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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes pus filled blister at the site of nail piercing?

my boyfriend fell the other day and a nail punctured his back. He said the nail was not rusty and the incident happened in an attic while repairing someone's air conditioning, so according to him less risky insofar it wouldn't have been exposed to much soil, dirt and moisture--places where bacteria thrive and tend to be more of a risk factor. However I don't share the same logic as him in that respect, and even if considering his situation "less risky" than if it had happened on a construction site (for instance), I hardly find his assessment convincing given the strangeness of the symptoms I've witnessed since.

The incident occured approx. two days ago and here is what Ive noticed from what I can see. He tells me has not experienced any internal symptoms like nausea, fever etc.
*The primary location of what appears to me as an obvious infection of some sort localized at the site of the nail puncture. You cant see a deep puncture wound at all. I may not even have noticed it if he didn't tell me how his skin got so irritated. In the center the color is mostly a pale whitish color, perhaps slightly yellowish in tone, and is a bit swollen and bumpy--the bumps look like clogged oil glands or the start of a zit if zits were more translucent rather than red and as well were filled with a yellow-tinted clear substance rather than the more dense/solid type consistency of a zit. Its almost like puss that would come from a blister or a boil if one tried to sweeze it out but of course fails and instead just breaks open the skin (not realizing of course that boils are beyond surface deep and so can't be "popped" just like zits). At any rate there is some blotchiness in the center that spreads into a red loosely shaped-rashy looking thing with more bumps, a couple of which are much larger than the rest. The largest bump, which was where the puncture wound occurred has already started to drain on its own, and seems to be pretty constant for the past 8 hrs. I noticed after a few hrs since he had me look at the first bump that had started to drain that there are multiple, much smaller bumps that seem to be getting a bit larger and producing puss, but none of them have broken in order to drain and I do not want to irritate the area more by doing anything aggressive to it, even though it would be nice to prevent this from escalating. Lastly the skin in that area is a bit drier looking and rough. What concerns me most however is that I noticed he has a red rashy kind of mark about 5 inches away from the other. If it's the same thing symptomatically and not just a strange coincidence, I am worried the infection is potentially more dangerous to his health, and perhaps even mine if he is highly contagious at all.

I am not a trained medical professional, but from what I do know, logic would lead me to believe its not just a sureface level infection--by which I mean that whatever it is, it is being spread throughout his blood and not just a "skin irritation" at this point, which can be taken care of by something like Neosporin. Could this possibly be telling of a much more serious condition?

Lastly, I don't know how relevant this is, but about two months ago my boyfriend got a staff infection from a spider bite, which he similarly disregarded as a simple non-serious ailment until it swelled so much he worried it would burst or cause a blood clot, etc. He went to a physician, got antibiotics and took them regularly for about a week or so. Then he started forgetting and just stopped altogether, having only used about a quarter of the bottle. About a week later his finger appeared to the swell up again and worsen in the same direction as it had when it first got infected. When noticing the infection returned I told him he had to take ALL the pills, and also stop and relax for a few minutes of the day since all work and no play (so to speak) can aggravate infections when under stress, and that its important to take all the precribed medication because how one feels is not always a good indication of how well the medicine precribed has worked to actually rid someone from the infection. In his case then, furthermore important to finish his prescription according to the prescribed dosage times, since healing his finger from the spider was one thing, but staff has different methods of operation--variables, in general--that may make it so that the primary bite site is healed while the rest of the body is still exposed to the irritating source in ways that are not visible to the naked eye or generally occuring upon obvious parts of the body. Could his staff have need been truly cured, and now that he punctured his skin it made his vulnerable enough to awaken it from an otherwise dormant or otherwise un-bothersome state?

Thank you! I am very worried and intrigued to find out at well!
Thu, 3 Sep 2015
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General & Family Physician 's  Response
Hi, thanks for using healthcare magic

There is a risk of infection with puncture of any area of the body. The presence of a pus filled blister indicates that there is an infection present.
This would need treatment with topical and possibly oral antibiotics.

Though the nail may not have been dirty he still needs to assess whether he needs a tetanus vaccine.
If he received a tetanus shot within the last 5 yrs, it is not necessary but if this is not the case then he needs to find out if a booster is required.

I hope this helps
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