Bacterial skin infections can range from impetigo, folliculitis, furunculosis, erysipelas, cellulitis to recurrent boils. All these skin conditions are caused by either staphylococcus aureus alone or together with streptococcus, but rarely streptococcus alone.
13.1.1 Impetigo
Is a contagious primary infection of the skin involving the stratum corneum of epidermis. It is particularly common in children and people in disadvantaged areas. Self-inoculation and small family or community outbreaks are frequent.
Diagnostic Criteria
- Polycyclic vesicles or blisters, which can contain pus
- Early lesions are isolated or confluent Erosions and yellowish crusts (“honeycolored”)
Note: Impetigo is a clinical diagnosis and the typical location in children is around orifices, especially the mouth
Non-Pharmacological Treatment
- Improve person hygiene
- Hand washing
- Wash lesions with soap and water
- Remove crust
Pharmacological Treatments
Wet dressing with weak Potassium Permanganate (PP) soaks, 1:40000 (0.025%) solution
12 hourly for 3–4 days. Each session to last for 15 to 20 minutes
A: G.V paint 0.5% 12 hourly for 5 days
OR
C: Mupirocin 2% 12 hourly for 5–7 days
OR
D: Fusidine 12 hourly for 5–7 days
If severe or systemic symptoms are present (e.g. pyrexia) add an oral antibiotic:
A: Phenoxymethylpenicillin 500mg (PO) 6 hourly for 7 days; and for children: 25mg/kg given 6 hourly
OR
A: Erythromycin (PO) for 10 days; Adults 500mg 6 hourly; Children 25—50mg/kg 8 hourly
OR
B: Amoxicillin + Clavulanic acid 625mg (PO) 8 hourly for 5 days
13.1.2 Folliculitis
Folliculitis is an infection of the hair follicles commonly due to Staphylococcus aureus
Diagnostic Criteria
Clinical features depend on risk factors, which may result into Pseudo-folliculitis, Carbuncles aggregation and Furuncle (boil). The following are some of the clinical features:
- Scattered or extensive follicular pustules
- Macular or papulo-erythematous lesions, mainly located on thighs, buttocks, back and bearded area
- Papules and pustules
- Post-inflammatory hyperpigmentation
- Painful nodule with a central follicular pustule
- Necrosis and suppuration with discharge of necrotic core
- Permanent scars or small scars (depending on the risk factors)
- Firm, broad swollen, painful, fluctuant deep nodules
- Multiple drainage tracts
- Fever and general body malaise
Non-Pharmacological Treatment
- Suspected irritants should be avoided
- In Pseudo-folliculitis of the bearded area, shaving should be stopped for several weeks until improvement occurs. Hair should be left to grow to at least 1 mm long.
- Shaving with electric razors is preferred over manual razors for beard folliculitis. Cleaning with water and soap
Pharmacological Treatment
A: Potassium Permanganate soaks, 1:40000 (0.025%) solution 12 hourly for 3– 4 days. Each session for 15 to 20 minutes Apply:
A: Gentian Violet paint 0.5% 12 hourly for 5 days
OR
B: Silver sulfadiazine cream applied twice daily
OR
B: Mupirocin 2% 12 hourly for 5–7days
OR
C: Fusidic Acid 2% 12 hourly for 5–7 days
Note: If severe, or systemic symptoms are present (e.g. pyrexia) add an oral antibiotic
13.1.3 Abscess
Abscess is a collection of pus caused by Staphylococcus aureus.
Diagnostic Criteria:
- Painful pus filled nodule
- Inflammatory erythematous plaque.
- Fluctuant palpable swelling
- Fever is rare
- Lymphangitis and satellite nodes may be experienced
Non-Pharmacological Treatment
- By placing hot compresses over the swelling until it breaks
Pharmacological Treatment
A: Erythromycin (PO) for 7–10 days. Adults: 500mg 8 hourly; Children: 25–50mg/kg 8 hourly
OR
B: Flucloxacillin (P0) for 7–10 days. Adults: 500mg 6 hourly; Children: 25mg/kg 6 hourly
Surgical Treatment
- Incision and drainage
13.1.4 Erysipelas
Erysipelas is an acute superficial dermal infection commonly caused by Streptococci.
Diagnostic Criteria
- A prodrome of fever, chills, and malaise
- Locally, a large erythematous, swelling, well-demarcated, and usually raised lesion
- Regional adenopathy is frequent
- Superficial blistering secondary to edema,
- Superficial hemorrhage, may be sometimes be observed
Non Pharmacological Treatment
- Bed rest
- Elevation of the affected part
- Venous compression is recommended during the acute phase and subsequent weeks to reduce the risk of lymphedema
- Prophylaxis of deep venous thrombosis (DVT) should be considered depending on presence of other risk factors
Pharmacological Traetment
Weak Potassium Permanganate soaks, 1:40000 (0.025%) solution 12 hourly for 3–4 days, with each session lasting for 15–20 minutes
B: Silver sulfadiazine cream 12 hourly daily
OR
C: Mupirocin 2% 12 hourly for 5–7 days
OR
C: Fusidic Acid 2% 12 hourly for 5–7 days
AND
A: Phenoxymethylpenicillin (PO) for 5–7 days. Adults: 250–500mg 6 hourly;
Children: 25mg/kg 6 hourly
OR
B: Flucloxacillin (PO) for 5–7 days. Adults: 500mg 6 hourly; Children: 25–50/kg 6 hourly
Surgical Treatment
- Incision and drainage (in case of secondary abscess formation)
Referral
If there are local or general signs of severity of developing necrotizing fasciitis refer the patient to a higher level health care facility with adequate expertise and facilities.
13.1.5 Paronychia
Paronychia is a painful infection that usually occurs at the nail fold. It may occur after injury or minor trauma, and is caused by Staphylococcus aureus. It may also occur as a result of fungal infection.
Diagnostic Criteria
- Painful nail
- Redness
- Swelling
Pharmacological Treatment
Acute Paronychia
B: Amoxicillin with clavulanic acid 625mg (PO) 8 hourly for 14 days.
Chronic Paronychia (commonly due to fungal infection)
A: Clotrimazole cream 1%, apply topically 12 hourly for 14 days
AND
C: Itraconazole tablets (PO) 200mg once daily for 14 days
AND
S: Clindamycin tablets 300mg (PO) 12 hourly for 14 days
Note: For both acute and chronic paronychia, incision and drainage may be needed
