Likely Etiology | Literature Support | Comments |
Infection | Systemic signs: fever, elevated white count. | Given the distant site from the injection and lack of systemic signs and symptoms, infection seemed unlikely |
Allergic reaction (to one or more agents) | Symptoms may range from blanching of the skin to urticarial lesions along the distribution of placement. | Prep, drape, tape, or bandages |
Steroid use | Acute generalized exanthematous pustulosis 2 days after SQ injection of dexamethasone. |
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Local irritation (topical agents) | Capsaicin causes local vasodilation and inhibits both autonomic and somatic nerves. Capsaicin at concentration of at least 0.1%, has shown to penetrate into a collagen mixture and be cytotoxic to both keratinocytes and fibroblasts. | Our patient used capsaicin cream 0.125% on the open lesion. |
Heating pads | Heating pad can result in a thermal burn. High risk in elderly patients, and patients with sensory deficits, atrophic skin, vascular insufficiency. |
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TENS | Case reports of third degree burn from interferential current therapy using the TENS machine and cutaneous irritation and contact dermatitis from pad placement. |
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