Sinus infections tend to linger, maybe even getting worse 7-10 days out. So if you’ve had sinus problems for over a week with no improvement, seeing your doctor is likely to be helpful.