skin infections Flashcards
what can skin infections be?
- Bacterial
- Viral
- Fungal
- Parasitic
what are skin red flags?
- Severe systemic illness – feeling very unwell,
abnormal temperature, rigors, anuria - Drowsiness
- Photo sensitivity
- Non-blanching rash
- Stiff neck
- Severe headache/other pain
- Vomiting
- Worsening symptoms
what are some examples of bacterial skin infections?
- Impetigo
- Erysipelas
- Cellulitis
- Wound infections
- Infected bites and stings
- Diabetic foot infection
what is impetigo?
- Contagious, common infection
- Often seen in young children
- Starts with red sores (nonbullous) or blisters
(bullous), which burst and leave crusty patches - These increase in size and can spread
what is cellulitis?
- Acute bacterial infection of the dermis and
subcutaneous tissue - Symptoms include acute onset of pain,
warmth, swelling, and erythema - Blisters may form
- Most commonly affects the lower limbs
what is eryispelas?
- Form of cellulitis but affects upper dermis
- Typically presents on face or limbs
- Caused by Group A Streptococcus
- Patient often unwell before rash develops
what are the risk factors for cellulitis?
Most cases of cellulitis arise from bacterial infection through a break in the skin
Risk factors include:
* Lymphoedema
* Leg oedema
* Venous insufficiency and history of venous surgery
* Immunocompromised
* Existing wound
* Drug user
* Obesity
* Pregnancy
* Have had cellulitis before
what are the acute complications of cellulitis?
- The person may be systemically unwell;
tachycardia, hypotension, tachypnoea, or
confusion may be present - Sepsis
- Deep-seated infection, such as necrotising
fasciitis, abscesses
what are the chronic complications of cellulitis?
- Persistent leg ulceration
- Lymphoedema
- Recurrent cellulitis
what would be the differential diagnosis with cellulitis?
– Erysipelas
– Thrombophlebitis
– Deep venous thrombosis
– Septic arthritis
– Acute gout
when would a patient need to be referred to hospital for cellulitis?
- Are severely unwell
- Have infection near the eyes or nose
- Could have uncommon pathogens
- Have spreading infection that is not responding
to an oral antibiotic - Cannot take oral antibiotics
how would a patient be managed for cellulitis in secondary care?
- Flucloxacillin PO/IV 1g/2g QDS
- Second line: Doxycycline PO or clindamycin PO/IV
- If MRSA: Doxycycline PO or daptomycin IV
what supportive measures should be done for cellulitis?
- Paracetamol or ibuprofen for the pain
- Raising the affected body part on a pillow or chair when sitting or lying down to reduce swelling
- Regularly moving the joint near the affected body part,such as wrist or ankle, to stop it getting stiff
- Drinking plenty of fluids to avoid dehydration
- Do not wear compression stockings until resolved
how do you prevent reoccurence?
- Keep skin clean and well moisturised
- Clean any cuts or wounds, or using antiseptic cream
- Prevent cuts and scrapes by wearing appropriate clothing and footwear
- Manage breaks in the skin which may become a portal of entry for organisms
- Treat eczema
- Treat tinea pedis
- Treat any leg ulcer
- Manage venous insufficiency by using compression stockings after
the acute cellulitis has resolved - Consider referring people with lymphoedema to a specialist clinic
- If a person has recurrent episodes of cellulitis (more than two episodes at the
same site within one year), consider routine referral to secondary care for
advice on the use of prophylactic antibiotics
how can you identify infection with wound/bite/ scratch/ sting?
- Look for signs of infection – swelling, redness, pus, systemic illness
- Infected wounds normally due to Staph aureus
- Do not offer antibiotic unless infected
- Treat as cellulitis/erysipelas
