OVERVIEW

Pyoderma means any pyogenic (pus forming) infection of the skin and is most commonly used in reference to bacterial skin infection. Bacterial infection can be superficial or deep and symptoms will also depend on level of infection. Common bacterial skin diseases are impetigo, folliculitis, furuncle, carbuncle, abscess and cellulitis. Impetigo is discussed as separate entity and rest of other common bacterial infection is mentioned here.

Causes

Most commonly involved bacterias in causing folliculitis, furuncle, carbuncle, ecthyma, abscess, erysipelas, and cellulitis are Staphylococcus and Streptococcus. Sometimes less commonly other bacteria like Pseudomonas, Klebsiella and many more can also be causative pathogen.
Risk factors for superficial bacterial infections like folliculitis, furuncle, or carbuncle

• Poor hygiene,
• Immuno-compromised status,
• Skin to skin contact with infected person
• Contact with object carrying these bacteria
• Nasal carriage
• Occlusion of hair follicle
• Excess sweating
• Scratching in Dry skin
• Long use of topical steroid
• Long term antibiotic therapy for other disease
• Shaving against direction of hair growth
• Hot bath

Risk factors for deep bacterial infections like abscess, erysipelas or cellulitis

• Presence of superficial bacterial infection and not treated properly at time
• Skin barrier disruption due to skin trauma
• Skin inflammation
• Long swelling due to abnormal lymphatic drainage or venous insufficiency
• Obesity
• Immuno-suppresion

Once bacteria get access to enter in skin, type of infection and severity depend on these risk factors, immunity of individual, load of bacteria and time taken to start treatment.

Symptoms

Symptoms of superficial bacterial infection

Folliculitis: It presents as pus filled (yellow colored) or red bumps arising from hair follicle. Itching and pain are common symptoms of folliculitis. Folliculitis can develop in any hair bearing area of body. Commonly scalp and face folliculitis are caused by simple bacteria while folliculitis in chest, scrotum, flanks and periumbilical region are caused by resistant bacterias.

“Folliculitis barbae” (sycosisbarbae) develops in the beard area of and it involves deeper part of multiple hair follicles.

“Hot tub folliculitis” is induced by Pseudomonas bacteria and usually it develop after 8 to 48 hours of contact with contaminated water in form of rash or red/yellow bumps. It involves bathing suit area.

Gram-negative folliculitis is associated with long use of oral antibiotics. It involves peri-oral and peri-nasal area commonly.

Furuncle: It involves deeper part of hair follicle and presents as rapidly developing painful red swelling which may progress in size and become fluctuant with time. Once it ruptures, sign and symptoms reduces but recurrence can happen it no treatment has taken. Common sites are face, neck , underarms, belt area or perineum. Usually systemic symptoms fever, body ache are not present.

Carbuncle: If multiple furuncles join each other then they form carbuncle, which extends deep into fat layer. There can be multiple pus-discharging opening on skin and sometimes frank ulcer can also formed. Commonly present on areas of thick skin like back of neck, hips, and thighs. Systemic symptoms can be present.

Abscess: These are painful localized fluctuant collection of pus in skin and fat layer with inflammation of different grading and can present at any site. It can follow furuncle or carbuncle. It can develop with or without cellulitis. Systemic features are rare.

Cellulitis & erysipelas: Cellulitis involves deep layers of skin. Erysipelas is superficial variant of cellulitis because it involves superficial layers of skin. Three essential features skin redness, swelling and warmth mostly present in affected area. Superficial fluid filled vesicles can also present. Fever and body ache are feature of severe infection. Most of the time they involve one side of body. Lower limbs are most common site. When they resolves desquamation (peeling of skin) and pigmentation changes may occur.

Treatment

Treatment of skin bacterial infection

Diagnosis : Most of the times dermatologist diagnose bacterial infection by clinical examination only. Gram stain and Pus culture and sensitivity are done to identify bacteria and its sensitivity to different antibiotics. Culture sensitivity test is useful in recurrent cases. In recurrent cases to rule out underlying immunosuppressive status some blood test (blood sugar etc) can be asked according to medical history.

Treatment: Topical antibiotics: Fewer smaller folliculitis.

Oral antibiotics: Empirical or based on culture report for numerous folliculitis, non-complicated furuncle, carbuncle and cellulitis.

Injectable antibiotics: Complicated cellulitis or presence of severe systemic symptoms.

Anti-inflammatory or analgesic: depends on symptoms like fever, pain, swelling

Skin care in infection: Keeping affected area clean and dry is important. Proper cleaning of involved skin with normal water and soap twice a day is required. We ask patient to avoid any crude or customized home method to clean wounds to avoid irritant contact dermatitis. Open wounds can be covered with dressing but in non-ruptured lesions no dressing is required.

Treatment of Recurrent folliculitis or recurrent furuncle (boil)

Risk factors need to find out which may cause recurrent infection.
Pus culture sensitivity
Antibiotic according to culture report
Treatment of persistent carrier sites of bacteria

TIPS

1. Don’t ignore at start. Apply topical antibiotic on initial lesion at home
2. Don’t stop medicine in between even you have recovered sooner.
3. Complete the oral antibiotic course as doctor suggested to prevent resistance to that antibiotic in your body.
4. Keep good hygiene of body.
5. Avoid contact with infection source (person or object)
6. Always mention to doctor if you have allergy to any antibiotic

Should I complete full course of antibiotic even if infection resolved in 1-2 days?

Yes, you should not stop antibiotic without completing its course to avoid development of resistance to that antibiotic in your body.

How many days it may take to cure?

Superficial bacterial infection like folliculitis may take 5-7 days to resolve. Deeper infection like carbuncle, cellulitis may take 7-14 days to resolve completely. If some patient requires injectable antibiotics for severe infection then it may take longer time to complete whole treatment.

Are antibiotics harmful?

Usually antibiotics being used in skin bacterial infection treatments don’t cause any serious side effect. About pre existing allergy to any antibiotic should be inform to doctor in advance so doctor will write you different antibiotic. Self-limiting mild GI upset and diarrhea are common side effects.

Why should I choose Dr. KothiwalaSkinEva Clinic for Skin Bacterial infection treatment?

Detailed Consultation with best dermatologist in Jaipur, Dr. Sunil Kothiwala, MD (AIIMS)

Effective and minimum antibiotic therapy based on pus culture sensitivity

Identification of risk factor at start of treatment

For more information on Bacterial Infection or to inquire about other services please contact us on 7669571405.