Skin and soft-tissue infections: Difference between revisions

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{{CMG}}; {{AE}} {{AL}}
{{CMG}}; {{AE}} {{AL}}


'''''Click on each condition for more information about that particular infection'''''
'''''Please click on the specific skin and soft-tissue infections below for further information.'''''


{| class="wikitable" border="1"
{| style="border: 2px solid #4479BA; width: 1200px" align="center"
! style="width: 200px;background: #4479BA"| !! style="width: 150px;background: #4479BA;"|{{fontcolor|#FFF|Layer}} !! style="width: 150px;background: #4479BA;"|{{fontcolor|#FFF|Condition}} !! style="width: 600px;background: #4479BA;"|{{fontcolor|#FFF| Definition }} !! style="width: 100px;background: #4479BA;"|{{fontcolor|#FFF| Image}}
! style="width: 150px; background: #4479BA;" colspan=2 |{{fontcolor|#FFF|Anatomic Layers of the Skin}}
! style="width: 150px; background: #4479BA;"|{{fontcolor|#FFF|Condition}}
! style="width: 500px; background: #4479BA;"|{{fontcolor|#FFF|Definition<sup>†</sup>}}
! style="width: 100px; background: #4479BA;"|{{fontcolor|#FFF|Image}}
|-
|-
| Rowspan="10"|File || Rowspan="2"|'''[[Epidermis]]''' || '''[[Impetigo]]''' || High contagious superficial skin infection that affects the epidermis. It is classified as bullous and non-bullous, being the latter the most common presentation of impetigo.
| style="padding: 0 0px; background: #F8F8FF;" | [[File:Epidermis.png|x100%|link=Epidermis]]
* Bullous: small vesicles that enlarge to a bullae, commonly associated with S. aureus infection.
| style="padding: 0 0px; background: #F8F8FF; text-align: center; font-weight: bold;" | [[Epidermis]]
* Non-bullous: characteristic "honey-crust" lesions,  can be caused by S. aureus or Streptococi.
| style="padding: 0 5px; background: #F5F5F5; text-align: center; font-weight: bold; font-size: 120%;" | [[Impetigo]]
|| [[File:Impetigo elbow.jpg|100px]]
| style="padding: 0 5px; background: #F5F5F5;" | Superficial pyogenic infection of the skin which usually begins as [[vesicle]]s with a very thin, fragile roof consisting only of [[stratum corneum]].
| style="padding: 0 0px; background: #F5F5F5;" | [[File:Impetigo elbow.jpg|100px|link=Impetigo]]
|-
|-
|'''Ecthyma''' || Severe form of [[impetigo]] with [[ulceration]] of the [[pidermis]] and formation of crust. The legs, thighs and buttocks are the most common affected areas. || 2
| style="padding: 0 0px; background: #F8F8FF;" rowspan=5 | [[File:Dermis.png|x100%|link=Dermis]]
| style="padding: 0 0px; background: #F8F8FF; text-align: center; font-weight: bold;" rowspan=5 | [[Dermis]]
| style="padding: 0 5px; background: #F5F5F5; text-align: center; font-weight: bold; font-size: 120%;" | [[Erysipelas]]
| style="padding: 0 5px; background: #F5F5F5;" | Infection of the upper [[dermis]] including the superficial [[lymphatics]] which typically presents as an indurated, "peau d’orange" lesion with a raised border that is demarcated from uninvolved skin.
| style="padding: 0 0px; background: #F5F5F5;" | [[File:Facial erysipelas.jpg|100px|link=Erysipelas]]
|-
|-
| Rowspan="5"|'''[[Dermis]]''' ||'''[[Folliculitis]]''' || Inflammation of a [[hair follicle]]. || [[File:Folliculitis.jpg|100px]]
| style="padding: 0 5px; background: #F5F5F5; text-align: center; font-weight: bold; font-size: 120%;" | [[Folliculitis]]
| style="padding: 0 5px; background: #F5F5F5;" | Inflammation and/or infection of the [[hair follicle]] in which [[suppuration]] presents in the [[epidermis]].
| style="padding: 0 0px; background: #F5F5F5;" | [[File:Folliculitis.jpg|100px|link=Folliculitis]]
|-
|-
| '''[[Furuncle]]''' || Infection of a [[hair follicle]], also known as [[boil]]. || [[File:Furuncle.jpg|100px]]
| style="padding: 0 5px; background: #F5F5F5; text-align: center; font-weight: bold; font-size: 120%;" | [[Furuncle|Furuncle<BR>(Boil)]]
| style="padding: 0 5px; background: #F5F5F5;" | Infection of the [[hair follicle]] in which [[suppuration]] extends through the [[dermis]] into the [[subcutaneous tissue]]. Each lesion consists of a deep-seated inflammatory [[nodule]] and an overlying [[pustule]] through which hair emerges.
| style="padding: 0 0px; background: #F5F5F5;" | [[File:Furuncle.jpg|100px|link=Furuncle]]
|-
|-
| '''[[Carbuncle]]''' || Collection of [[furuncles]] with a larger area of involvement and may extend to the [[subcutaneous tissue]].
| style="padding: 0 5px; background: #F5F5F5; text-align: center; font-weight: bold; font-size: 120%;" | [[Carbuncle]]
| style="padding: 0 5px; background: #F5F5F5;" | Infection of several adjacent [[hair follicle]]s, producing a coalescent inflammatory mass with [[pus]] draining from multiple follicular orifices.
| style="padding: 0 0px; background: #F5F5F5;" | [[File:Carbuncle on buttok.JPG|100px|link=Carbuncle]]
|-
|-
|'''[[Erysipelas]]'''  || Superficial skin infection with a clear line of demarcation between involved and uninvolved tissue and raised lesions above the level of the surrounding [[skin]]; affects the [[epidermis]] and upper [[dermis]].
| style="padding: 50px 5px; background: #F5F5F5; text-align: center; font-weight: bold; font-size: 120%;" rowspan=2 | [[Cellulitis]]  
| style="padding: 5px 5px; background: #F5F5F5;" rowspan=2 | Acute spreading infection of the deeper [[dermis]] and the [[subcutaneous tissue]] which lacks sharp demarcation from uninvolved skin.
| style="padding: 0 0px; background: #F5F5F5;" rowspan=2 | [[File:Cellulitis4.jpg|100px|link=Cellulitis]]
|-
|-
| Rowspan="2"|'''[[Cellulitis]]''' || rowspan="2"| Diffuse [[skin]] infection that involves the deeper [[dermis]] and the [[subcutaneous tissue]].  It is classified as non-purulent and purulent [[cellulitis]].
| style="padding: 0 0px; background: #F8F8FF;" rowspan=2 | [[File:Subcutaneous tissue.png|x100%|link=subcutaneous tissue]]
* Non-purulent: with no purulent drainage or exudate and no associated [[abscess]].
| style="padding: 5px 5px; background: #F8F8FF; text-align: center; font-weight: bold;" rowspan=2 | [[Subcutaneous tissue|Subcutaneous<BR>Tissue]]
* Purulent: associated with purulent drainage or exudate in the absence of a drainable [[abscess]].
||[[File:Cellulitis3.JPG|100px]]
|-
|-
|Rowspan="2"| '''[[Subcutaneous tissue]]'''
| style="padding: 0 5px; background: #F5F5F5; text-align: center; font-weight: bold; font-size: 120%;" | [[Necrotizing fasciitis|Necrotizing<BR>Fasciitis]]
| style="padding: 0 5px; background: #F5F5F5;" | Rapidly progressive infection of deep [[fascia]] associated with bullae and [[necrosis]] of underlying skin.
| style="padding: 0 0px; background: #F5F5F5;" | [[File:Necrotizing fasciitis left leg.JPEG|100px|link=Necrotizing fasciitis]]
|-
|-
| '''[[Necrotizing fasciitis]]'''||  ||[[File:Necrotizing fasciitis left leg.JPEG|100px]]
| style="padding: 0 0px; background: #F8F8FF;" | [[File:Muscle layer.png|x100%|link=Muscle]]  
|-
| style="padding: 0 0px; background: #F8F8FF; text-align: center; font-weight: bold;" | [[Muscle]]  
| '''[[Muscle]]''' || '''[[Myonecrosis]]''' ||   ||[[File:Gas gangrene.jpg|100px]]
| style="padding: 0 5px; background: #F5F5F5; text-align: center; font-weight: bold; font-size: 120%;" | [[Gas gangrene|Myonecrosis<BR>(Gas Gangrene)]]
| style="padding: 0 5px; background: #F5F5F5;" | Rapidly progressive toxemic infection of injured muscle, producing marked [[edema]], [[crepitus]], and brown bullae, characterized by extensive gaseous dissection of muscle and fascial planes on radiography.
| style="padding: 0 0px; background: #F5F5F5;" | [[File:Gas gangrene.jpg|100px|link=Myonecrosis]]
|-
|-
| style="padding: 0 0px; background: #F5F5F5;" colspan=5 |<sup>†</sup><SMALL>Adapted from ''Clin Infect Dis. 2005;41(10):1373-406.'',<ref name="pmid16231249">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ et al.| title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 10 | pages= 1373-406 | pmid=16231249 | doi=10.1086/497143 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16231249  }} </ref> ''Rook's Textbook of Dermatology'',<ref name="Rook's Textbook of Dermatology">{{cite book | last = Rook | first = Arthur | title = Rook's textbook of dermatology | publisher = Wiley-Blackwell | location = Chichester, West Sussex, UK Hoboken, NJ | year = 2010 | isbn = 1405161698 }}</ref> and ''Infectious Diseases of the Skin''.<ref>{{cite book | last = Elston | first = Dirk | title = Infectious diseases of the skin | publisher = Manson | location = London | year = 2011 | isbn = 1840761776 }}</ref></SMALL>
|}
|}
<SMALL>Table adapted from Rook's Textbook of Dermatology, Seventh Edition<ref name="Rook's Textbook of Dermatology">{{cite book | last = Rook | first = Arthur | title = Rook's textbook of dermatology | publisher = Wiley-Blackwell | location = Chichester, West Sussex, UK Hoboken, NJ | year = 2010 | isbn = 1405161698 }}</ref> and Clinical Infectious Diseases 2005; 41:1373–406<ref name="IDSA">{{Cite journal
| author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
| title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
| journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| volume = 41
| issue = 10
| pages = 1373–1406
| year = 2005
| month = November
| doi = 10.1086/497143
| pmid = 16231249
}}</ref></SMALL> 


A [[cutaneous abscess]] could occur at multiple locations.
Patients who require hospitalization for ICU admission, operating room surgical intervention, or death have one of the following six risk factors upon presentation<ref name="pmid30420232">{{cite journal| author=Mower WR, Kadera SP, Rodriguez AD, Vanderkraan V, Krishna PK, Chiu E et al.| title=Identification of Clinical Characteristics Associated With High-Level Care Among Patients With Skin and Soft Tissue Infections. | journal=Ann Emerg Med | year= 2018 | volume=  | issue=  | pages=  | pmid=30420232 | doi=10.1016/j.annemergmed.2018.09.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30420232  }} </ref>:
* abnormal cross-sectional imaging result
* systemic inflammatory response syndrome
* previous infection at the same location
* infection involving the hand
* diabetes
* age >65 years


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 16:46, 1 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Please click on the specific skin and soft-tissue infections below for further information.

Anatomic Layers of the Skin Condition Definition† Image
x100% Epidermis Impetigo Superficial pyogenic infection of the skin which usually begins as vesicles with a very thin, fragile roof consisting only of stratum corneum.
x100% Dermis Erysipelas Infection of the upper dermis including the superficial lymphatics which typically presents as an indurated, "peau d’orange" lesion with a raised border that is demarcated from uninvolved skin.
Folliculitis Inflammation and/or infection of the hair follicle in which suppuration presents in the epidermis.
Furuncle
(Boil) 		Infection of the hair follicle in which suppuration extends through the dermis into the subcutaneous tissue. Each lesion consists of a deep-seated inflammatory nodule and an overlying pustule through which hair emerges.
Carbuncle Infection of several adjacent hair follicles, producing a coalescent inflammatory mass with pus draining from multiple follicular orifices.
Cellulitis Acute spreading infection of the deeper dermis and the subcutaneous tissue which lacks sharp demarcation from uninvolved skin.
x100% Subcutaneous
Tissue
Necrotizing
Fasciitis 		Rapidly progressive infection of deep fascia associated with bullae and necrosis of underlying skin.
x100% Muscle Myonecrosis
(Gas Gangrene) 		Rapidly progressive toxemic infection of injured muscle, producing marked edema, crepitus, and brown bullae, characterized by extensive gaseous dissection of muscle and fascial planes on radiography.
†Adapted from Clin Infect Dis. 2005;41(10):1373-406.,[1] Rook's Textbook of Dermatology,[2] and Infectious Diseases of the Skin.[3]

A cutaneous abscess could occur at multiple locations.

Patients who require hospitalization for ICU admission, operating room surgical intervention, or death have one of the following six risk factors upon presentation[4]:

  • abnormal cross-sectional imaging result
  • systemic inflammatory response syndrome
  • previous infection at the same location
  • infection involving the hand
  • diabetes
  • age >65 years

References

  1. ↑ Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ; et al. (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin Infect Dis. 41 (10): 1373–406. doi:10.1086/497143. PMID 16231249.
  2. ↑ Rook, Arthur (2010). Rook's textbook of dermatology. Chichester, West Sussex, UK Hoboken, NJ: Wiley-Blackwell. ISBN 1405161698.
  3. ↑ Elston, Dirk (2011). Infectious diseases of the skin. London: Manson. ISBN 1840761776.
  4. ↑ Mower WR, Kadera SP, Rodriguez AD, Vanderkraan V, Krishna PK, Chiu E; et al. (2018). "Identification of Clinical Characteristics Associated With High-Level Care Among Patients With Skin and Soft Tissue Infections". Ann Emerg Med. doi:10.1016/j.annemergmed.2018.09.020. PMID 30420232.
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