Skin and skin structure infections (SSSIs) make up to about 10% of hospital visits in the U.S. These include deeper infections like necrotizing fasciitis, myositis, and gas gangrene and milder infections like erysipelas, cellulitis, boils, small abscesses, and wound infections. Treatment depends on the cause of infection or injury. The choice of antibiotic depends on the severity of infection. Unfortunately, few antibiotics effectively treat resistant bacteria in serious skin infections. However, novel treatment regimens are being researched to improve available treatments.

Skin and soft tissue infections affect many people in the U.S. Fourteen million people suffer every year due to these skin infections. Males, black individuals, and those aged 18 to 44 are affected most. Community acquired MRSA leads to 59% of emergency treatments.

Microbial pathogens: Many microbes like bacteria, fungi, viruses, and parasites cause SSSIs. The most common are bacteria like Streptococcus pyogenes and Staphylococcus aureus. These include drug resistant strains like MRSA. Sometimes other bacteria are also involved, like Pseudomonas aeruginosa, Enterococcus species, and anaerobic bacteria. Fungi like Candida, Trichophyton, Epidermophyton, and Microsporum can infect skin. Common viruses are HPV, chickenpox, and herpes simple­x viruses. Head lice and scabies mites are parasitic pests.

Disruption of skin barrier: SSTIs often arise due to weaker immune systems. This allows germs to enter and grow in the tissue. Trauma, cuts, scrapes, surgery wounds, burns, insect bites, and diseases like psoriasis or eczema can damage the skin barrier. Skin moisture, maceration, and occlusion can also help germs grow and invade.

Inflammatory response: The body reacts to invading germs by starting an inflammatory process. Many immune cells move to the infection site to fight the germs. These cells are neutrophils, macrophages, and lymphocytes. Prostaglandins, cytokines, and chemokines are examples of signaling chemicals. They coordinate the immune response and cause inflammation symptoms such as redness, swelling, heat, and pain.

Production of toxins: Some bacteria produce toxins and other harmful chemicals. They can worsen the skin and tissue infections. For example, S. aureus bacteria can release poisons like PVL (pantone-valentine leukocidin) and hemolysin (alpha-toxin). These break down cells and tissues. They cause abscesses and severe infections that destroy tissue.

Many germs cause skin and soft tissue infections. Bacteria like Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae, Enterococcus species, Pseudomonas aeruginosa, Escherichia coli, Proteus species, and anaerobic bacteria are the main organisms responsible for the infection. Candida species cause a fungal infection called cutaneous candidiasis. Dermatophytoses or tinea infections come from other fungi. Herpes Simplex Virus (HSV), Variola-Zoster Virus (VZV), and Human Papillomavirus (HPV) are viral infections. The mite Sarcoptes scabiei causes scabies. Lice like Pediculus humanus capitis and corporis infect too. These germs lead to skin lesions, secondary bacterial infections, bacterial infections. Identifying and treating these infections can prevent them.

Infections of skin and soft tissue may be harmful and severe. The prognosis of the infections depends on various prognostic factors. Skin and soft tissue infe­ctions can be serious. Their prognosis de­pends on several factors. Severity of the disease depends on underlying medical issues, timely treatment, and response to the treatment.

Most SSTI patients have redness, warmth, swelling, and pain. They often have fever and other symptoms also. The legs are most affected areas. Hard lumps form in cellulitis and erysipelas, which spread under the skin. In necrotizing fasciitis, pain exceeds visible issues. Bleeding, fluid-filled sacs, numb areas, rapid spread, and crackling sounds of gas happen. Big swelling and sacs help identify it from milder infections.

Finding signs of infection on the skin such as redness, swelling, warmth, tenderness, firmness, fluid-filled areas, open sores, and dead tissue. Identify for superficial infections.

• Peripheral neuropathy
• CKD (chronic kidney disease)
• Obesity
• Chronic skin conditions
• Peripheral vascular disease
• Diabetes milletus
• Immonuosuppression
• Venous insufficiency

Acute presentation:

Sudden Onset Syndrome is a condition that often comes with sharp pain, swelling, and heat around the injured area. It can also bring fever chills, a general sick feeling, swollen lymph nodes, and inflammation throughout the body. These systemic symptoms are common signs of Sudden Onset Syndrome. The injury site experiences acute discomfort, puffiness, and warm

Subacute presentation:

Infections that are chronic tend to start slowly, over a course of days or even weeks. The symptoms may shift during this period too. Those affected can feel a constant discomfort, of moderate intensity.

Chronic presentation:

Along with persistent symptoms which often intensify despite treatments, chronic surgical site infections may lead to ulcers. They cause granulation tissue growth, delayed wound healing, and secondary infections producing foul-smelling discharge.

Complicated presentation:

Severe pain and tissue necrosis can re­sult from deep surgical site infections. These affect muscles, bones, or fascia. Pus collections, called abscesses, often develop. They need drainage to resolve the problem.

Assessment of symptoms and likely cause of infection leads to proper use of antibiotics. It depends on local resistance patterns, patient factors, and possible germs. For simple skin infections, cephalexin, dicloxacillin, clindamycin, or trimethoprim-sulfamethoxazole pills may be employed. If it is severe or MRSA is suspected, oral or IV drugs could be used. Antibiotics may change based on cultures or worsening symptoms. Proper wound care helps healing and prevents issues. Topical antiseptics or antibiotic ointments treat minor skin infections along with oral antibiotics. Other therapies manage pain, provide support, and address underlying conditions. Patients need close check-ups, follow-ups, and specialist referrals as needed. Prevention means good hygiene, vaccinating against germs, and not sharing personal items.

Dermatology, General

• Wound irrigation:   Cleaning wounds is important. Irrigation utilizes potable water or sterile saline solution. It flushes out debris, bacteria, and dead tissue from wounds. Bulb syringes or high-pressure equipment provide fluid flow to clean wounds. Proper technique reduces risk of contamination. Avoid directing fluid at wound edges. Maintain consistent flow rate.
• Removing unhe­althy tissues: Debridement gets rid of dead tissue, foreign things, and tissues that can’t heal. This helps in the growth of new healthy tissue. Techniques include sharp (scalpel, scissors, curette), mechanical (wet dressings, enzymes), autolytic (bandages), and surgical (operating room). Only trained healthcare workers should do debridement properly. Following the right sterile procedures minimizes risk of infection and tissue damage.
• Wound dressings: Wound dressings manage SSTIs based on the type of wound. For infected wounds or wounds with high risk, antimicrobial dressings like silver, iodine, or honey can beused. Moist dressings help in growth of new skin and shrinkage of wounds. Compression dressings or wraps promote the back flow of blood from veins and reduce swelling for venous stasis ulcers or swollen wounds. Non-adherent dressings minimize damage when changing dressings.

Dermatology, General

Linezolid is a member of novel oxazolidinone derivatives with wide spectrum of activity against gram+ve bacteria including VRE and MRSA. It possesses bacteriostatic action by inhibiting the protein synthesis iin bacteria.

Dermatology, General

Daptomycin belongs to cyclic lipopeptide having antimicrbail activity against gram+ve bacteria, enterococci, and staphylococci. It acts by binding to the bacterial membrane via calcium-dependent manner leading to disruption of RNA, DNA and protein synthesis by depolarization leading to the death of bacterial cell.

Dermatology, General

Tigecycline derived from minocycline is a glycylcycline antibiotic active against gram+ve and gram-ve bacteria.

Dermatology, General

Telavancin, a glycopeptide derived from vancomycin shows bactericidal activity against staphylococci, MRSA and VRSA.

Dermatology, General

Diagnosing and treating skin infections requires a thorough assessment of the patient’s symptoms, signs, and risk factors. This involves a complete physical exam, medical history review, and diagnostic tests. Treatment includes supportive care, abscess drainage, and empirical antibiotics. Patients need education on preventing recurrence and proper wound care. Monitoring and follow-up are key factors. Optimizing wound healing involves cleaning, debridement, and dressing selection. Preventive measures address risk factors predisposing to infections. For high-risk groups, vaccination against specific pathogens may be considered. Long-term care involves regular surveillance, symptom tracking, and actively managing underlying conditions. Coordinating care with specialists is crucial for minimizing complications and optimizing long-term outcomes.