Skin Infection

Aka: Skin Infection, Pyoderma, Fungal Dermatoses, Parasite infestation, Parasitic Infections of the Skin, Skin and Soft Tissue Infection, SSTI, Skin and Subcutaneous Tissue Infection and Infestation

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II. Pathophysiology: Predisposing factors

  1. Decreased tissue perfusion oxygenation
  2. Peripheral fluid stasis and edema
  3. Increased Skin Trauma risk
  4. Suppressed immune function

III. Types: Bacterial Skin Infections (Pyoderma)

  1. Impetigo
  2. Folliculitis
  3. Furunculosis (Furuncle or Skin Boil), Carbuncle or Skin Abscess
  4. Ecthyma
  5. Erysipelas
  6. Cellulitis
  7. Acute Paronychia
  8. Felon
  9. Necrotizing Fasciitis
  10. Staphylococcal Scalded Skin Infection
  11. Nodular Lymphangitis
  12. Preseptal Cellulitis and Periorbital Cellulitis
  13. Intertrigo

IV. Types: Complicated Bacterial Skin Infections

  1. Methicillin Resistant Staphylococcus Aureus (MRSA)
  2. Deep space infection including deep Skin Abscess
  3. Decubitus Ulcer
  4. Necrotizing Fasciitis
  5. Fournier's Gangrene
  6. Perirectal Abscess
  7. Diabetic Foot Infection
  8. Dog Bite Infection
  9. Cat Bite
  10. Cat Scratch Disease
  11. Human Bite

V. Types: Fungal Skin Infection

  1. Cutaneous Candidiasis
  2. Onychomycosis
  3. Chronic Paronychia
  4. Tinea Barbae
  5. Tinea Capitis
  6. Tinea Corporis (Ringworm)
  7. Tinea Cruris (Jock Itch)
  8. Tinea Faciale
  9. Tinea Pedis (Athlete's Foot)
  10. Tinea Versicolor
  11. Intertrigo

VI. Types: Parasitic Skin Infection

  1. Scabies
  2. Lice
  3. Bed Bugs

VII. Types: Viral Skin Infections

  1. See Also Viral Exanthem
  2. Herpetic Whitlow
  3. Genital Herpes
  4. Herpes Zoster
  5. Chicken Pox

VIII. Risk Factors

  1. Immunodeficiency
    1. Asplenia
    2. Diabetes Mellitus (5 fold increased SSTI risk)
    3. HIV Infection
    4. Chemotherapy
    5. DMARDs (Rheumatoid Arthritis)
  2. Chronic Disease
    1. Comorbidity (e.g. cardiopulmonary, hepatorenal, debility)
    2. Dialysis (ESRD)
    3. Longterm intravascular access (MRSA risk)
    4. Lymphedema
    5. Obesity
    6. Peripheral Neuropathy
    7. Peripheral Artery Disease
    8. Trauma or surgery
    9. Eczema and other Pruritic Conditions
  3. Demographics
    1. Children and older adults (MRSA risk)
    2. Healthcare Worker
    3. Prolonged hospitalization (MRSA risk)
    4. Longterm Care (MRSA risk)
    5. Military (close quarters)
    6. Athlete
  4. Lifestyle
    1. Alcohol Abuse
    2. Nutritional deficiency
    3. IV Drug Abuse
    4. Water exposure (swimming in lakes, hot tubs)

IX. Classification

  1. Class 1
    1. Simple infection without systemic symptoms or signs of spread
    2. No uncontrolled comorbidities impacting treatment
    3. Outpatient Antibiotic management planned
  2. Class 2
    1. Infection with systemic symptoms or signs of spread (e.g. fever, sweats, Tachycardia) or
    2. Uncontrolled comorbidities impacting treatment or
    3. ParenteralAntibiotics required
  3. Class 3
    1. Infection with systemic symptoms or signs of spread (e.g. fever, sweats, Tachycardia) or
    2. Uncontrolled comorbidities impacting treatment
    3. Inpatient ParenteralAntibiotics required
  4. Class 4
    1. Infection with life-threatening systemic symptoms or signs of spread (e.g. severe Sepsis)
    2. Inpatient management with ParenteralAntibiotics (may require ICU care)
    3. Surgical Consultation may be warranted

X. References

  1. Ramakrishnan (2015) Am Fam Physician 92(6): 474-83 [PubMed]
  2. Ki (2008) Can J Infect Dis Med Microbiol 19(2): 173-84 [PubMed]
  3. Stevens (2014) Clin Infect Dis 59(2): e10-52 [PubMed]

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