Download Superficial skin infections: causes, prevention and manage

SKIN CARE
Superficial skin
infections: causes,
prevention and management in the pharmacy
Patients with the following conditions have a higher risk of
getting skin infections:
• Diabetes mellitus
• Hepatitis
• Obesity
• Chronic skin conditions such as eczema
• Suppressed immune systems due to HIV, chemotherapy or
use of certain medicines
Sumari Davis, BPharm
If these patients develop a skin infection, it tends to be more
severe than in healthy patients.
Amayeza Information Services
Introduction
Types of skin infections
The skin provides a good barrier against infections and
although many organisms come in contact or live on the
skin, they usually do not cause infection. When the skin gets
inflamed or damaged by sunburn, scratching or other trauma,
infection with bacteria, fungi or viruses can occur. This article
discusses the causes and management of some of the minor
skin infections most commonly seen in the pharmacy.
Skin infections can occur due to several different types of
bacteria, fungi or viruses. The most common infections are
listed in Table I.
Factors that can increase the risk of a skin
infection
Any break in the skin increases the risk of a skin infection.
Advanced age, living in old age homes and walking barefoot
at communal changing rooms such as at a gym, sport club or
school can also increase the risk of getting infected.
Impetigo (bacterial)
Impetigo usually affects children between the ages of two
and five years, but can also occur in older children and adults.
The areas most affected include the face, arms or legs. This
bacterial infection causes red bumps on the skin that turn into
blisters. The blisters burst and scab over with a distinctive
yellow, gold or brown crust. Sometimes, the blisters become
painful sores that heal slowly. Patients with impetigo do
not usually have fever, and if fever, severe pain, worsening
Table I. Summary of the most commonly occurring skin infections
Bacterial infections
Fungal and yeast infections
Viral infections
Impetigo (S. aureus and sometimes S.
pyogenes)
Athlete’s foot (tinea pedis)
Cold sores (herpes labialis caused by herpes
simplex virus)
Folliculitis (infection of the hair follicle from
hot tubs or swimming pools)
Beard ringworm (tinea barbae)
Warts
Furuncles (“boils”)
Scalp ringworm (tinea capitis)
Shingles
Carbuncles
Body ringworm (tinea corporis)
Cellulitis
Jock itch (tinea cruris)
Tinea versicolor
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swelling and redness or loss of appetite is present, the patient
should be referred to a doctor.
Less severe cases of impetigo can often be treated
successfully with mupirocin or retapamulin cream or ointment.
Treatment should continue for at least five days but not longer
than 10 days without seeing a doctor.
Patients should receive the following information on how to
prevent the spread of the infection to other contacts:
• Keep the affected areas covered with dry dressings
• Regularly wash the hands with soap and water
• Use disposable tissue paper to blow or wipe the nose and
discard safely after use
• Do not share personal items such as towels, face cloths or
hair combs
• Wash towels, bed linen and face cloths in hot water and dry
them on high heat
Tinea infections (fungal)
Tinea infections are fungal infections and are named based
on the location of the infection. Treatment also varies based
on the site infected. Table II provides a summary of the most
common tinea infections and suggested treatment options.
Patients with severe or widespread infection and infections
that do not respond to topical treatment, should be referred
to a doctor.
that have missing patches of hair or a rash may have a tinea
infection which requires treatment.
Cold sores “fever blisters” (viral)
Initial infection occurs mostly in children and often goes
unnoticed. The virus then remains dormant in the nerve roots
and can be reactivated by sunlight, wind, local trauma to
the skin, menstruation or an infection such as a cold or flu.
Physical and emotional stress can also serve as triggers for
developing a cold sore. Patients may experience a tingling
sensation or discomfort within 6–24 hours before appearance
of a cold sore. Minute blisters appear on top of a red inflamed
area mostly on the lips or face. Lesions are usually very painful
and blisters break down to form raw areas with crusting
usually by the fourth day, and complete healing within a week.
Starting treatment with aciclovir or penciclovir when the initial
tingling and itching occurs can reduce the time the cold sore
takes to heal. Patients with poor immunity, cold sores in the
eye or sores that are painless, should be referred to a doctor.
“Starting treatment with aciclovir
or penciclovir when the initial
tingling and itching occurs can
reduce the time the cold sore takes
to heal.”
Tinea infections may be prevented by adhering to the following
measures:
• Do not share clothing, sports equipment, towels and
brushes or combs with other people
• Wear sandals or shoes in public areas such as the gym or
swimming pools, including the showers
• Dry the skin completely after swimming or bathing
Patients with a tinea infection should be treated as soon as
possible to prevent the spread of the infection to others. Pets
Warts (viral)
Warts occur most commonly as a raised flesh-coloured lesion
with a rough surface on the back of the hands, palms or around
the fingernails. Warts on the soles of the feet are pushed
inwards due to pressure from the body’s weight and are called
plantar warts. Warts have a network of small blood vessels
that distinguish warts from corns and callouses. Warts on
Table II. Summary of the most common tinea infections and treatment suggestions
Infection
Appearance and location
Suggested treatment
Athlete’s foot
(tinea pedis)
Itchy flaky skin affecting the web space between the toes,
most commonly between the fourth and fifth toes
Topical antifungals such as terbinafine,
clotrimazole, miconazole or ketoconazole.
Terbinafine is more effective in preventing
recurrence
Scalp ringworm
(tinea capitis)
Dry scaly patches on the head that may be itchy and/or cause
hair loss. Hair shafts may break off at the skin surface or just
above the surface leaving short stubs
Children: Oral treatment with griseofulvin* with
antifungal cream and selenium sulfide shampoo
Adults: Oral itraconazole or terbinafine*
Body ringworm
(tinea corporis)
Round patches of clear red or pink skin surrounded by raised
scaly borders that can occur on any part of the body
Topical application of ciclopirox or terbinafine
Jock itch
(tinea cruris)
Rash usually starts in the skinfolds of the groin area and can
spread to the inner thigh, has a scaly pink border and can be
itchy and painful
Topical treatment with miconazole, ketoconazole or
clotrimazole
Tinea versicolor
Does not usually cause symptoms, but patients with fair skin
may develop dark scaly patches and patients with dark skin
may notice lighter patches on the neck, trunk, abdomen and
sometimes the face
Topical application of selenium sulphide shampoo
to the skin (10 minutes a day for one week) or
ketoconazole cream
* On prescription only
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other parts of the body such as the face or genitalia are best
referred to a doctor for management.
or wide-spread infections and those not responding to topical
treatment should be managed by a doctor.
Warts usually disappear as soon as the body develops
immunity against the virus but this can take up to two years.
Products for treatment of warts aim to reduce the size by
gradual destruction of the skin and removal of the infected
tissue within a period of three months. Salicylic acid and
podophyllin should be used very carefully. Patients with
diabetes should not be treated with products available over
the counter as they may not always feel pain due to damage
to the nerve endings and are also at risk of developing wounds
that may not heal.These patients, as well as patients with poor
immunity, should be referred to a doctor.
Bibliography
Conclusion
Skin infections can occur due to bacterial, fungal or viral
infection after penetration of the organism through damaged
skin. It is important to correctly identify the cause of the
infection in order to recommend effective treatment. Severe
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