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| Dr. Joel Aronowitz - Pimple-popping Danger! Dr. A explains the risk |
Dr. Joel
Aronowitz: Hi everyone, and welcome back to Aronowitzland. Hope
you're having a great day. Everything's wonderful here in Aronowitzland. I
wanted to do a quick video about a TikTok reaction Instagram I just posted.
This was a woman who had a stye on her upper eyelid. So, she squeezed the stye,
and it was very watchable, I guess, to watch her express this stye. And I made
a reaction video to warn people that really squeezing that kind of thing,
especially on your upper eyelid, is on the dangerous side.
So I wanted to expand upon that just a little
bit more, explain a little bit about lumps on the eyelid. They're fairly
common, and infections in general in the soft tissues because those are fairly
common as well. So let's begin with the woman who did the self-doctoring. So
we'll show a little clip of it here. And as you can see, she has a little lump
right here on her eyelid. It's just above the margin of the eyelid, and these
lumps typically occur because the glands that are along the margin of our upper
and our lower eyelid, they produce an oily secretion similar to the sebaceous
glands in our skin that produce oil in our skin. There are two kinds of glands
in the skin, basically: oily glands and eccrine, or sweaty, glands. So the
sweaty glands produce sweat, and this is a watery secretion. And then the other
kind of secretion is oily secretion.
So, obviously, we have a lot of secretions
from our body and a lot of different kinds of glands. But on the skin, they're
basically those two kinds. These glands along the eyelid were described in the
late 1600s by a German scholar named Maibomian, or Maibom, and so they're
called Maibomian glands in his honor, which is a whole other subject. I'm not a
big fan of eponyms, but 'Maibomian glands' is something that you're going to
see, so you may as well know the name of it. When they get stopped up, they cause
what's called chalazion, or chalazion.
So, a chalazion is just a stopped-up gland
along the eyelid, either the upper or lower lid. They usually occur in adults,
not children, because adults have a little more thicker secretion. When they
get stopped up, they're usually painless, and they usually are two or three
millimeters above the actual margin of the lid, and they can get quite large.
When you feel one, the answer is not to squeeze it. Don't squeeze it. What you
want to do, usually, there are good home remedies, and you can look them up.
You can use boric acid soaks or warm compresses or things like that to reduce
the inflammation, because when it gets swollen up, the tube or the little
orifice that the material or the glandular secretion comes out of, the little
duct gets stopped up. If you squeeze it and cause more swelling, that'll just
make it harder. So you want to soften it by warming it up a little bit,
reducing inflammation. Usually, they'll clear on their own, but the last thing
you want to do is squeeze it.
A chalazion is painless because it's generally
not too inflamed on its own, and it generally is not infected. Once it gets
infected, it basically turns into a stye or a hordeolum, but 'stye' is the
common term for it. Then now it's red, it's very inflamed, it's even painful.
Sometimes it'll drain itself, like in this woman's case, you could see that
there was already an opening in the skin if you look carefully at that video.
She squeezes that. This is a particularly dangerous thing to do in the face because
you've got to remember the physics of it. If you have a sack and you're
squeezing something out of the sack, even though there's a hole in that sack
and that cheesy, thick material is coming out, you're creating pressure inside
that sack. The same pressure that's forcing that material out through the
opening is also present throughout the rest of that sack and pushing on that
sack. If that sack gives way somewhere else, what you're going to do is you're
going to extrude or force that material out in a direction you didn't count on,
which is inside. That can obviously be disastrous because you have this
irritating material that's already colonized with bacteria and now you've
contaminated all this surrounding tissue that's already inflamed and swollen
and tender and is already having trouble healing itself. Now you've just
created another big disaster. That infection can then spread and can be a real
mess.
You don't want to squeeze these things because
even though it's gratifying to relieve the pressure, you're really risking
creating a bigger problem. That's the difference between chalazion and a stye
or hordeolum. These both are rising out of a clogged duct from the Maibomian
glands, which are sebaceous glands along the margin of the eyelid. That brings
up then the topic of soft tissue infections in general. That's sort of the big
topic, but I think that it's easiest to approach it by just simplifying it down
to some basics. We're not going to deal with the oddball soft tissue
infections, but rather the more common ones that occur in a healthy population.
Most of us at some point in our lives will have some type of soft tissue
infection. It's good to know some of the basics. Here's the basics: Most of
these soft tissue infections are caused by a bacterial infection. This is
discovered a couple of hundred years ago by the first people who started seeing
bacteria with the aid of microscopes. The first person obviously was, well,
Galileo did a little bit, but Loewenhoek, the Dutchman, is really credited with
the first workable microscope. He saw all of these little miniature animals,
including bacteria, and then the next generation put that together with the observation
that we saw these creatures in wounds that were obviously infected. That led to
what's called the germ theory, that bacteria cause many infections. If you can
identify that bacteria, that infectious living agent that's causing the
infection, and somehow kill it with the patient's own immune system or the aid
of antibacterial agents, then you can treat the soft tissue infections and
other infections. And the age of germ theory and then later with the
development of antibiotics, which came about at the very end of World War II in
the 40s, with the advent of penicillin. You should remember the name Alexander
Fleming, the scientist who discovered the first really usable antibiotic. There
were others before, but the first antibiotic of the modern era.
So that led to the ability for the medical
profession to deal with infections for the first time, and infectious diseases
went way down as a very, very common cause of premature death to something
that's generally treatable nowadays. So, sorry for that aside, but good to kind
of put it in context. Now, with soft tissues, there are basically two patterns
of soft tissue infections that are caused by bacteria. One is a little volcano
that fills with white creamy fluid, and that eventually explodes or is lanced,
and that's an abscess, of course, and that's caused by staph species typically.
And the white creamy material is white blood cells mixed with some blood, mixed
with some fluid, and mixed with bacteria. And if you take that creamy fluid,
you look at it under the microscope, you'll see loads of white blood cells.
It's white because there's a lot of DNA in white blood cells, and because
they're dividing rapidly, they've got a lot of DNA as a consequence, and that's
what gives that grayish-white color to pus.
So, every fluid that comes out of a wound
isn't pus, and the yellow watery fluid that comes, that weeps from a wound, is
typically not pus, but rather plasma, and it congeals into a scab, and that's a
whole different process that has nothing to do with the bacteria, typically. It
has to do with the fact that capillaries weep fluid, and the blood without the
blood cells is that yellowish fluid. It's yellowish because of the proteins in
the rest of the blood, and it congeals or desiccates and forms that scab. But
that's a whole different thing than pus. Pus is that white creamy fluid that
comes out and it's typically filled with bacteria as well, although sometimes
we can have what's called a sterile abscess. So if you've ever seen a suture
close to the skin that spits out, that it starts poking out of the skin, forms
like a little tiny mini abscess, and then it drains itself, that's usually a
sterile abscess, meaning you have all the white blood cells, and you have that
creamy fluid, but it's not really infected. There's no bacteria in it.
So abscesses are one form of soft tissue
infection, usually associated with staph. The other is cellulitis, and
cellulitis also, there's syphilis, which is another kind of spreading soft
tissue infection, or flesh-eating bacteria. You've heard of that, necrotizing
fasciitis, that spreads as a red wave, if you will, across the skin very
rapidly, almost sometimes so fast you can watch it. Those soft tissue
infections are characterized, or called cellulitis, and they are characterized
typically by an infection with strep, although mixed flora, or we refer to
bacteria as flora, mixed flora, there are a lot of different bacteria
sometimes. But if you just remember that abscesses are caused by staph usually
and cellulitis is caused by strep, that'll give you a good starting point, and
then you'll see the cellulitis is characterized by redness, a little bit of
swelling and redness, and then you can have ascending lymphangitis, where that
redness is spreading along the lymphatics, so you'll see little streaks, like a
map, going up. And once you see those streaks coming out of that red area,
that's a very dangerous sign because that infection is spreading now and has a
risk of spreading into the bloodstream and causing bacteremia in the
bloodstream, also known as bacteremia, and that's a big problem because the
bacteria then can seed different parts of the body, especially if you have a
breast implant, or a heart valve implant, any kind of foreign body, where that
bacteria can find a place to set up shop, becomes a big risk when the bacteria
is in the bloodstream. And then, of course, the next step with bacteria in the
bloodstream is a whole systemic, or body-wide, system-wide reaction to this
foreign invasion, called sepsis, and sepsis is a highly dangerous state where
multiple organs become affected, and the patient's vital signs become affected,
the blood pressure, pulse, and all that, and it can be fatal. So that's the
next step after cellulitis begins to spread.
So those are the two forms of soft tissue
infections, generally speaking, caused by bacteria. Let's talk about a basic
thing then, that we should know when we're looking at something that may be
infected, and that is, how do we identify something that's infected? Do we have
to take a culture? Do we have to have a microscope? Well, no, most of these
things, clinically, are pretty obvious, at least for the majority of cases. The
clinical examination should give us some clue that there's an infection going
on. So what are the four cardinal signs? The four big signs of a soft tissue
infection? So let's count them down: One is going to be redness, erythema. So,
redness, obviously, is associated with infection; two is edema, or swelling.
So, swelling, the tissue gets puffy and red; three is when you feel that
tissue, and usually feel with the back of your hand like this. You're more
sensitive on the back of your hand for heat. That's why your mother would put
the back of her hand to your forehead to see if you had a fever. Heat is the
number three, and so we have redness, we have swelling, we have heat, and we
have pain. So those four things—redness, swelling, heat, pain—those are the
signs of inflammation, but they're the signs of infection also, and it can be
difficult sometimes to tell the difference between simple inflammation caused
by something other than a bacterial infection and a bacterial infection, such
as an abscess or cellulitis, based on that. Those, the presence or absence of
those cardinal signs, and of course, somebody who has a very suppressed immune
system will not necessarily show those signs, or won't show them as obviously
as somebody who has a very healthy, functioning immune system. Those are the
local signs. So, the systemic signs don't occur until later. So, the fact that
the person does not have a fever, does not have an elevated pulse, is not
showing systemic or system-wide signs doesn't mean that they don't have a local
infection. So, just good to know.
The other point I wanted to expand on is
self-doctoring. So, with a lump, it's always fun to squeeze it, and there's a
whole industry associated with, um, watching people squeeze lumps. And there's
whole professions, I think, that are populated by people that love squeezing
lumps. That's all well and good, and that is a very acceptable mode of
treatment for a lot of these things, but there are some big dangers. So, it's
good to understand that when you squeeze on something, you can. You're
squeezing in all directions when you're squeezing on a sphere, or a something
that's a, you know, it's a ball, basically. And when you're providing external
pressure, that pressure is being applied internally to the walls almost
equally, probably. So, you can cause a rupture of that cyst, or mass, or
whatever it is, abscess, and force that material into places you don't expect,
or you don't want that to happen. And when that happens in the central part of
the face, it can be particularly dangerous. In some of the some other areas of
the body, the body can be particularly dangerous.
So, if you're going to self-doctor, and I'm a
big fan of being in charge of your own healthcare, I would, my advice would be
to be informed and to educate yourself before you embark on that. You, if you,
if you wouldn't wish that kind of care for your child or your loved one, or
your best friend, why would you give that kind of care to yourself? So, a lot
of self-doctoring ends up in problems and unnecessary trips to the emergency
room, and even stays in the hospital and surgery, and that sort of thing. So,
better to be prudent, inform yourself before you embark on that.
So, I hope you enjoyed this little diatribe on
self-doctoring, soft tissue infections, and eyelid cysts. And if you have any
comments, any suggestions, something I left out, or I got wrong, please leave
it in the comments below. If you have any ideas for other topics you'd like to
see me address, please leave it in the comments below, and until then, I will
get back to work, and I wish you a great day. - Dr. Joel Aronowitz
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