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Infections of the Skin

From Mediwikis

Cellulitis

  • Risk factors - diabetes, increased BMI, chronic lymphoedema
  • Symptoms- Spreading area of hot, tender, swollen, erythematous skin, often on the lower legs. There is regional tender lymphadenopathy. Systemic symptoms may be present- malaise, high temperature.
  • Pathology-Infection of the dermis and subcutaneous tissue, caused by β-haemolytic streptococcus or staphylococcus aureus.
  • Management- IV flucloxacillin or erythromycin if penicillin-allergic

Folliculitis

Red, itchy, tender raised areas around the hair follicles due to Staph. aureus. Treat with topical sodium fusidate or oral flucloxacillin.

Necrotizing Fasciitis

Strep. pyogenes causes this rare acute bacterial infection of the superficial and deep layers of skin, and produces toxins which erode the skin("flesh eating" is a misnomer). The bacteria is inoculated following acute trauma or skin damage, and patients will complain of intense pain as well as showing a complex erythematous swollen wound. Emergency surgery is needed, plus Piperacillin/Tazobactam with Clindamycin.

Gas gangrene

This deep infection of skeletal muscle is cause by Clostridium perfringens following contamination of a wound with soil. The patient will have excruciating pain and signs of shock, with a highly odematous and necrotic wound area. Again, this is a medical emergency, with surgical debridement/amputation along with piperacillin/tazobactam with clindamycin necessary to save the patient's life.