Integumentary System
Lesson 4: Common Skin Diseases
4-4
4-4. BACTERIAL INFECTIONS OF THE SKIN
a. Impetigo.
(1) Description/characteristics. Impetigo is an inflammation of skin marked by isolated pustules. These skin lesions become crusted and ruptured. The causes of impetigo include minor skin injuries such as scratches, insect bites, mosquito bites, etc., which become infected with staphylococcal or streptococcal (group AB--hemolytic) infections. Initial lesions have vesicles, bullae, and pustules on the face and extremities. The lesions rupture, becoming red erosions. Ecthyma (ulcerated impetigo) is usually present. Impetigo is very contagious and often found in infants and young children. The organism staphylococcus is the most common cause of impetigo, but streptococcus occasionally causes the disease.
(2) Treatment. Begin by washing the affected area with soap and water three times a day. Scrub gently to remove crusts. Administer erythromycin 250 mg by mouth four times a day for 10 days.
b. Furuncle (Boil)
(1) Description/characteristics. A furuncle or boil is an inflammation of subcutaneous layers of skin gland or hair follicle. Causes include chronic diseases, staphylococcal organisms, or trauma to the skin such as shaving or squeezing. The nodules are hot, tender, red, and hard. They may break down to form a necrotic core that has a pus-filled center and pus point. A boil starts with a hair follicle and occurs especially at the neck, axilla, and buttock. They are painful because of pressure being put on nerve endings, particularly in areas where there is little room for swelling of underlying structures.
(2) Treatment. DO NOT squeeze lesions near the nose. Treat these and other boils in this way. Administer penicillin VK by mouth four times daily for 10 days. Apply warm soaks to make the boil form a head. Make an incision and drain the boil.
c. Carbuncle.
(1) Description/characteristics. A carbuncle is an abscess of skin and deeper tissues--an extension of a furuncle invading multiple follicles. Carbuncles are caused by staphylococcal infections. Deeper than a furuncle and usually located on the lower neck and upper back, carbuncles heal slowly and leave a large scar. Signs and symptoms include the following:
(a) Possible fever.
(b) Two or more cores to one lesion.
(c) Multiple drainage points.
(d) Deep suppuration (production and discharge of pus).
(e) Extensive local sloughing.
(f) Multiple draining abscesses.
(2) Treatment. Apply hot compresses. Then perform an incision and allow the lesion to drain. Apply an antibiotic topically to the lesion or have the patient take an oral antibiotic. Consult a physician if the patient is resistant to conservative local antibiotic therapy.
d. Cellulitis.
(1) Description/characteristics. Cellulitis is an acute or chronic infection of the skin caused by complication of a wound, ulcer, or impetigo. Invasion of normal skin is possible, especially on the feet and lower legs. Cellulitis is usually caused by streptococcal bacteria, but rarely caused by staphylococcus bacteria. The affected area becomes warm, red, and tender. When pressure is applied to the skin, there is pitting edema in various places around the affected
area. Later, blisters with pus form. If the affected area is large, the patient's entire body reacts. The lower extremities are often involved. Recurrent attacks of cellulitis may sometimes affect the lymphatic vessels and produce permanent swelling called "solid edema."
(2) Treatment. To treat cellulitis, give oral antibiotics; for example, penicillin VK. Elevate the affected area, if possible, and give warm soaks. If cellulitis is severe, recommend bedrest. Continue treatment until signs of the infection are absent for four to five days.
e. Miliaria (Heat Rash).
(1) Description/characteristics. Heat rash is an acute inflammation of the sweat glands. The rash occurs when the free flow of sweat from the pores is obstructed. Heat rash is most common during hot weather or when an individual is working in areas where the environmental temperature is unusually high with humidity. The skin lesions are numerous and profuse, but they are usually confined to the covered areas of the body because these areas are where the temperature is the hottest. Three types of lesions are usually present; all are pinhead size. The vesicles are usually clear with red papules and very small pustules. Itching may be present.
(2) Treatment. Keep the patient cool and advise him to take cool, not hot, showers. The patient should wear light clothing and use talcum powder or cornstarch generously over the affected areas. DO NOT cover the area with ointments because they trap sweat causing the heat rash to become worse.
f. Paronychia.
(1) Description/characteristics. Paronychia is an inflammation of the skin around the nail. In acute cases, the causative organism is usually microcci, Pseudomonas, or Proteus and sometimes Candida. The organism enters through a break in the skin; for example, hangnail or break caused by manicuring. Infections may follow the nail margin or may extend beneath the nail, and pus may form.
(2) Treatment. Do not apply hot compresses or soak acute cases that are infected. For bacterial infections, administer an appropriate systemic antibiotic. If the skin lesion has a pus-filled pocket, open the lesion carefully using the point of a scalpel.
g. Folliculitis.
(1) Description/characteristics. Folliculitis is an inflammation of the hair follicles caused by staphylococcal infection. Sycosis (barbare vulgaris) is a chronic, hard to manage type also known as pseudofolliculitis or barber's itch. This type of folliculitis is a deep-seated lesion. It is caused by trauma such as shaving and autoinoculation. The skin lesions will burn and itch slightly, and pain will occur on the manipulation of hair. In sycosis, the surrounding skin becomes involved also; therefore, the lesions look much like a form of impetigo or eczema with redness and crusting.
(2) Treatment. Treatment should include using good personal hygiene and keeping the affected area clean. Medications that can be applied to the affected area include iodochlorhydroxquin three percent in cream or ointment form, applied locally twice a day, as well as an antibiotic such as polymyxin B in combination with bacitracin or oxytetracycline. The protocol of treatment facility for folliculitis or pseudofolliculitis should be followed.
