Bacterial Skin Infections

October 14, 2019

Skin and soft-tissue infections,
specifically bacterial infections, are some of the most common complaints we see in the urgent care setting, so we figured it was an appropriate topic to
cover for one of our medical minutes. The first kind I wanted to discuss is the
furuncle, and closely related, the carbuncle. Funny names, I know. Many
patients aren’t necessarily familiar with the term furuncle, but one term
that they are more familiar with is the abscess, which is another name for furuncle. These start with an infection of the hair follicle, and they are
typically red, painful, might have some tenderness there, may see some swelling
as well. And they can occur anywhere that you have a hair follicle, but more often
than not you’re going to find them in areas where there’s a lot of friction, so the
groin or the armpit/axillary areas, as well as along the waist. Those are the
more common locations that we see furuncle, or an abscess.
The carbuncle is closely related to the furuncle, and essentially this is just
a number of these abscesses that have connected themselves with what we call
“sinus tracts.” In most patients, a simple I&D, or an incision and drainage, along
with antibiotics, is effective treatment for these types of infections. However, in
immunocompromised patients, or those with a more severe infection, a simple I&D and
antibiotics isn’t enough, and they may require something more significant, such
as IV antibiotics or a trip to the OR where they can actually do surgical
debridement. The next type of infection I want to talk about is probably the second
most common skin infection that we see, or at least
bacterial skin infection we see in the urgent care setting, and that is
cellulitis. Similar to the other types of skin infections you’re gonna have
redness, pain, tenderness, and with cellulitis, because it’s a deeper
infection of the skin, the borders are somewhat fuzzy, or less demarcated is the medical term for that. In most patients we can treat them with oral antibiotics
to cover the typical causes. And with any of these types of skin infections,
the typical causes are going to be Staph and then Strep. The exception to this is
going to be in patients who are immunocompromised. The types of
illnesses or things that could cause immunocompromise include diabetes,
certain types of medications that patients might be taking for certain
autoimmune diseases, as well as autoimmune diseases themselves can put you at risk for more extensive infections, or infections that aren’t
necessarily going to be treated with simple oral antibiotics. With cellulitis
we definitely have some red flag type things that we look out for. We would expect to see when patients get treated for cellulitis, that
within 24 hours of antibiotic initiation, you’re gonna see improvement in the
symptoms. Not necessarily complete resolution, but you definitely see improvement. If after 24 to 48 hours you’re not seeing improvement, that would be a sign that this is a more significant infection and something
that’s going to require perhaps some imaging to make sure there’s not an
infection deeper in the in the tissue, or an abscess deeper. Perhaps it’s just going to require some IV antibiotics. The other things to look out for are if patients have had recurrent infections in one area that would be another red flag,
severely/rapidly worsening symptoms or particularly infections that involve the area around the eye- what we call an
Orbital Cellulitis. This is something that we can identify based on pain if you’re looking in different directions and you’re noticing
that you’re having a lot of pain, or an inability to change gaze and look in
different directions, changes in your vision, or another symptom that you might see is what we call proptosis. Proptosis, which is basically when the eye
actually bulges out, kind of like bug eyes. The next category of infection that I’d like to talk about is erysipelas. Another term for erysipelas is St. Anthony’s Fire, although I don’t hear that really used that often. This is a more superficial infection of the soft tissue. Unlike cellulitis, which is deeper, so it’s harder to tell the borders
of the the infection, with erysipelas, because it’s more superficial it’s going to be much easier to tell those borders of the infection. Like cellulitis, it’s going
be treated in much the same way, with antibiotics. And more often than not,
we’re going to be able to effectively treat this with oral antibiotics. Again, as with
other types of infections, and without trying to sound too redundant, if you’re
immunocompromised or you have a more severe infection, it may require
additional testing to make sure that we’ve found the appropriate antibiotic
to treat your infection. Another type of skin infection that we
encounter in the urgent care setting is folliculitis. Folliculitis is an
infection of the hair follicle, but unlike a furuncle, where it develops
into this abscess, it’s gonna be somewhat more superficial. Folliculitis is any
type of irritation of the hair follicle. This can be mechanical, from rubbing or abrasion. It can be chemical. And again, as we’re discussing today, it
can be something that’s bacterial. Signs and symptoms are gonna be similar to other types of bacterial skin infections, so you’re
going to have redness, pain, perhaps some tenderness of the area that’s involved. And as with the other types of skin infections, the the causes are gonna be
the same. So you know Staph and Strep, antibiotics are gonna be effective for
for treating it. One type that’s significant, or something that’s worth
mentioning, is hot tub folliculitis. This is caused by a particular bacteria
called Pseudomonas, and results from hot tubs and pools that are under treated, or improperly treated, with chemicals to remove the bacteria, so it kind of
proliferates in the the water. Symptoms typically occur, so the folliculitis
symptoms typically occur, on the trunk, as well as on the extremities, although less so on the extremities. And you’d expect to see the symptoms anywhere from 6 to 72 hours after exposure to the water. More often than not these are going to resolve on their own. If you’re someone who has, you know you’re healthy and normal and don’t have any kind of mute immunocompromise, but for those
immunocompromised patients, if you are immunocompromise, or if within 7 to 10 days after symptom onset you haven’t seen
resolution, that’s definitely indication to seek treatment for appropriate
antibiotics. It’s also worth mentioning that for those in immunocompromised
patients, they can have other causes of any of these types of skin infections so
besides just bacterial. They can also have fungal causes for the skin
infection, which again seeking treatment in an appropriate healthcare setting
they should be able to identify and help you to find the appropriate treatment.
The last type that we see, and probably the third most common that we see in the
urgent care setting, is Impetigo. Commonly you’re going to see it in
children aged 2 to 5 years old. They have, this is usually caused by against Staph and/or Strep, and there’s really two big broad categories, the bullous and non-bullous types. So the non-bullous is the more common. This is really going to be something you can expect to see, or more commonly your going to see where there’s breaks in the skin, as well as when you have skin
that’s been exposed to prolonged moisture which has caused a breakdown in the skin and allowed the bacteria to enter. Typical locations for this are
gonna be around the mouth, you’ll see it as well as around the nostrils. And the
bullous, on the other hand, is going to be, you’ll find these fluid-filled bullae,
that are anywhere from two to five centimeters in size. And you get
essentially serous fluid that accumulates underneath the skin in any
areas where the infection has taken hold. Treatment for these is going to be- you
know it used to be they just recommended a topical antibiotic, but now they’ve come
around to recognizing the importance of an oral antibiotic, and that’s usually
our default go to. We’ll always say, “Hey you can apply a topical, but we really
want to go ahead and prescribe you oral antibiotics as well, and that is the
current your treatment of choice recommendation. Again, thanks for tuning in to this Sinai Urgent Care Medical Minute with Dr. Nick. As always, if you have any questions, feel free to send them to us via our email which is
available on our website, as well as you can comment on, whether you’re viewing
this on Facebook or YouTube, any questions or comments. And if you have
any other topics that you’d like to see us cover, please make sure you send those to us via any of those you know forums- Again through through email or
through the comments section. Thanks.

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