Blog

McXtra Care Newsletter | July 2021

Section A

MAIN FEATURE

Skin Hygiene and Care

Skin Infections can be caused by bacteria, fungi, viruses, or parasites. The tropical and subtropical regions of the world like India which have a hot and moist climate, can predispose to skin infections.

Common predisposing and risk factors for skin infections are:

– improper hygiene
– tight clothes or irritating fabric
– infrequently changed diapers
– heat with moisture (tropical climate)
– cuts, injuries, scrapes, and insect bite
– repeated itching (especially in inflammatory skin diseases like eczema and psoriasis)
– crowded living/schools/workplaces
– poor nutrition
– coexisting diabetes or poor circulation
– underlying immune deficiency

Skin hygiene and care are important to not only avoid skin infection but also to improve overall skin and general health.

Face hygiene

Wash your face regularly for effective skin hygiene. This is a must –

– when you get up in the morning
– during bath
– after coming home from public places
– after removing make-up (always remove make-up before sleeping)
– before going to bed at night

Use a mild face wash instead of alkaline or irritant soaps. Some substances in soaps, detergents, and cosmetics can cause skin irritation and contact dermatitis. Certain ingredients like triclosan, sodium laureth and lauryl sulphates (SLES/SLS), benzalkonium, and chloroxylenol can cause skin/eye irritation, and should be avoided in soaps and face washes.

– Scrub gently but firmly all over the face, including the corners of the eyes and eyelids.
– Do not pick at, burst, or peel pimples/boils.
– Avoid touching your face in public places or with unclean hands.

Regular Bathing

– Have a bath at least once every day in cool to lukewarm water (avoid very hot water). It is good to bathe or have a shower when returning from public places, to maintain skin hygiene. Any non-irritant soap may be used.
– Make sure to wash private parts and the groin/pubic area well, and apply soap in often missed areas like the nape of the neck, under the breast, arm-pits, behind the ears, and in between fingers and toes.
– Dry all parts well with a non-irritant fabric towel. Change towels regularly (at least once in 2 days) and do not share towels.

Clothing and Sweating

– Avoid tight clothes and the use of irritant fabric. Change into comfortable clothing on returning home from work.
– Diapers should be changed frequently, and immediately when soiled.
– In hot and moist weather there is increased sweating, which accumulates in unexposed areas like skin creases, under-arms, chest, feet, and groin. This predisposes to bacterial and fungal skin infections. Clean these areas well during bath.
– Use talcum powder to absorb sweat in these unexposed areas.

Natural Skin Care Agents

– Certain herbal and natural agents like turmeric, neem, tulsi (Indian basil) and aloe vera have anti-inflammatory, antiseptic, and soothing properties and may be used as home-made pastes or part of available soaps, washes, and lotions for skin hygiene and care.
– Coconut oil is traditionally known to have skin benefits like moisturization and reducing skin irritation. Olive oil, jojoba oil, tea tree oil, shea butters, and almond oil are also beneficial, are rich in vitamin E, and part of moisturizers, soaps, and body washes.
– If the skin is dry and feels itchy, applying a moisturizer especially at night is helpful.

Diet

– Eat a nutritious diet, low on processed/refined carbohydrates and saturated/trans fats.
– Avoid or reduce highly fried food, junk food, and items with high sugar.
– Include more green vegetables, fruits, and whole grains in the diet.
– Drink plenty of water (at least 1.5-2 L/day) and be well hydrated at all times.
– Green tea and chamomile tea may be had twice a day.
– Fresh air, outdoor walks, and well-ventilated homes are important for skin and general health.

Section B

TRENDING FEATURE

Bacterial Skin Infections

Bacterial skin infections are the most common. They often involve the hair follicles on the skin (from where the skin hair arises). The causative bacterium is usually Staphylococcus aureus.

– Folliculitis is an infection of the hair follicle confined to the upper outer layer of the skin (epidermis).
– Furuncle (also called boil) implies a deeper infection in the dermis and appears as a pus-filled bump that is painful on touching.
– Carbuncle is formed sometimes when furuncles join together.
– Skin abscess is a deep pocket (walled off enclosed area) of pus (bacteria, white blood cells, and dead skin cells).

Some skin infections are also caused by Streptococcus pyogenes (Group A Streptococci- GAS) along with Staph aureus. This happens through small breaks or cracks in the skin.

– Impetigo is a contagious skin infection causing red sores which break down to ooze pus then form yellow crusted scabs, and usually heal without scarring. It is commonly seen in young children (2-5 years) around the nose or mouth and on the arms or legs. It usually resolves with antibiotics in 7-10 days.
– Erysipelas effect superficial skin layers and cause the skin to look bright red, firm, painful, and swollen with sharp raised borders. It is more common in children and the elderly, and can be seen on the face (usually in a ‘butterfly’ distribution) and on the arms or legs. It usually resolves with antibiotics in a few days without scarring.
– Cellulitis is a bacterial infection involving the deeper skin and fat layer that can be fast-spreading, serious, and life-threatening requiring urgent medical care. Complications can also rarely occur like abscesses, gangrene, and sepsis involving other organs like heart, kidney and joints.

bacterial skin infections

Treatment

Bacterial infections are usually treated by topical antibiotics like mupirocin, fusidic acid, framycetin, neosporin, clindamycin, or nadifloxacin. Sometimes topical povidone-iodine (Betadine) ointment/cream may also be prescribed. Topical antibiotics alone are usually enough for superficial infections like folliculitis and furuncles.

Oral antibiotics like amoxicillin/clavulanate or cephalosporins are prescribed in case of more extensive or deeper infections like impetigo, and erysipelas. Intravenous antibiotics (like vancomycin in resistant Staphylococcus infections -MRSA) are needed in cellulitis and sometimes in erysipelas.

Antibiotic treatment duration is usually 7-14 days. Rarely long-term antibiotics may be needed in persistent or recurrent infections like erysipelas.

An abscess often requires incision and drainage.

Supportive treatment includes dressings, wet compresses for removing crusts, medicines to reduce pain and inflammation, and improvement of skin hygiene.

Section C

SPECIAL FEATURE

Fungal Skin Infections

TINEA

The most common fungal skin infections are superficial and caused by the mold like or filamentous fungus Tinea (condition is called Dermatophytosis). Predisposing factors include the triad of heat and moisture, restrictive or irritant clothing/soiled diapers, and poor hygiene. It is characterized by skin redness and itchy rash (prominent itchiness differentiates fungal from bacterial skin infections). Sometimes the rash may show scales, blisters, and crusts.

Tinea infections are named according to the part of the body involved. Tinea corporis involves the body and causes a typical appearance known as ringworm (progressing active border of the rash with central clearing). Tinea cruris commonly known as crotch itch, gym itch, jock itch and ringworm of the groin (seen more common in men). Tinea pedis is also called athlete’s foot as it is common in athletes sweating in socks-shoes for long hours.

Tinea unguium (onychomycosis) is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed.

fungal skin infections

These infections are treated by antifungal drugs. Those commonly used are

Topical antifungals:

– Imidazole group (clotrimazole, miconazole, sertaconazole and luliconazole): These are available as creams, lotions, solutions/suspensions or powders. For scalp infections, ketoconazole and sertaconazole are available as shampoos/scalp lotions.
– Allylamine group (terbinafine and amorolfine): Terbinafine is available for both topical and oral use, and as a nail lacquer. Amorolfine is available as a cream and as a nail lacquer for onychomycosis.
– Ciclopirox: It is available as a topical solution/suspension, cream and nail lacquer but is less popular than the others mentioned.

Oral antifungals: These may also be needed in case of more severe, recurrent or persistent infections, for which the triazole group (fluconazole and itraconazole) or terbinafine are commonly used.

Antifungal treatment duration: It may range based on the type and location of the infection. Tinea corporis usually needs 1-2 weeks while Tinea cruris and capitis may need 2-4 weeks. Tinea pedis may need up to 6 weeks, while Tinea unguium may require 3-6 months treatment.

Supportive care includes proper hygiene, and keeping the area dry and aerated.

MALASSEZIA

This fungus (formerly called Pityrosporum) is a yeast like fungus present as part of our skin flora. It can sometimes cause skin rash, itching and discoloration.

Excess and persistent dandruff (small pieces of dry skin flakes from the scalp) is associated with Malassezia.

Seborrheic dermatitis (‘seborrhea’ implies excess sebum which is the oil produced from the hair follicle sebaceous glands) is a condition presenting with greasy and itchy patches with flaky white/yellow scales or crust on the hairy areas like scalp, face, eyebrows, eyelids (blepharitis), ears, nose, chest, armpits, groin or under the breasts. Seborrheic dermatitis is sometimes also called seborrheic eczema. The treatment involves frequent washes with anti-dandruff shampoo/scalp lotions. These contain zinc pyrithione, selenium sulfide, antifungal agents like ketoconazole or sertaconazole, and sometimes keratolytic agents to remove scales like coal tar or salicylic acid. Treatment may be required from a few weeks to few months.

Pityrosporum folliculitis is the term used to describe the infection by Malassezia of hair follicles producing excess sebum. This may sometimes be hard to distinguish from bacterial folliculitis or acne. However, presence of itching favors the diagnosis of Malassezia (but sometimes diagnostic culture and microscopy tests may be needed). Pityrosporum folliculitis does not respond to antibiotics or acne medications, and requires topical antifungal creams or lotions.

Pityriasis versicolor (formerly misnamed Tinea versicolor due to its resemblance to Tinea corporis) is a rash caused by Malassezia that appears patchy in color due to skin pigment production irregularity. This is also treated by antifungal creams and lotions.

malassezia

CANDIDA

Candida is a yeast like fungus and its infection is more common in babies (cause of diaper rash), and in people with coexisting conditions like diabetes, obesity (more sweaty, unexposed skin creases), prolonged antibiotic use, and weakened immunity due to corticosteroid use, chemotherapy or conditions like HIV. It commonly causes infections of the skin (cutaneous candidiasis), mouth (oral thrush) and vagina (vaginal candidiasis). It leads to a red, itchy rash or patch that can bleed on scraping. It occurs in skin creases and folds (intertrigo), armpits, groin, and nails.

It is treated with topical antifungals (clotrimazole, miconazole, sertaconazole or nystatin) and if required oral antifungals (fluconazole or itraconazole) till resolution of symptoms.

Section D

Important Points for Treating Skin Infections

Sometimes bacterial and fungal infections may coexist as predisposing factors are often common. Itching in fungal infections can also lead to a secondary bacterial infection. It may be difficult to distinguish bacterial and fungal infection in some cases, especially in case of the presence of other skin inflammatory conditions.

Therefore, there are several topical combination creams and ointments of antibiotic and antifungals available and these are often prescribed in practice. However, these combinations should be used judiciously, and not as an alternative to making a correct diagnosis, as irrational usage can lead to antibiotic resistance.

Itching, skin irritation and rash can sometimes be distressing, and there is need for early symptomatic relief. This is especially true when infections occur in the presence of eczema (dermatitis – skin inflammatory conditions).

In such cases, topical corticosteroids are also prescribed. There are several topical triple combinations of antibiotic-antifungal-corticosteroid available. However rampant use of such combinations can sometimes lead to worsening or persistence of the infection. Therefore, these combinations should not be used irrationally or as over-the-counter treatments.

Skin care and hygiene is the cornerstone for preventing and managing bacterial and fungal skin infections.