The Australasian College of Dermatologists
Recommendations from the Australasian College of Dermatologists on leg cellulitis, epidermal cysts, urticaria, distorted toenails & acne. The Australasian College of Dermatologists was established in 1966 as the medical college responsible for the training and professional development of medical practitioners in the speciality of dermatology.
Do not routinely prescribe antibiotics for inflamed epidermoid cysts (formerly called sebaceous cysts) of the skin.
The inflammation is secondary to an intense foreign body reaction to the cyst contents leaking into adjacent tissues and will respond to incision and drainage. The use of intralesional corticosteroid injections has been suggested, but there are no formal studies to support this practice. Although oral antibiotics are often prescribed, there is no evidence on which to base recommendations for their routine use in this setting.
Diven D, Dozier S, Meyer, D, Smith EB. Bacteriology of inflamed and uninflamed epidermal inclusion cysts. Archives of Dermatology 1998; 134(1):49-51.
A long-standing College Fellow, in consultation with the Honorary Secretary has prepared 5 recommendations. All ACD members were invited to choose three out of the five recommendations. Following an NPS Representatives meeting, it was noted that five recommendations are needed. Therefore the remaining two recommendations were selected.
- 1 Do not assume that bilateral redness and swelling of both lower legs is due to infection unless there is clinical evidence of sepsis such as malaise, fever and neutrophilia, plus an expanding area of redness or swelling over a period of hours to days.
- 2 Do not routinely prescribe antibiotics for inflamed epidermoid cysts (formerly called sebaceous cysts) of the skin.
Acute urticaria (i.e. of less than 6 weeks duration) does not routinely require investigation for an underlying cause. Where clinical history and examination suggest the possibility of a bacterial infection or food as a likely trigger, further testing may be warranted. If individual lesions (weals) persist for longer than 24 hours an alternative diagnosis may need to be considered.
- 4 Do not prescribe topical or systemic anti-fungal medication for patients with thickened, distorted toenails unless mycological confirmation of a dermatophyte infection has been obtained.
- 5 Monotherapy for acne with either topical or systemic antibiotics should be avoided.