Fire Needle Combined Topical Mupirocin for the Treatment of Simple Skin Abscesses in Pediatric Patients: A Case Series

Figures & data

Figure 1 Needle used in fire needle therapy in this study (A). Fire needle therapy (B).

Table 1 Quantitative Criteria for Grading of Disease

Skin Lesion		Pain Degree		Therapeutic Effect Evaluation
Manifestation	Scale	FLACC Score	Scale	Efficacy Index	Therapeutic Effect	Abbreviation
Erythema or mild pigmentation	0	0	0	100%	Complete remission	CR
Tubercle	1	1 ~ 3	1	60% ~ 99%	Significant remission	SR
Pustule	2	4 ~ 6	2	30% ~ 59%	Partial remission	PR
Purulent discharge	3	7 ~ 10	3	<30%	No remission	NR

Table 2 Demographic and Clinical Characteristics of Patients

No.	Sex	Age (Year)	Duration (Day)	Site of Lesion	Size of Lesion (cm)
1	F	3	6	Cheek	2.5 × 2.5
2	M	9	6	Cheek	1.0 × 0.8
3	M	7	10	Nasal root	2.5 × 2.5
4	M	5	12	Nasal root	3.0 × 1.5
5	M	2	6	Frontal face	2.0 × 2.0
6	F	8	6	Zygomatic and periorbital	1.8 × 1.5
7	F	2	12	Tempus	2.8 × 2.2
8	M	8	7	Inner corner of the eye	2.0 × 1.0
9	F	7	7	Nasal root	1.5 × 1.0
10	M	2	5	Neck	2.5 × 1.5
11	F	2	3	Thigh	1.5 × 1.5
12	M	1	3	Arm	2.8 × 1.3
13	F	1	6	Buttock	1.3 × 1.3
14	F	5	4	Chest	1.5 × 1.5
15	F	1	7	Chest	1.3 × 1.0
16	F	8	5	Thigh	2.5 × 2.5
17	F	6	3	Thigh	2.0 × 1.5

Table 3 Efficacy and Follow-Up of Patients

No.	Before Treatment		3 Days After Treatment		7 Days After Treatment		Efficacy Index (%)	Therapeutic Effect	Basic Healing Time (Day)	Number of Fire Needle Therapy
	Skin Lesion	Pain Degree	Skin Lesion	Pain Degree	Skin Lesion	Pain Degree
1	2	2	1	1	0	0	100	CR	6	1
2	2	2	2	1	0	0	100	CR	7	1
3^a	2	2	1	1	0	0	100	CR	7	2
4^a	2	2	2	1	1	0	75	SR	14	2
5	2	3	2	1	1	0	80	SR	8	1
6	2	2	2	0	0	0	100	CR	6	1
7^b	3	2	2	1	1	0	80	SR	12	3
8^a	3	3	2	1	1	0	83	SR	9	2
9^a	2	2	2	1	1	0	75	SR	12	2
10	3	2	2	1	0	0	100	CR	7	1
11	2	2	1	0	0	0	100	CR	4	1
12^a	2	2	1	0	0	0	100	CR	5	2
13	2	2	2	1	0	0	100	CR	6	1
14	2	1	2	1	0	0	100	CR	7	1
15	2	2	1	0	0	0	100	CR	5	1
16	2	2	2	1	1	0	75	SR	8	1
17^a	2	2	1	0	0	0	100	CR	4	2

Notes: Skin Lesion Scale: Erythema or mild pigmentation, nodules, pustules and purulent discharge are scored 0, 1, 2 and 3 in that order.·Pain Degree Scale: The pain level was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC). 1 to 3 were classified as mild pain, 4 to 6 as moderate pain and 7 to 10 as severe pain. The scores were 0, 1, 2 and 3 on a scale of no, mild, moderate and severe pain.·Efficacy Index and efficacy rating: Total score = pain level score + skin lesion level score. The Efficacy Index is calculated based on the total score before and after 7 days of treatment [(total score before treatment - total score after 7 days of treatment)/total score before treatment × 100%]. There were four levels of efficacy: complete remission (CR): Efficacy Index of 100%; significant remission (SR): 60% ≤ Efficacy Index ≤ 99%; partial remission (PR): 30% ≤ Efficacy Index ≤ 59%; no remission (NR): Efficacy Index < 30% or worsening of symptoms. ^aReceived the second treatment on the 3rd day after the initial fire needle therapy. ^bReceived the second and third treatments on the 3rd and 7th days after the initial fire needle therapy.

Table 4 Summary of 17 Cases of Simple Skin Abscesses in Pediatric Patients

Characteristics	Results
Number of patients	17
Gender, n (%)
Male	7 (41)
Female	10 (59)
Age, years	4.5 ± 2.9
Duration, days	6 (4.5, 7.0)
Distribution of skin lesions, n (%)
Face and neck	10 (59)
Trunk and limbs	7 (41)
Therapeutic effect after 7 days of treatment, n (%)
Complete remission, CR	11 (65)
Significant remission, SR	6 (35)
Partial remission, PR	0 (0)
No remission, NR	0 (0)
Efficacy Index after 7 days of treatment, %	100 (80, 100)
Basic healing time, days	7 (5.5, 8.5)
Times of fire needle therapy, n (%)
1	10 (59)
2	6 (35)
3	1 (6)

Table 5 Comparison of Skin Lesion and Pain Degree Before and After Treatment

	Before Treatment	After 7 Days of Treatment	Difference	Z Value	P value
Skin Lesion Scale, M (P25, P75)	2 (2.0, 2.0)	0 (0.0, 1.0)	2 (1.5, 2.0)	3.782	<0.001
Pain Degree Scale, M (P25, P75)	2 (2.0, 2.0)	0 (0.0, 0.0)	2 (2.0, 2.0)	3.877	<0.001

Figure 2 Case1: A skin abscess on the face of a 3-year-old child before (A) and after (B) 3 days of fire needle combined therapy. Case 3: A skin abscess on the nasal root of a 7-year-old child before (C) and after (D) 3 days of fire needle combined therapy. Case 13: A skin abscess on the buttock of a 1-year-old child before (E) and after (F) 3 days of fire needle combined therapy.

Figure 3 Case 4: A skin abscess on the nasal root of a 5-year-old child before (A) and after (B) 7 days of fire needle combined therapy. Case 8: A skin abscess on the inner corner of the eye of an 8-year-old child before (C) and after (D) 7 days of fire needle combined therapy. Case 12: A skin abscess on the arm of a 1-year-old child before (E) and after (F) 7 days of fire needle combined therapy. (All three patients received two needle treatments, with a 3-day interval between the second treatment and the first).