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The Physician
The Physician, General Practitioner
Category: Dermatology
Satisfied Customers: 1100
Experience:  Versatile, practising GP with a dermatology experience
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I think I was bit by an insect on 4/3/2017. I went to Urgent

Customer Question

I think I was bit by an insect on 4/3/2017. I went to Urgent Care on 4/6/2017 with an area on my forehead swollen, pink, stiff, and lots of pain. I was given cephalexin and acyclovir by a nurse practitioner who said it could be an insect bite, or it could be shingles. After taking the medicine, I developed a big, thick green scab. I put bacitracin ointment on the scab, and the green scab went away and became several smaller scabs. Five weeks later I still have a pink/red spot on my forehead with a very rough texture and small red bumps under the skin. This is extremely noticeable, and really bothers me. The nurse practitioner told me on the telephone that she thinks I have shingles, and shingles lasts for 3 months. Last Thursday I saw a Physician's Assistant who practices dermatology only. He told me that this is not shingles because shingles would go away in two weeks with the medicine. I had scheduled Botox injections for 3 weeks ago, but Botox had to be delayed because of the red rough spot on my forehead.
JA: How long have you been dealing with this? Are the bumps painful?
Customer: The bite happened 5 weeks ago. The PA who practices dermatology inspected the spot with a magnifying glass and told me that it is NOT CANCER. The PA who gives Botox injections has scheduled an appointment for me to see their aesthetician about zapping the rough red spot with a lazer. I was told that it is best to wait as long as possible before having lazer treatment for a red rough spot. HOW LONG SHOULD I WAIT BEFORE HAVING LAZER TREATMENT ON THE RED?PINK SPOT? WHAT CAN I DO TO HELP THIS ROUGH RED SPOT HEAL WITHOUT FORMING A SCAR?
JA: Our average wait time is under 20 minutes. Sometimes it takes just a minute. More complicated questions that need more research might take an hour or two. I'd be happy to chat with you while you wait. The stories I've heard working here... Anything else in your medical history you think the doctor should know?
Customer: The older physician's assistant who practices dermatology told me that I should NOT have BOTOX injections and lazer treatment on the spot on my forehead.
Submitted: 4 months ago.
Category: Dermatology
Customer: replied 4 months ago.
I think the spot is an insect bite because there is a dark red spot in the center of the pink/red spot. However, I never realized that the insect bit me until the area became painful, pink, stiff, and swollen. DO YOU AGREE THAT I SHOULD NOT have lazer treatment on the spot and Botox injections in my forehead? The red spot with bumps under the skin was very painful for about 3 weeks. It is not painful now, but it still has mild pain and discomfort at times.
Expert:  The Physician replied 4 months ago.

Hello

Welcome to JA. I am an Emergency Physician and has 25 years experience. Quickle let me explain the pathophysiology of why shingles wil not be a consideration and neither would I think of Cancer.

It is a spot!, Shingles affect dermatomes (areas supplied by a nerve, like an area supplied by a cell phone tower). So it is unlikely. Secondly, shingle start as a group of 'vescicles' like fine water bumps in very red surrounding and then gradally become red and painful.

Next, it cannot be cancer which often start with a non painful lesion and slowly progress.

Insect bite start with the insect penetrating the skin at variable lengths depending on which insect, and then they deposit a fluid or 'venom'. The pain and sting is the response of your body to the venom, because your body 'reacts' to it and elicits an inflammation which causes the redness and swelling.

The size and severity depends on both the type of venom, the amount of venom and how sensitive your immune system is to it.

The overall 'objective' of your immune system is to localize the venom neutralize it, and if it cannot 'wrap' it up so that it does not spread. ALSO the mouth of the insect carry bacteria, and these are mostly uncommon types.

So the first phase of the lesion was the infection and immune response, the second phase of the lesion is the 'wrapped, destroyed venom and dead bacteria in the middle'. It will keep remodeling over a period as your body 'heals' it

It is now caseated in a fibrous casing and the body will over a period remodel that area of your skin.

The Only concern I have with botox at this stage is the 'unknown factor' of how the toxin will affect the fibrosis that is still ongoing in the wound, So I will advise you to wait. I will advise about 3 full months of wait.

Thanks for making it JA.

If you have any clarifications let me know, otherwise feel free to rate my answer and accept