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:
Skin hygiene and care are important to not only avoid skin infection but also to improve overall skin and general health.
Wash your face regularly for effective skin hygiene. This is a must –
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.
Clothing and Sweating
Natural Skin Care Agents
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.
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.
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.
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.
These infections are treated by antifungal drugs. Those commonly used are
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.
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.
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.
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.
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