Forearm with multiple raised red bumps and irritated skin

Hives – What am I allergic to?

On March 10, 2012August 29, 2026 By Dr. Scott RennieIn Skin & Wound Care1 Comment

The medical term for hives is urticaria and they are described as raised areas of skin that itch intensely and they are red and often have a pale color to the center. They are common and occur in at least 20% of people at some point in their lives. Why hives develop: This skin rash occurs as the body’s immune system is exposed to an allergen (such as a food or chemical) that it inappropriately believes could be harmful. The body then responds by activating it’s army of immune cells in the skin to fight off the allergen. When these immune cells (called mast cells) are activated, they release histamine that is a natural chemical that causes itching, redness and swelling of the skin. In most cases, hives appear and can reappear suddenly – within several hours. Skin appearance: Hives can occur anywhere on the body and actually appear and disappear and give the appearance that the rash is actually moving around the body. They are raised areas of skin that itch and these red areas may enlarge and merge together. The itching is usually the most bothersome symptom and it can be severe enough to interfere with work or sleep. Angioedema: Some people who get hives also have puffiness of the face/lips, eyelids, mouth, hands, feet and genitalia. Swelling usually affects one side of the body more than the other and may give the sensation of fullness or discomfort in the area of swelling. Anaphylaxis: Hives can occur as part of a serious allergic reaction called Anaphylactic shock. You should see a medical provider right away if you have symptoms along with hives such as: 1) Trouble breathing 2) Tightness in the throat 3) Nausea/vomiting 4) Cramping or abdominal pain 5) Passing out 6) Dizziness or light-headedness Types of hives: Hives are usually classified based on how long they’ve been present. Acute (brief) hives, vs. chronic (long-standing) or physical (triggered by a physical stimulation such as sun exposure or cold). Acute hives: These are the type that we see most often in the medical clinic. They usually don’t last beyond a few days to a week or two. Triggers that can cause acute hives include: 1) Infections: Viral infections actually have been found to cause more than 80% of the cases of hives in children. The hives usually last a week or two. 2) Medications: Many different kinds of drugs can cause hives including nonsterioidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or Aleve. Antibiotics can also cause hives, as well as narcotic pain medication such as morphine or codeine. 3) Insect stings: Stings from bees, wasps, hornets or fire ants can cause hives around the sting. If you get hives all over your body after a sting, this could be sign of anaphylaxis, and you should be seen by a medical provider as soon as possible. 4) Food allergies: food-associated hives usually occur within 30 minutes to an hour after eating the food. Common foods which can cause hives include milk, eggs, peanuts or other nuts, soy, wheat, fish or shellfish. 5) Physical contact: After you touch a certain substance that you are allergic to, you may get hives. Common substances that can cause hives are plants, raw fruits and vegetables, latex (found in balloons, certain gloves, condoms, etc.) Chronic hives: Many people have hives that occur daily or almost every day. We call hives that last longer than 6 weeks chronic hives. Sometimes they can even last for years. Hives are frustrating and can effect how you look but it is important to remember that hives are not contagious, they are rarely permanent, they are not life-threatening and symptoms are treatable in most people. For most people who get chronic hives, the cause is unknown. Chronic hives can be a sign of other medical problems including thyroid or liver problems, chronic infection or lupus. People with these problems usually have symptoms other than just hives however. Physical hives: Hives can be triggered by exposure to cold (they often appear as the skin warms up), changes in body temperature or sweating, vibration, pressure, exercise, sunlight or water. Some people can develop reddened, raised lines if the skin is stroked firmly or scratched. This is called dermatographism. Diagnosis: Most people do not need testing. The diagnosis can be made by the medical provider by taking a history and performing a physical examination. Sometimes testing is done if symptoms are not resolving within six weeks. Skin testing may be ordered by an allergist to test for food and medication allergies. Blood tests can also be performed to look for other underlying medical problems. A skin biopsy is a small sample of skin that is removed and examined under the microscope. The biopsy can sometimes be helpful for patients who have chronic hives and it is usually performed by a dermatologist (skin doctor). Treatment: 1) Avoid the cause/trigger. Many times the cause in not found and the hives usually disappear over days or weeks anyway. 2) Antihistamines – there are two types of antihistamines. The older type such as Benadryl often work well, but can cause drowsiness, and are usually taken multiple times per day. The newer types of antihistamines such as Zyrtec, Claritin or Allegra have fewer side effects are usually taken only once or twice a day. 3) Oral steroids such as prednisone at a high dose are often used in combination with antihistamines. We are careful with the use of steroid medications because long-term use can cause serious side effects if taken of long periods of time (months to years). 4) Topical steroids or creams: Sometimes topical creams may help with the itching, however we usually don’t use topical steroid creams on the hives because the rash may move from one area of the body to another rapidly. I hope that you have found this information useful. Wishing you the best of health,

Hives were everyday family medicine for me. These days I write more about metabolic and menopause care, including the FDA pulling the black box warning off menopause hormone therapy.

Head Injury: Is It a Concussion or Something More Serious?

On March 9, 2012August 28, 2026 By Dr. Scott RennieIn NeurologyLeave a comment

Head injuries are common all year long in the urgent care setting. In the winter months, skiing or snowboarding is one of the leading causes of head injuries. In the summer months, more sports injuries occur with the improved weather in the Seattle area. Most head injuries are not associated with brain injury or longer-term complications. Rarely, however more significant injuries may develop which could be due to bleeding around the brain. Causes of head injuries: Most of the time falls are the cause, but motor vehicle accidents, pedestrian or bicycle accidents and sports-related trauma also cause head injuries. In the medical setting, we also have to be alert for signs of child abuse as well. The risk of brain injury depend on the type of trauma and the age of the patient. Higher risk injuries: 1) High speed motor vehicle accidents 2) Fall from a great height 3) Being hit by a high speed, a heavy or sharp object 4) Inflicted injury such as abuse Symptoms of head injuries: 1) Scalp swelling 2) Loss of consciousness/passing out – Happens only 5% of the time and usually lasts less than 60 seconds 3) Headache – Occurs in 20% of patients. In children who are too young to speak, they may become irritable. 4) Vomiting – occurs in about 10% of patients. Children who have a head injury and vomit, do not necessarily have a serious brain injury. 5) Seizures – Less than 1% of patients have a seizure right after a head injury. A few of these patients will have a serious head injury. We will usually do a CT scan of the head if the patient has a seizure. 6) Concussion – common symptoms include confusion or inability to remember events around the time of the injury, headache, vomiting, and dizziness. When to seek help: 1) The patient has recurrent vomiting 2) The patient has a seizure (convulsion) 3) The patient loses consciousness after the injury 4) Severe headache after the injury, or it worsens with time 5) Head injury in a child with behavior change (lethargic, difficulty to wake, extremely irritable, other abnormal behaviors). 6) Difficulty walking, is clumsy or has lack of coordination 7) Slurred speech or confusion 8) Dizziness that is not resolving 9) Blood or watery fluid comes from ears 10) The patient is a child less than 6 months of age 11) There is a cut that will not stop bleeding after pressure is applied for 10 minutes 12) The patient fell from a height greater than 5 feet, or was hit with a high speed object or with great force 13) Patient’s friends/family are concerned about how the patient is acting When do I need a Cat Scan/CT Scan of the brain? A CT scan is a special X-ray that expose children/adults to radiation and should be avoided if possible. Sometimes, however a Cat scan will be recommended to diagnose more severe injuries. Some possible symptoms which may prompt your medical provider to order a CT scan are: 1) Prolonged loss of consciousness 2) Persistent or severe memory loss/confusion 3) Persistent vomiting 4) Seizure 5) Severe, persistent or worsening headache 6) Suspicion of intentional injury (abuse) 7) Behavioral changes (lethargy, decreased alertness, extreme irritability) 8) Signs of skull fracture such as a bulging fontanel or skull deformity 9) Abnormal neurological exam 10) Severe scalp bruising or swelling in a very young child Why not an MRI? We use CT scanning instead of an MRI to look for brain injury in most head injuries because it is available at most hospitals, and CT is relatively quick compared to MRI. MRI requires patients – including children to be completely still for at least 30 minutes and that can be challenging. Head injury treatment at home: 1) Rest – lie down or participate in quiet activities 2) If the head is bleeding, clean the area with soap and water and apply pressure with gauze. If bleeding does not stop, the child should be evaluated 3) Tylenol may be given in most cases for pain/headache. If the headache worsens, please have the child evaluated (see above). Monitoring after head injury: The patient should be observed for signs of worsening injury. Please call your healthcare provider if any of the following are noted: 1) Vomiting more than once or vomiting continues for 4-6 hrs after the injury. 2) Severe/worsening headache 3) Becomes more drowsy or hard to wake up. 4) Confused or not acting normally. 5) Has trouble walking, talking or seeing 6) Develops stiff neck. 7) Has a seizure (convulsion) or any abnormal movements or behaviors. 8) Cannot stop crying – children 9) Has weakness or numbness involving one side of the body. Return to normal activities: Patients who have sustained a concussion are at a risk for serious or even fatal complications of they have a second injury within a short time after the first injury – this is called second impact syndrome. It important not to participate in high impact sports or risky activities for 6 weeks. Post-concussion syndrome: Sometimes the patient who has sustained a head injury may develop a group of symptoms in the first few days after the injury called “post concussion syndrome.” These symptoms can include headaches, anxiety, irritability, dizziness, or impaired memory or concentration. In 85-90% of patients, this resolves within a few weeks-few months after the injury. There isn’t any specific treatment for post-concussion syndrome. Head injury prevention: 1) Wear a bicycle helmet when riding bikes, skating , sledding or participating in activities where you may hit your head 2) Install car seats/booster seats correctly. At least a booster seat is needed until the child is at least 4 feet 9” tall. Individual states may have additional regulations about the use of booster/car seats. 3) Use gates on stairways to prevent injuries in infants/young children 4) Install window guards on all windows above the first floor 5) Do not use wheeled baby walkers 6) Teach kids to safely cross the street. Young children should never cross the street alone. 7) Discuss sports safety with your healthcare provider. Be sure that a child has appropriate protective equipment. I hope that you have found this information useful. Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Dry, red, cracked skin surrounding a person's elbow

Dry, Itchy Skin: Could It Be Eczema or Dermatitis?

On March 8, 2012August 29, 2026 By Dr. Scott RennieIn Skin & Wound Care1 Comment

Eczema (atopic dermatitis) is a problem that is characterized by dry, itchy, scaly and often red skin. There seems to be a genetic predisposition for eczema in some people. People who have eczema seem to have more allergies than those who do not. Causes: The epidermis or outside layer of skin seems to get irritated by environmental irritants. Patients who have this can be extremely sensitive to water – and if they repeatedly put their hands in water, it may be more common. Other times, there are certain skin products that seem to bring it on such as makeup, and petroleum products are a common cause in those who work in the automotive industry. For healthcare workers, latex gloves can cause severe irritation to the skin. In children, it has been linked to food allergies. Symptoms: Most individuals have their first symptom of eczema before the age of 5. The symptoms are often characterized by itching, small bumps, skin flaking and patches of redness. Scratching the skin can cause worsening symptoms. It is more commonly found in certain areas of the body, which help in the diagnosis. Most common areas of the body affected: 1) Hands/fingers of healthcare workers 2) In infants – front of arms, legs, cheeks or scalp may be red/scaly. 3) Back of the neck, elbow creases and backs of the knees as well as the face, wrists and forearms may be affected. Diagnosis: There is no specific tests to diagnose eczema. The diagnosis is made by taking a medical history and performing a physical examination. Cure: There is no cure for eczema – it is controlled/treated. Treatment: It typically improves and then flares (worsens) periodically. Eczema is not curable, but it is controllable with proper self-care and medications such as: 1) Keeping skin hydrated with skin emollients (creams and ointments that moisturize the skin and prevent it from drying out). The best emollients for people with eczema tend to be thick creams or ointments such as (Eucerin or Vaseline petroleum jelly). They are most effective when applied immediately after bathing. Lotions contain more water than creams and are less effective. 2) Avoid hot baths (greater than 10-15 minutes) because they actually can dry the skin out 3) Topical steroids – prescription strength steroid creams or ointments may be recommended and are usually applied twice a day. 4) Protopic and Elidel are often effective for eczema but don’t work as quickly as topical steroids. The are useful in sensitive areas such as the face or groin and can be used in kids under age 2. 5) Oral Steroids are very rarely used to treat a severe eczema flare. There are potential side effects, therefore it is not the most common treatment. 6) Ultraviolet light therapy (phototherapy) can control eczema, but is expensive and may increase the patient’s risk for skin cancer so is usually only used if other therapies are not successful. 7) Oral antihistamines can be useful for itching, but do not usually help with the eczema. 8) Wet dressings may also help soothe the skin, and reduce itching and redness but do not treat the eczema, but rather help with symptoms. Factors that make eczema worse: Reducing or eliminating some of these factors may help: 1) Heat, perspiration or chronic exposure to water (such as handwashing) 2) Emotional stress/anxiety 3) Rapid temperature changes 4) Exposure to certain irritating chemicals/soaps/detergents/perfumes. I hope that you have found this information useful. Wishing you the best of health,

Dizziness, Vertigo and Lightheadedness: Possible Causes

On March 7, 2012August 28, 2026 By Dr. Scott RennieIn Eyes, Ears, Nose & ThroatLeave a comment

Patients present to the urgent care or medical clinic with dizziness quite frequently. Finding the cause is sometimes challenging. Hopefully a discussion on the topic will answer some questions if you or someone you know has dizziness/vertigo. Dizziness: often described as feeling that you are spinning or tiliting, or that you are about to fall or pass out. Dizziness can also cause you to feel light headed or have difficulty walking straight. Vertigo: A specific type of dizziness that causes a sense of spinning, dizziness, swaying or that you are moving or the world is moving around you. Several different issues within the inner ear or brain can cause vertigo. Some of these issues are not serious and others are more concerning. These feelings can last days, hours or just seconds and can come and go. It may feel worse when you change positions (roll over or stand up) or move your head. You may also feel nauseated or vomit, have a headache and be sensitive to light or noise, have double vision, have a racing heart Causes: Possible causes include: 1) Inner ear problems – infection in the vestibular system, or small pieces of calcium can cause dizziness 2) Meniere’s disease 3) Benign paroxysmal positional vertigo 4) Medications 5) Migraine headaches 6) Stroke or TIA 7) Bleeding in the brain 8) Brain tumor 9) Heart problems such as low blood pressure or a rapid heart rate 10) Motion sickness from a boat ride or similar motion 11) Infection such as a bladder infection (especially in the elderly When to seek help: Warning signs that should prompt you to speak with a medical provider include: 1) New or severe headache 2) Fever greater than 100.4 degrees F 3) Trouble seeing or double vision 4) Trouble talking or hearing 5) Weakness of an arm or leg 6) Inability to walk without assistance 7) Passing out 8) Numbness or tingling 9) Chest pain 10) Persistent vomiting 11) The patient is elderly 12) The patient has had a stroke in the past 13) The patient has high blood pressure, diabetes or smokes Treatment: The treatment is tailored to the individual patient and the cause of their dizziness/vertigo. In addition to treating the underlying cause, other treatments may include: 1) An antihistamine such as Benadryl or meclizine 2) Anti-nausea medications such as Phenergan or Zofran 3) Eply maneuver: If the problem is due to benign positional vertigo due to small stones in the inner ear being out of place. I hope that you have found this information useful. Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Doctor using a stethoscope to examine a seated patient who is holding his chest

Costochondritis: Chest Pain Not Related to Your Heart

On March 6, 2012August 28, 2026 By Dr. Scott RennieIn Cardiology/HeartLeave a comment

This is for informational use only and should not be used to substitute for seeing a medical provider to determine the cause of your pain. Sometimes patients come into the clinic with complaints of pain in the chest and are worried about their heart. It can be confusing because the pain can occur in the same general area as pain that we think of when we say cardiac chest pain, but the history and physical exam is different. A variety of terms have been used to describe this syndrome such as costochondritis, costosternal syndrome, anterior chest wall syndrome, Tietze’s syndrome (costochondritis with swelling at the painful area). The diagnosis is based upon the ability to reproduce pain by pushing on the involved cartilage on the rib cage. In the photo, the grey colored areas represent cartilage. It is caused by inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone (sternum). It is very common syndrome that is seen in the medical clinic and often follows some sort of activity or trauma. Many patients with a cough develop this as a result of the continued coughing and rapid expansion/contraction of the rib cage. Symptoms: Pain and tenderness in the locations where your ribs attach to your breastbone (costosternal joints), often sharp pain, often worse when taking deep breaths, pain when coughing, and difficulty breathing. Causes: We don’t know what exactly causes most cases of costochondritis, but some causes might be: Injury such as a blow to the chest, physical strain from lifting or stenuous exercise, upper respiratory illness (produces cough/sneezing), pain from other areas of your body can sometimes be misinterpreted by your brain, causing pain in places far away from where the problem occurs – this is called referred pain. Treatment: Heat or ice may be helpful in relieving symptoms. Medications can also be used to reduce the inflammation – ibuprofen or naproxen are commonly used for this. Avoid unnecessary exercise or activities such as contact sports until there is improvement in your symptoms. I hope that you have found this information useful. Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Steaming cup of lemon tea, thermometer reading 98.9°F, tissues, and medicine on bedside table

What Is a Viral Upper Respiratory Infection (URI)?

On March 5, 2012August 29, 2026 By Dr. Scott RennieIn Eyes, Ears, Nose & ThroatLeave a comment

The common cold is a group of symptoms that are caused by one of a large number of viruses. Most viruses only cause the patient to be sick once, but because of the large number of viruses, a person can have a cold multiple times throughout a lifetime. The average adult experiences 3-4 upper respiratory infections per year, while children experience 8-12 colds/year. Transmission: Spread of the infection is from person-to-person, but can also be transmitted by an infected person touching a surface and leaving some virus particles and then an un-infected person touching the contaminated surface. Direct contact is the most frequent way the virus is spread. Most commonly the virus is on the infected persons hands. If a sick person shakes another persons hand and that un-infected person touches their eye, nose or mouth, they can get infected. Inhaling viral particles is another way cold viruses are spread. They can be breathed, coughed or sneezed into the air by a sick person and the virus can be transmitted to another person if they are standing nearby (within a few feet) and the droplets touch the unsick persons eye, nose or mouth. Covering the mouth while coughing reduces the risk of transmission. Symptoms: Possible symptoms include nasal congestion, runny nose, sneezing, sore throat, low grade fever and cough. Usually symptoms last from 3-10 days, but sometimes last longer. Most of the time a cold does not cause a serious illness, however if the virus depress the immune system enough, a secondary bacterial infection such as a sinus infection, ear infection, or pneumonia can result. We usually don’t treat for these kind of infections until the patient has not had resolution for 10-14 days because the infection is likely viral. Influenza virus: Symptoms can be similar to a common cold, but are usually more severe and can include high fever (above 102 degrees), body aches, headaches, etc. The influenza virus is more serious and has even caused death in elderly and young people. Treatment: Most treatments are aimed at relieving the symptoms, but they do not shorten the course of the illness. The body has a series of defenses and fights off the virus over the course of a few days to two weeks. Runny nose/congestion: 1) Benadryl or other antihistamines can be helpful for the nasal drainage 2) Nasal sprays may also be helpful for the nasal congestion 3) Afrin is often helpful but can cause rebound congestion if used more than 3 days in a row. Sore throat: 1) Tylenol, ibuprofen or aleve may be helpful for sore throat pain 2) One dose of oral Dexamethasone has been shown to reduce throat swelling and pain. 3) Tessalon is a medicine that numbs the back of the throat and can reduce the pain Cough: This is controversial because cough is the body’s natural mechanism for ridding the airways in the lungs of mucus. It can be miserable however, so we do treat it in some people. (be aware that cough is very difficult to treat) 1) Humidifying the air is helpful to increase the bodies ability to express the mucus from the airways. Therefore I recommend a steamer in the sick person’s house/room. 2) Robitussin(guaifenesin) or dextromethorphan may be helpful 3) Codeine cough syrup is not something I recommend, and this post used to say that some people find it helpful. The FDA restricted prescription cough medicines containing codeine to adults 18 and older in 2018, they are contraindicated under 12, and they carry a boxed warning for breathing problems. The evidence that codeine quiets a cough better than a placebo was never strong. Neither dextromethorphan nor any other over-the-counter cough and cold product belongs in a child under 4 Using antibiotics to treat a cold: Antibiotics should NOT be used to treat a common cold because they do not work for viruses. The possible consequences of using antibiotics for a virus include: 1) Allergic reaction to the antibiotic 2) Side effect of the antibiotic such as nausea, heartburn, headache, or diarrhea 3) Allergic reaction to antibiotic such as hives, swelling of the lips or rash 4) Antibiotic resistance – the bacteria that are present within the patients body may become resistant to the antibiotics that are being used and thereby increase the chances in the future a bacterial infection caused by these bacteria might not be susceptible to antibiotics. In fact, there are bacteria in our community now that we have no way to treat. They are resistant to every antibiotic that we have. The “super” bacteria are created by overuse of antibiotics or stopping an antibiotic too early in a person who does have a bacterial infection. I hope that you have found this information useful. Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Feet soaking in wooden bowl with steaming water, lavender, and Epsom salts

Ingrown toenails and paronychia

On March 4, 2012August 29, 2026 By Dr. Scott RennieIn Skin & Wound Care1 Comment

I see patients who come into the clinic for ingrown nails, most often toenails but even ingrown fingernails can bring people to the doctor. Paronychia: an inflammation involving the lateral and proximal fingernail folds. It can be acute (rapid onset) or chronic (long-standing). Causes: occupations where the hands are in the water frequently, nail biting, thumb sucking, overzealous manicuring and even diabetes can lead to fingernail infections. Ingrown toenail: The big toe is most commonly affected. Signs and symptoms can include pain, swelling, drainage and granulation tissue. It’s more common to get ingrown toenails from poor fitting shoes, toe trauma, excessive trimming of the lateral nail plate, or in patients who have a over-curvature of the nail which can be hereditary or acquired. Acute nail infections are usually accompanied by redness, and pain at the sides of the nail, sometimes with a blister that can be filled with purulent material If the patient hasn’t been biting their nails, the infection is most often caused by Staphylococcus aureus or Steptococcus pyogenes or a combination of both. Different bacteria are often present if the patient is a nail biter. Chronic nail infections are often associated with eczema, however it can also be complicated by a Candida or yeast infection of the nails. Diagnosis: In the clinic we can usually tell that there is a nail infection by the appearance of the nail folds on examination. If a purulent fluid collection is present, the diagnosis is even easier to make. Treatment: If the infection has come on rapidly (acute onset), the treatment usually involves warm compresses or soaks to the affected finger or toe for 20 minutes three times/day. Antibiotics that are taken orally may be helpful in severe causes. Topical antibiotics such as triple antibiotic ointment might be helpful after soaking the digit, but there isn’t a lot of research to support it. If there is an abscess present, incision and drainage is usually helpful in addition to the above treatments. We usually perform a digital block to numb the finger or toe for comfort before the surgery is performed. Treatment with antibiotics is common and we usually use them for 5 days after a surgical drainage and for 7-10 days if there is no drainage. The choice of the antibiotic depend on whether the patient has been biting the nails, and the patient’s history of drug allergies. Possible treatment options include dicloxacillin, Keflex (no no MRSA in suspected) or Bactrim. We may also add metronidazole or clindamycin to the regimen if the patient has been biting their nails. For ingrown toenails that are mild, we may place a cotton wedge or dental floss underneath the lateral nail plate to relieve the pressure and doing the soaks in warm soapy water for 10-20 minutes 3x/day. If the ingrown nail is severe however, we usually perform a partial nail removal after doing a digital block to relieve the discomfort. Antibiotics may be prescribed after partial nail removal may be helpful, however evidence has not shown that antibiotics decrease the healing time. Follow-up after 3-4 days to assess treatment. Recurrent ingrown toenails: May require treatment with permanent nail ablation surgery using both surgical excision plus phenol ablation (chemical matricectomy). The keeps the toenail from returning. Post-op care after toenail removal: You should be able to put weight on both feet immediately after surgery, but walking will be uncomfortable. Some mild bruising and bleeding is normal after foot surgery. We usually apply some antibiotic ointment and 4×4” gauze, tube gauze and paper tape. After 24-48 hours, soak the affected toe in warm, soapy water and reapply antibiotic ointment and a clean bandage. This should be done 3-4x/day for 1-2 weeks after the procedure. Keep your foot and leg elevated while sitting or lying down and make sure your bandages are clean and dry at all times. We ask patients not to wear shoes for 3 days and recommend antibiotics and anti-inflammatory medications for 10 days. I hope that you have found this information useful. Wishing you the best of health,

For most people an ingrown toenail is a nuisance. With diabetes or neuropathy it is a different problem, because an infected nail edge on a foot you cannot feel well is how some ulcers start, which is why I wrote about protecting your feet if you have diabetes.

Updated for 2026: Mostly Confirmed, With One Number Worth Having
I went looking for what had changed here since 2012 and the honest answer is: not much. No major society has rewritten this in the last few years. The approach I described holds up. So rather than manufacture a revolution, here is what has been sharpened. For an ingrown toenail bad enough to need a procedure, the thing that matters is whether the nail matrix gets treated, not just the nail edge removed. Partial nail avulsion combined with chemical destruction of the matrix using phenol gets cure rates above 95 percent. Avulsion alone does not. A 2025 trial of 140 patients put recurrence at 1.43 percent with phenol against 10 percent without (1). So if you are offered a procedure for a recurring ingrown nail, the question worth asking out loud is whether the matrix is being treated. That single detail is the difference between fixing it and doing it again next year.
Chronic Paronychia Is Not an Infection
This is the part I most want to correct, because it is treated wrongly all the time. Acute paronychia, the hot painful swelling beside a nail that comes on over a day or two, is an infection. Warm soaks, and if there is a pocket of pus it needs draining. Once it is drained, oral antibiotics usually are not necessary. They get reserved for spreading cellulitis, a suppressed immune system, or someone who is genuinely unwell (2). Chronic paronychia, meaning six weeks or longer, is a different animal. It is an irritant dermatitis, driven by repeated wet work and exposure, and treating it with antifungals or antibiotics does not work because it is not an infection. The treatment is getting the hands out of the water, barrier protection, and a topical steroid or calcineurin inhibitor. It takes weeks to months to settle, and people abandon treatment long before that (2). If you have had a swollen nail fold for two months and have been through three courses of antibiotics, that is the pattern.
What This Looks Like Over Video
A photograph does most of the work here, and this is one where I want more than one angle. From directly above and from the side, so I can see whether the nail fold is simply inflamed or whether there is a pocket of pus lifting it. What I need from you beyond that is duration, which is the single most useful question, along with what your hands or feet are exposed to during the day, whether you are diabetic, and what has already been tried. I can settle the chronic cases from here, and those are the ones most often mismanaged. What I cannot do is drain anything or take a nail off, so if there is pus, or if the nail needs a procedure, my job becomes telling you that clearly and getting you to someone who can do it.
When To Be Seen, Sometimes Urgently
Spreading redness, red streaking, or fever. Any toe infection at all if you have diabetes or poor circulation, where the threshold to be seen should be much lower than you think. Severe pain in the finger pulp, which can mean a felon. And pain on straightening the finger with a sausage shaped swelling, which suggests flexor tenosynovitis and is a same day surgical problem, not something to sleep on.
The Bottom Line
For a nail that keeps growing in, ask whether the matrix is being treated. For a nail fold that has been swollen for months, stop taking antibiotics for it and start treating the skin.
Sources
1. Comparison of Partial Nail Avulsion With or Without Phenolization in the Management of Ingrown Toenails. Cureus. May 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12147675/ 2. Acute and Chronic Paronychia. American Family Physician. 2017;96(1):44-51. https://www.aafp.org/pubs/afp/issues/2017/0701/p44.html 3. Ingrown Toenail Management. American Family Physician. 2019;100(3):158-164. https://www.aafp.org/pubs/afp/issues/2019/0801/p158.html
Related Reading
Abscesses and MRSA: What To Do About a Skin Infection When to Use Telemedicine vs. Urgent Care: How I Spot the Sick One Ringworm, Athlete’s Foot and Jock Itch and Fungal Nail Infections – “There Are Fungus Among Us” Calluses and Corns: Causes, Prevention, and Treatment Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Red first aid kit with assorted bandages, scissors, gloves, thermometer, antiseptic, and medication arranged on white surface

Basic Wound Care Tips for Non-Medical Professionals

On March 3, 2012August 29, 2026 By Dr. Scott RennieIn Skin & Wound Care1 Comment

I find that many patients who come into the clinic with a wound have questions about how to take care of it. The wound might be a post-surgical incision or even a minor cut. Hopefully this will help with some of those questions. Do I need stitches?: The best way to know for sure is to be examined by a medical provider, but some basic things we look at: 1) Depth of the skin wound – if it does not go all the way through the skin, it usually doesn’t need stiches 2) The size of the wound, whether it’s wide, or jagged. If it’s large, wide or jagged – there is a higher likelihood of needing stiches 3) Where on the body the wound is – in areas of the body with lots of stress on the wound, the stitches help hold the skin together better than tape, or a butterfly bandage. 4) How long ago the injury occurred: If you got cut 5 days ago, there is less chance sutures would be appropriate because wound healing has already begun. 5) If it was an animal bite or dirty wound: We will sometimes put stitches in a wound that was created by an animal bite, but these are generally dirty wounds and we are very careful not to bring the skin together too tight so that the wound can drain. What to do at home – basic guidelines: 1) Clean the cut or scrape with soap and water. If there is a piece of glass, or foreign object in the wound that will not come out, you will need to see a medical provider 2) Stop the bleeding with direct pressure on the wound. Press a clean cloth or bandage on the wound for 20 minutes minimum without releasing. If the bleeding is not stopping, contact a medical provider. 3) Put a thin layer of antibiotic ointment on the wound edges – not in the wound. I recommend bacitracin (mupirocin) and not Neosporin. 4) Cover the wound with bandage/gauze to keep the wound clean and dry. Change the bandage 1-2 times every day until the wound heals 5) Examine the wound for signs of infection – see below. Healing time for most wounds is 7-10 days but this can vary. When to see a medical provider: 1) The wound is deep and/or you can see fatty tissue, muscle, bone or dirty/debris within the wound 2) You are having severe pain 3) There are signs of infection (usually begin on about 2-4 days after the wound injury) such as: Fever, redness, swelling, increased warmth around the wound, pus draining from the wound or red streaks on the skin around the wound. 4) The wound is from a bite 5) The wound is a puncture wound caused when a sharp object goes through the skin into the tissue underneath. There is a higher chance of infection with these kinds of wounds. Do I need a tetanus shot?: You may need a tetanus booster depending on when your last one was. If you have deep wound, it is best to contact a medical provider if you’re unsure of whether you need a tetanus vaccine. Abscess: An abscess is an infection under the skin where bacteria (pus) collect. A surgical procedure called an I&D (incision and drainage) can be done to drain the pus and heal the infection. If you’ve had an incision and drainage done at your doctor’s office: After having a surgical procedure done at your doctors office, the wound is often packed with sterile gauze to allow the wound to heal from the bottom upwards. This way, the wound doesn’t close up at the top and leave a space underneath the top of the skin where bacteria can start growing and cause an infection. This type of wound needs special attention and observation each day. Basics of wound care after an I&D (incision and drainage): 1) Keep the bandage/wound clean and dry. 2) Only remove the bandage to clean around the wound and follow the advice of your medical provider on how to do this. 3) The packing gauze should be removed little by little until the wound heals completely. The decision on how much to remove (if any) should be made by a medical provider but this can be explained to the patient on an individual basis (ie. Wounds heal differently depending on the situation). 4) You may need to wear a splint to decrease movement to the area and allow wound healing. 5) Antibiotics and pain medication may be prescribed. I hope that you have found this information useful. Wishing you the best of health,

What Should Every Patient Know About Ankle Sprains?

On March 2, 2012August 29, 2026 By Dr. Scott RennieIn Orthopedic/Musculoskeletal2 Comments

Editor’s note, August 2026. This post recommends RICE with two to three days of rest. Sports medicine has moved away from that. Prolonged rest and routine icing are no longer advised, and getting a gentle amount of weight and movement through the ankle sooner produces better outcomes. Read what follows as the older protocol.

Another common condition that we see in the urgent care and clinic is the ankle sprain. Sometimes there can be some worry about whether there is an ankle fracture by the patient and the doctor. Here is some general information about ankle pain that might be helpful if you have or know someone who has ankle pain. Ankle sprains include stretch injuries, partial ruptures or even a complete ruptures of at least on ligament of the ankle. Ligaments provide stability and help direct the motion of the ankle. If the ankle starts to move in a direction that causes too much stretch and puts the ligaments at risk of injury, there are sensors built into the ligament that help provide a reflex to move the ankle back to a safe position. This happens without conscious effort of the patient. These stretch receptors within the ligament can become damaged with a prior ankle sprain. If this happens, they might not work properly to protect the ankle from future sprains. How bad is the sprain?/Grading: There are three classes of ankle sprains that help describe how bad the sprain is by loss of function and clinical signs. Grade 1 is less severe and results from mild stretching of the ligament with microscopic tears. There is no joint instability on exam. Grade 2 sprains are more severe and involve the complete tear of a ligament. There is usually mild to moderate joint instability on exam with reduced range of motion and loss of function. Walking with a grade 2 ankle sprain is painful. Grade 3 ankle sprains involve a complete tear of a ligament, and there is significant mechanical instability. Patients are usually unable to walk with these sprains. Lateral ankle sprain: The most common injury to the ankle is when the ankle is plantar-flexed (toes pointed down) and the ankle rolls inward. This causes damage to the lateral ligament complex of the ankle (anterior talofibular ligament [ATF], calcaneofibular ligament [CFL] and posterior talofibular ligament [PTF]). The ATF is the first or only ligament that is injured in almost all ankle sprains. If the ankle injury is more severe, the TF and CFL might become injured, which can result in ankle joint instability. Very strong forces to the ankle may result in injuries to all three ligaments. These are less common injuries, but are more debilitating and are often associated with ankle nerve injury. Medial ankle sprain: The strongest ligament of the ankle is the medial deltoid ligament complex. If the ankle rolls outward in a forced motion, it can cause damage to this structure but usually this type of motion causes an avulsion fracture of the medial malleolus. High Ankle Sprain: 1-11% of all ankle sprains are this type and are more common with contact sports. This sprain is caused by the toes pointing upwards and rolling the ankle outwards. This can cause a sprain that includes the interosseous membrane as well as the ATF, PTF and transverse tibiofibular ligaments. These ligaments are critical to ankle stability. Physical exam of the ankle: We look at the ankle and look for several signs on examination which may include: Swelling, bruising, palpating the fibula, the Achilles tendon, the edge or tip of the lateral malleolus, the posterior edge or tip of the medial malleolus, the base of the 5^th metatarsal and the navicular bone. We use a set of rules called the “Ottawa ankle Rules” to determine the need for an ankle x-ray. Treatment: For lateral ankle sprains, the treatment goal is to limit inflammation and swelling to maintain range of motion to the ankle. This is usually done via early treatment with RICE (rest, ice, compression and elevation) for the first 2-3 days. 1) Rest is done by limiting any standing or walking and using crutches until the patient can walk normally. 2) Ice is applied (or cold water emersion) for 15-20 minutes every 2-3 hours during the first 2 days or until the swelling has improved. 3) The sprained ankle should be elevated above the level of the heart to reduce swelling. 4) Compression with a gel splint or elastic bandage such as an ACE wrap or SAM splint is helpful to minimize swelling and reduce further injury. 5) Ibuprofen, Aleve or Tylenol can be used to reduce pain. Rehabilitation/Physical Therapy: For ankle sprains, I feel that early rehabilitation with range of motion exercises can be very helpful for retuning to activity and preventing chronic instability. In most patients with mild to moderate sprains, rehab should begin as soon as the initial pain and swelling have decreased to allow them to perform simple exercises. The program will take several weeks in order for the ankle to become stronger and limit the chance of re-injury. Indications for referral to an ankle surgeon include: 1) Ankle fracture 2) Dislocation or subluxation 3) Syndesmosis injury 4) Tendon rupture 5) Wound that goes into the ankle joint 6) Uncertain diagnosis Prevention of ankle sprains: Some possible options for prevention of ankle sprains include: 1) External ankle supports (lace up, high-top shoes, taping, etc) 2) Stretching and strengthening 3) Proprioceptive ankle training using a wobble board 4) Appropriate shoes/boots for the planned activity – ie. Hiking boots for a hike on uneven terrain. I hope that you have found this information useful. Wishing you the best of health,

Tuberculosis: A Growing Problem in the Seattle Area

On March 1, 2012August 29, 2026 By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Tuberculosis, or TB, is caused by the bacterium Mycobacterium tuberculosis. It remains a major public health problem worldwide and still shows up here in the Seattle area. I recently spoke with an infectious disease colleague who noted more documented cases on the eastside. TB most often attacks the lungs, but it can also spread to the brain, bones, or kidneys. Because so many people travel or move here from countries where TB is more common, we continue to see cases in our local community.

One of the challenges with TB is that it exists in two forms. Latent TB means the person is infected but has no symptoms. You only find it with a skin test or a blood test. Active TB, on the other hand, makes people sick. Symptoms can include fever, night sweats, a persistent cough that sometimes brings up blood, chest pain, weight loss, and fatigue. On a chest x-ray, we often see abnormalities in the upper part of the lungs, especially in the lymph nodes.

The disease spreads when someone with active TB coughs and another person inhales the airborne particles. That is why TB transmission in healthcare settings is such a concern. Doctors, nurses, and patients who share space with someone infected can be exposed. To reduce the spread, hospitals use protective masks, isolation rooms, and yearly testing of healthcare workers.

Treating TB depends on whether it is latent or active. With latent TB, the goal is to kill the bacteria before it has a chance to become active. This usually involves months of medication. Isoniazid is the most common, sometimes taken for six to nine months. Rifampin and rifapentine are other options, often used in shorter regimens. These medicines can stress the liver, so patients on therapy need regular monitoring for problems such as jaundice, nausea, or abdominal pain.

If the infection is active, treatment is more aggressive. Patients often start on four antibiotics while waiting for culture results. Those cultures, taken from sputum samples, can take up to two months to confirm the diagnosis. Using multiple drugs at once helps prevent the bacteria from becoming resistant. Multi-drug resistant TB, or MDR-TB, is already a serious global issue. Some strains no longer respond to the standard medications like isoniazid or rifampin, which makes treatment more complicated.

Public health reporting is central to TB control. Anyone diagnosed with active TB must be reported to the health department. They work closely with the patient and the medical team to track treatment and prevent spread. In many cases, directly observed therapy is used, where a nurse watches the patient take each dose. This ensures the full course is completed, since partial treatment can fuel resistance.

I’ve seen how confusing TB can be for patients. A person exposed to someone with active TB may test positive on a skin or blood test but feel completely fine. In that case, they have latent TB. They aren’t contagious, but they do carry the bacteria. About five to ten percent of these people will go on to develop active disease, especially in the first two years after infection or if their immune system becomes weakened by something like HIV, diabetes, chemotherapy, or long-term steroid use. This process is called reactivation.

There is a vaccine, BCG, which is given in many countries where TB is widespread. In the United States, it is not used because it provides little protection beyond early childhood. That leaves testing and treatment as the main tools for prevention here. The PPD skin test is the most widely used. It involves placing a small amount of inactive TB protein under the skin of the forearm. If someone has been infected, the area becomes red and swollen after 48 to 72 hours. Blood tests are also available in some areas. They are more expensive, but they don’t require a second visit to read the result and may be more accurate.

TB remains one of the leading infectious killers worldwide. Identifying people who carry the infection before it becomes active is one of the most effective ways to protect communities.

Doctor Rennie's Blog

Author: Dr. Scott Rennie

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