SKIN INFECTIONS

BACKGROUND

Your skin is the largest organ of your body. Its function is to protect your body from infection. Sometimes the skin itself becomes infected. Skin infections are caused by a wide variety of germs, and symptoms can vary from mild to serious. Mild infections may be treatable with over-the-counter medications and home remedies, whereas other infections may require medical attention.

Some common types of skin infections are

• Bacterial: Cellulitis and impetigo. Staphylococcal infections can also affect the skin.
• Viral: Shingles, warts, and herpes simplex
• Fungal: Athlete's foot and yeast infections
• Parasitic: Body lice, head lice, and scabies

DISEASE OCCURRENCE IN POPULATION

Globally, bacterial skin infections affected about 155 million people and cellulitis occurred in about 600 million people in 2013.

RISK FACTORS

• Recent injury to the skin (a wound, abrasion, cut, shaving, or injection drug use)
• Prior radiation therapy to the area
• The presence of a fungal or viral skin infection, such as athlete's foot or chickenpox
• Accumulation of fluid (oedema) due to poor circulation, heart failure, liver disease, or past surgery to remove lymph nodes
• Being overweight
• Chronic skin conditions, such as eczema

SIGN AND SYMPTOMS

Symptoms of a skin infection include:

• Rash (localized)
• Fever
• Chills
• Skin swelling
• Skin pain
• Skin redness
• Skin tenderness
• Skin warmth
• Pus draining from the skin
• Swollen glands (localized)
• Located near the infection
• Itching and burning

Additional symptoms of skin infection include:

• Confusion
• Fever over 102 degrees F (38.8 C)
• Headache
• Joint pains
• Leg swelling
• Muscle aches
• Nausea
• Vomiting
• Weakness or fatigue

DIAGNOSTIC TEST

A good medical exam is the best way to determine what is causing a skin infection. Often, doctors can identify the type of skin infection based on the appearance and location.

Your doctor may ask about your symptoms and closely examine any bumps, rashes, or lesions. For example, ringworm often causes a distinct circular, scaly rash. In other cases, a sample of skin cells can help your doctor determine the type of infection.

Tests that may be used to evaluate a skin infection include:

• Complete blood count
• Blood cultures
• Antistreptolysin O titer
• Anti-DNAse level
• X-ray of the infected area
• Skin biopsy
• Culture of the fluid draining from the skin

TREATMENT OPTIONS

Treatment for skin infections depends on the underlying type and severity of the infection. The location for a skin infection is also important. For example, cellulitis on the face or hand is potentially more serious than isolated cellulitis on the leg. Another important factor is the potential for antibiotic resistance. Methicillin-resistant staph infections (MRSA infections) are more serious because they require treatment with more potent antibiotics.
General measures for skin infections include rest, elevation of the infected area, warm compresses, antibiotics, or nonsteroidal anti-inflammatory medications for pain and fever. Surgery may be required to remove infected tissue, drain an abscess, or remove a skin foreign-body.
Specific treatment for a skin infection may include:

• Rest
• Elevation of the infected area - Above the heart if possible
• Warm compresses
• Nonsteroidal anti-inflammatory medications for pain and fever : Ibuprofen, Naproxen ,Ketoprofen
• Narcotic pain medication
• Antibiotics for skin infections: Selection may be guided by culturing the skin to identify the organisms causing the infection
  • Cefepime
  • Dicloxacillin
  • Cephalexin
  • Amoxicillin and clavulanate
  • Clindamycin
  • Sulfamethoxazole-and-trimethoprim
  • Ciprofloxacin
  • Cefazolin
  • Nafcillin
  • Ceftazidime
  • Ampicillin and sulbactam
  • Imipenem and cilastatin
  • Linezolid
  • Ertapenem
  • Vancomycin Metronidazole
  • Mupirocin
• Surgery to drain a skin abscess
• Surgery to remove a skin foreign body

Lifestyle Modifications

• Where possible, avoid or minimize wet-work.
• Avoid excessive sweating and dry conditions which are sometimes triggers.
• Avoid scratching which worsens the condition and may cause cracks allowing bacteria to enter leading to infection. Sometimes applying cold compress to area reduces itch. Keep fingernails short.
• Avoid the substance(s) causing the irritation or allergy. Avoiding all substances can be very difficult-if not impossible-especially if these substances are encountered at work. Using barrier cream, wearing gloves, and practicing glove hygiene is often helpful.
• Minimize contact with fruit juices, fruits, vegetables, raw meat while preparing food, or wear gloves.
• Protect hands by using cotton gloves as liner under vinyl gloves.
• Shampoo and style hair while wearing vinyl gloves, if possible.
• Take off rings before wet-work or hand washing.
• Use emollients frequently to help restore normal skin barrier function. A thin smear of a thick barrier cream should be applied to all affected areas before work, and reapplied after washing and whenever the skin dries out.
• Stress management-stress triggers flare-ups in many people so reducing stress may be beneficial.

PRECAUTIONS

Precautions for skin infections include:

• Gently clean the skin every day.
• Avoid skin injuries.
• Do not scratch the skin.
• Clean skin wounds immediately after they happen.
• Clean wounds every day, until they heal.
• Keep wounds covered with a bandage.
  

REFERENCES

• webmd.com/skin­problems­and­treatments/guide/skin­problems­treatments­treatment­care
• Global Burden of Disease Study 2013, Collaborators (22 August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet (London, England). 386 (9995): 743–800. 

www.freemd.com/skin­infections/prevention.htm