A 71-year-old woman, discharged after total hip replacement arthroplasty, returned to the hospital on postoperative day 9 with a 3-day history of itchy eczematous lesion around the surgical wound (Fig. ). The patient was afebrile, and there was no warmth, redness, or tenderness on wound examination. A blood test at that time showed the following: white blood cell (WBC) count, 5100/μL (normal 4000–10,000/μL); erythrocyte sedimentation rate (ESR), 84 mm/h (normal 0–20 mm/h); and C-reactive protein (CRP), 4.43 mg/dL (normal 0–0.6 mg/dL). The patient's inflammatory markers were mildly elevated compared with the blood test results 5 days earlier: WBC, 3600/μL; ESR, 30 mm/h; and CRP, 2.46 mg/dL. Because SSI could not be ruled out, the patient received cefazolin, 2 g, intravenously. The next day, the patient was diagnosed with contact dermatitis at the dermatology clinic and treated with local steroid ointment without additional antibiotics. Also, the mesh applied at the surgical wound was removed immediately. The skin lesion resolved after 1 week of treatment.
A 38-year-old African American woman with a BMI of 28.13 and an allergy to codeine and iodine () was prepped with chlorhexidine gluconate and the following sutures were utilized: deep polyglactin 910, deep poliglecaprone 25, and intracuticular poliglecaprone 25. The patient presented eight days later with numerous erythematous papules on the upper poles of the breasts that had presented that morning. Over-the-counter hydrocortisone cream had not alleviated symptoms. She was instructed to continue hydrocortisone. Ten days later, the rash had spread to her flexor forearms. She began a methylprednisone taper pack and the rash resolved within two days.