Common bacterial infections of the skin are caused by pus producing organisms mainly Staphylococcus aureus and Streptococci pyogenes.

Predisposing factors

1.   Poor Hygiene

2.   Diabetes

3.   In immunosuppressed conditions like HIV/AIDS

4.   Patients on steroids & other immunosuppressive drugs.

FOLLICULITIS

•        Inflammation of terminal part or ostium of hair follicle of infective or non- infective origin.

•        Non-infective causes include contact with oils, adhesive tapes etc.

•        Presents as small superficial pustules.

FURUNCULOSIS

•        Extended involvement of the entire hair follicle including the perifollicular region in the dermis & subcutaneous tissues.

•        Commonly known as Boil.

•        Presents as painful nodule, later becomes pustular and necrotic.

CARBUNCLE

•        Deep infection of two or more contiguous hair follicles.

•        Commonly seen in diabetics at back of neck, shoulders

•        Presents as extremely painful plaque with multiple pus points.

•        Constitutional symptoms like fever, malaise usually present.

IMPETIGO

•        Contagious, superficial infection of skin.

•        2 types - Bullous and non-bullous impetigo.

•        Common in children, around mouth and nose and in limbs.

•        Presents as discrete thin-walled vesicles that rapidly become pustular and then rupture leading to honey coloured (yellow brown) crusts.

CELLULITIS/ ERYSIPELAS

•        Cellulitis – infection cause suppurative inflammation of the deeper dermis and subcutaneous tissue.

•        Erysipelas - Infection of dermis and superficial lymphatics.

•        Sites - scalp, face and limbs are more frequently involved.

•        Presents as diffuse ill -defined swelling of affected part with warm, shiny surface. It may present with vesicles, bullae & erosions. Erysipelas have a typical raised, well defined edges.

•        Constitutional symptoms like fever, malaise, generalised weakness, Iymphadenopathy present.

•        Complications - Fascitis, myositis, subcutaneous abscess, nephritis and septicemia.

Diagnosis

•        Mainly clinical

•        Gram staining

•        Swab for Culture &Sensitivity.

•        Patient should be investigated for diabetes and other predisposing conditions.

Non-pharmacological treatment

•        Good personal hygiene and nutrition

•        Proper washing with soap and water

•        Avoid overcrowding

Pharmacological treatment

•        Topical antibiotics for mild and localized disease –

-         Mupirocin cream, Fusidic Acid cream, framycetin cream

-         To apply twice a day for 1 week.

•        Systemic antibiotics for widespread and severe disease-

-         Cap. Flucloxacillin 500 mg QID for 5-7 days. (50-100mg/kg/day in children).

-         Tab. Erythromycin 500mg QID for 5-7 days.

-         Cephalosporins 1-2gm daily (adult) and 30-50mg/kg/day (children).

-         In case of penicillin allergy: Clarithromycin 500 mg BD or Roxithromycin 50 mg BD.

-         Other drugs which are effective depending upon the causative organis in are amoxicillin /clavulanic acid, clindamycin, ampicillin /sulbactum, imipenem, vancomycin, piperacillin /tazobactum.

-         NSAIDS may be used to reduce constitutional symptoms.

Surgical treatment

•        Surgical Drainage of pus if required.

•        Debridement and regular aseptic dressings for deeper infections.