This article was medically reviewed by Dr. Damanprett Ubhi.
The skin is the largest organ in the body and the most visible one. Although it’s designed to protect us from microbes and the elements, the skin’s three layers – the epidermis, dermis, and subcutaneous fat – provide many opportunities for infections that range in severity. In fact, there are over 14 million cases of a common bacterial skin infection called cellulitis each year in the U.S. alone. So, it’s important to understand the different types of skin and soft tissue infections (SSTIs), the causes, treatment options, and how to prevent them. In this article, ID Care’s Dr. Damanprett Ubhi discusses all you need to know about SSTIs.
What Are Skin and Soft Tissue Infections?
Skin and soft tissue infections (SSTIs) encompass any type of microorganism – bacterial, viral, or fungal – that enters any break in the skin and can invade the subcutaneous tissue (soft tissue under the skin), fascia (connective tissue), and muscles.
“Even things like small cuts, scratches or wounds should be treated with the utmost care,” says Dr. Ubhi. “While some skin and soft tissue infections like cellulitis or boils (furuncles) are considered simple or uncomplicated, there are other more serious or complicated infections, like abscesses and necrotizing fasciitis (known as flesh-eating bacteria), that go deeper in the tissues and can be systemic. That’s why it’s very important to be cognizant of your environment, pay close attention to your body, and get medical attention at the onset of any symptoms of a possible skin infection.”
What are the Causes and Types of Skin and Soft Tissue Infections?
There are a variety of microorganisms that cause different types of skin and soft tissue infections:
Bacterial
Bacteria live on and around the skin and are the most common cause of SSTIs as they can enter your body in many ways, including through punctures, burns, small cuts, scrapes, and surgical site wounds. The most common bacteria that cause these infections are Staphylococcus aureus (Staph) and Streptococcus (Strep). Cellulitis is one of the most common infections to result and must be treated immediately with a course of antibiotics.
Other common types organisms causing simple bacterial infections are:
- Pseudomonas folliculitis: contracted in hot water tubs
- Pseudomonas: from a nail puncture
- Vibrio: from exposure to sea water
- Pasteurella and skin flora: from a cat or dog bite
- Eikenella and other oral flora: from a human bite
It is important to note that Methicillin-resistant Staphylococcus aureus (MRSA) is another type of skin infection caused by a type of staph bacteria that is resistant to penicillin antibiotics. It is typically contracted in a hospital or healthcare setting like nursing homes. However, there is also a community-associated MRSA that occurs in more healthy people and is spread via human skin contact. This form is more common among childcare workers, school wrestlers, and people dwelling in crowded environments.
Viral
The most common types of viral skin infections are herpes simplex (HSV), herpes zoster virus (HZV), and varicella zoster (VZV). There are two types of herpes simplex, HSV-1 and HSV-2. HSV-1 presents as cold sores and blisters around the mouth and face. HSV-2 is genital herpes. Varicella zoster causes chickenpox. Herpes zoster causes shingles. Herpes zoster is caused by a reactivated varicella zoster virus, the same virus that causes chickenpox. Chickenpox and shingles can occur anywhere on your body.
Fungal
Fungal skin infections thrive in warm, moist places, but can happen anywhere on the body. One of the most common types of fungi is called tinea. It causes jock itch, athlete’s foot, and ringworm. Candida, another common fungus, can lead to an infection called intertrigo, a rash between larger skin folds, typically in more obese people. And another fungus Sporothrix causes an infection called sporotrichosis – commonly known as “rose gardener’s disease” – as it lives in soil and on plants like rose bushes.
How Do You Contract a Skin or Soft Tissue Infection?
Bacterial skin and soft tissue infections are the most common. Covering even minor wounds, like cuts and scrapes, can decrease your chances of getting a bacterial skin infection. Bacterial infections can happen in several ways, like stepping on a dirty nail, sitting in a contaminated hot tub, exposing open wounds to salt water, or from human or animal bites.
Viral skin infections are transmitted by touching someone else or through human contact. Fungal infections, however, are often lifestyle driven. Common behaviors that can result in a fungal infection include going to a gym (showers and equipment) and working in a garden (soil and rose bushes), to name few.
Skin and soft tissue infections are also contracted more readily among those with weakened immune systems, which is the result of a pre-existing medical condition or a side effect of medication. The complexity of all the ways you can contract an SSTI makes an infectious disease specialist your go-to medical professional for the fastest and most effective resolution.
What are the Signs and Symptoms of a Skin or Soft Tissue Infection?
The signs of a skin or soft tissue infection are vast. They generally start with mild symptoms like redness, warmth, swelling, or discharge at the infection site. More serious symptoms can include fever, chills, change in mental status, nausea, skin dimpling, or vomiting. Very severe infections can have life-threatening symptoms like rapid heartbeat, intense pain, foul-smelling drainage, and potentially shock.
SSTIs are classified into two groups: Uncomplicated and Complicated.
Uncomplicated SSTIs and Treatments: these can be either bacterial, viral, or fungal, and are generally not risky. Most uncomplicated SSTIs can be treated with outpatient care. They respond well to antibiotics, drainage, or tissue removal. Examples include cellulitis, inflamed hair follicles (folliculitis), boils (furunculosis), and minor wound infections. Commonly used oral antibiotics for Staph and Strep infections include Doxycycline, Bactrim as well as Augmentin, Ceftin, or Levaquin.
Complicated SSTIs and Treatments: these are rapidly spreading, inflammatory bacterial infections like necrotizing fasciitis, infected burn wounds, deep wound infections, infections in diabetics, and infected ulcers. This type of infection requires immediate medical attention because it involves deep tissues. IV antibiotics such as Vancomycin, Zosyn, Cefepime, Rocephin, or Clindamycin are typically administered in an inpatient or healthcare setting dependent on the specific infection and patient’s course of treatment.
How Do You Diagnose a Skin or Soft Tissue Infection?
A skin infection requires a medical diagnosis. An ID Care infectious disease specialist will evaluate a patient’s health history, including lifestyle-related questions as part of the diagnostic exam. For example, our physician might ask someone with itchy toes or peeling, cracking skin on the feet if they’ve been walking barefoot around a public pool or locker room. That will help determine if the patient has the fungus that causes athlete’s foot. Additionally, an ID expert may perform a series of tests to diagnose and isolate the cause of a skin or soft tissue infection depending on the patient’s health condition and SSTI presentation. These can include:
- Lab Test: to test drainage culture from the infection site to determine the microbial cause of the infection
- Blood Test: Blood cultures to isolate the specific microorganism involved
- Biopsy: examination of a skin or tissue sample to narrow the infection further
- Computed Tomography (CT) Scan: for a more comprehensive internal review in complicated skin and soft tissue infection.
Who is Most at Risk for Skin and Soft Tissue Infections?
Age, underlying health conditions, a weakened immune system, certain medications, open wounds, and use of IV drugs will all increase your risk for skin and soft tissue infections. Skin problems are also common among recent travelers.
Here is a Breakdown of Key SSTI Risk Factors:
- Age: older adults 65+ are more susceptible to SSTIs; additionally, children under 5 years old childhood skin infections
- Underlying Health Conditions and Weakened Immune Systems: those with comorbid health conditions including diabetics (especially uncontrolled cases), those who are obese or smokers, individuals with venous insufficiency (like varicose veins), lymphedema (poor lymphatic system), or liver cirrhosis, those immunocompromised (like cancer patients), and individuals who recently underwent surgery are most at risk. Also, individuals who suffer from chronic neuropathic pain due to conditions like HIV infections or AIDS, multiple sclerosis, and thyroid issues are also at a higher risk of skin infections.
- Prescription Medications: although the benefits far outweigh the risks, it is important to be mindful that side effects of some medications can make people prone to skin infections. For example, blood thinners cause more frequent breaks in the skin and chemo can injure skin cells, making it easier for germs to enter the body. Use of chronic steroids makes skin fragile and makes it easier for germs to enter the body.
- Open Wounds: anyone with a break in the epidermis (the outer skin layer), is at a higher risk for infection. This is especially true if the wound is left uncovered.
- IV Drug Users: abscesses are the most frequent type of SSTI among IV drug users. They happen when drugs are injected into the skin or muscle. Medical professionals administer prescription IV medications intravenously which is different and very safe.
- Recent Travelers: according to the Centers for Disease Control and Prevention (CDC), 30% of returning sick travelers have skin issues. Bug bites are one of the most common types of skin lesions. You can minimize the chances of getting a travel-related illness or infection by seeing a travel medicine specialist prior to your trip.
When are SSTIs Treated on an Outpatient Versus Inpatient Basis?
The severity of the skin and soft tissue infection, how it responds to medication, and the patient’s overall health will determine whether outpatient versus hospital-based care is needed. Untreated infections can cause a life-threatening condition called sepsis. Sepsis is a dramatic response of your immune system to infections and affects 1.7 million Americans each year. Symptoms can include confusion or disorientation, extreme pain, high heart rate, or low blood pressure. You can mitigate risk of hospitalization and resolve your infection quickly by seeking medical attention from an ID Care infectious disease specialist as soon as possible.
What is the Best Way to Prevent Skin and Soft Tissue Infections from Occurring or Recurring?
“The best way to prevent skin and soft tissue infections from occurring or recurring is to maintain a sanitary environment and look at your risk factors,” says Dr. Ubhi. “Risk factors, aside from health status, can include things like going to a gym, working in a garden, or spending time in a public hot tub.” These are Dr. Ubhi’s top tips for success.
- Wash Your Hands: always use soap and water or an alcohol-based sanitizer. Make a point to wash your hands several times throughout the day, especially when you’re in public. Always wash your hands prior to touching any open cuts, bites, or surgical wounds.
- Be Cautious at the Gym: shared sports equipment should be wiped down prior to use. Always check that locker room showers are clean. Wear protective footwear like flip flops in common areas. And when possible, shower when you get home.
- Keep Wounds Covered: even minor cuts and scrapes should be consistently cleaned and bandaged until the skin and wound is fully healed.
- Pay Attention to Skin Product Use: don’t re-use anything that comes into contact with an infected area of your body. For example, if your armpit contains a boil and you shave the area, throw the razor out immediately afterwards and wash your hands.
If you are experiencing a recurring skin and soft tissue infection, seek medical attention from an ID Care specialist.
What is ID Care’s Role in Caring for Patients with Skin or Soft Tissue Infections?
The ID Care team plays a pivotal role in caring for patients with skin or soft tissue infections. You can see a SSTI specialist at one of the practice’s 10 outpatient locations at the onset of symptoms, or if you’ve received care elsewhere and have not seen improvement. As highly trained infectious disease experts, they will get you on the road to recovery quickly ¬– and more importantly before your skin infection worsens. By asking very specific questions as part of an in-depth initial exam, the ID Care team gets to the root cause of the problem fast to make the proper diagnosis and treatment plan. That means you’ll get the right treatment protocol immediately, versus being over-prescribed medications you don’t need or given the wrong antibiotic. If your diagnosis requires intravenous (IV) antibiotics, ID Care makes it easy and convenient. Patients can go to one of the practice’s comfortable outpatient IV infusion centers. They’re fully equipped with recliners, TVs, and WIFI. Arrangements for convenient IV infusion care in the comfort of your home can also be made possible in certain situations.
How Can ID Care’s Skin and Soft Tissue Infection Specialists Help You?
ID Care’s team of infectious disease, wound care, and travel medicine experts are here to address any concerns you may have about skin and soft tissue infections. The combination of these three specialties gives ID Care’s medical professionals an edge to successfully diagnose any bacterial, viral, or fungal skin infection. As the largest infectious disease practice in New Jersey, ID Care offers 10 convenient outpatient locations and has a presence in many of the state’s leading hospitals, so scheduling a visit is easy. To make an appointment, call 908-281-0610 or visit idcare.com.