Anyone who has a break in the skin is at risk for an infection. There are several types of skin infections:
There are many bacteria that live on the surface of healthy skin. But with a break in the skin, these bacteria can invade the outer layer of skin and cause an infection and rash. Staph is a common cause of bacterial infections of the skin. Impetigo is one of the most common causes of skin infections in children. Oral or topical antibiotics are used to treat bacterial skin infections.
Also known as skin abscesses, boils form as a result of a cut or break in the skin, which leads to a bacterial infection. They are characterized as a red, tender area with a painful, pus-filled center that can open spontaneously or by surgical incision. Some boils are caused by an ingrown hair. Others are caused by plugged-up sweat glands, such as some types of cystic acne. Anyone can get a boil. They grow quickly and are usually painful until they drain. However, left alone a boil will naturally come to a head and burst open, allowing the pus to drain and the skin to heal. People with weakened immune systems are more susceptible to boils than the general population.
Boils tend to occur on parts of the body that have hair or sweat glands and are exposed to friction, typically on the face, neck, armpits or buttocks. There are a variety of different types of boils:
Furuncle or Carbuncle. A furuncle is an individual boil; carbuncles are deep clusters of boils that most often form on the back of the neck, shoulders or thighs.
Pilonidal Cyst. An infected hair follicle around the buttocks area caused by long periods of sitting. Pilonidal cysts almost always require medical treatment.
Hidradenitis Suppurativa. These are multiple abscesses that form from blocked sweat glands in the armpits or groin areas.
Cystic Acne. These boils are situated more deeply into skin tissue than the more superficial forms of acne.
Boils respond well to home remedies. To promote healing, apply heat to the boil in the form of hot soaks or compresses. Keep the area clean, apply over-the-counter antibiotics and then cover with gauze. Do not puncture or squeeze the boil because it can lead to further infection. If the boil does not go away within two weeks, is accompanied by a fever or is painful, contact your dermatologist. The doctor will clean, lance and drain the boil and prescribe an antibiotic to alleviate the infection.
Candidiasis is the medical term for yeast infections in the body. There are three forms of candidiasis that relate specifically to the skin:
Oral Candidiasis (Oral Thrush). This infection is characterized by lacy, white patches on top of reddened areas that occur on the tongue, throat or elsewhere in the mouth. It is usually accompanied by a fever, colic or diarrhea. Oral thrush can be painful and lead to an uncomfortable burning sensation in the mouth. People who are diabetic, have suppressed immune systems, patients undergoing antibiotic or chemotherapy treatment and denture wearers are more susceptible to this infection. It is particularly important to catch it early in infants and children. Because of the discomfort caused by oral thrush, they may stop eating and/or drinking.
Diaper Rash. Candidiasis breeds in warm, moist environments and in the natural creases of the skin. Some diaper rashes are bacterial, but many are caused by yeast infections. To treat diaper rash, use over-the-counter powders and ointments and antifungal creams and lotions. Plan on frequent diaper changes to give the skin a chance to be exposed to air regularly. If diaper rash doesn’t abate in seven to 10 days, contact your dermatologist.
Candidal Intertrigo. This yeast infection occurs in moist overlapping skin folds, such as areas in the inner thighs, armpits, under the breasts, below the belly, behind the ears and in the webbed spaces between the fingers and toes. It is more common among people who are overweight. It is characterized by red, raw skin surrounded by scaling and, in some cases, lesions that itch, ooze or hurt. Candidal intertrigo is treated with medicated topical creams.
Cellulitis is a common bacterial skin infection that is often caused by either Staphylococcus or Streptococcus bacteria. A break or cut in the skin causes the bacteria to enter the body, which leads to an active infection. Cellulitis most often occurs from:
- cracking or peeling skin between the toes,
- insect bites or stings, and
- a skin cut, break or trauma.
Cellulitis appears as a swollen red area of skin that is tender and hot to the touch. Symptoms include chills, fever, muscle ache, fatigue, pain or tenderness in an area with a skin rash or sore. The redness increases in size as the infection spreads. It typically comes on suddenly and spreads quickly. Cellulitis can arise anywhere on the body, but usually appears on the face or legs. Be sure to contact your dermatologist as soon as you observe these symptoms to start an effective treatment.
To prevent cellulitis, be sure to clean any cut or break in the skin promptly with soap and water and cover the wound with a bandage until it scabs over. Watch for redness, tenderness, drainage or pain as these are signs of infection.
Chicken Pox (Herpes Varicella Zoster)
Chicken pox is a common illness, particularly among children. It is characterized by itchy red spots or blisters all over the body. Chicken pox is caused by the Herpes Varicella Zoster virus. It is highly contagious, but most cases are not dangerous.
Chicken pox can be passed on from two to three days before the rash appears until the blisters are crusted over. It spreads from exposure to infected people who cough, sneeze, share food or drinks or by touching the blisters. It is often accompanied by a headache, sore throat and possibly a fever. The incubation period (from exposure to first appearance of symptoms) is 14 to 16 days. When the blisters crust over, they are no longer contagious and the child can return to normal activity. This normally takes about 10 days after the initial appearance of symptoms.
It is important not to scratch the blisters as it can slow down the healing process and result in scarring. Scratching may also lead to another infection. To help relieve the itching, soak in a cool bath. The child should get plenty of bed rest and can take over-the-counter analgesics to reduce any fever. More serious cases are usually seen in people with other long-term health problems.
An effective vaccine for chicken pox is available. Children should receive two doses of the vaccine — the first between 12 and 15 months and the second between ages four and six. Older children who have not been vaccinated can be effectively treated with two catch-up doses. Adults who have never had the illness should also be vaccinated.
A particular type of skin infection (cellulitis) that is characterized by blisters; skin that is red, swollen, warm and/or painful to the touch; or by lesions with raised borders that most frequently appear on the face or legs. It also appears as sores on the cheeks and bridge of the nose. It is usually caused by the Streptococcus bacteria and occurs in both adults and children.
Erysipelas requires medical treatment, so you should contact your dermatologist as soon as you suspect you may have this infection. Antibiotics (usually penicillin) are generally prescribed. In severe cases, the patient may need to have antibiotics delivered intravenously.
Folliculitis is an inflammation of one or more hair follicles. It appears as a rash or white-headed pimples or pustules near a hair follicle. It can occur anywhere on the body, but typically affects hairy areas, such as the neck or groin. Follicles can be damaged from repeated friction (such as rubbing of too tight clothes) or a blockage of the hair follicle (for instance, from shaving). In some cases, follicles become infected with the Staphylococcus bacteria.
There are two types of folliculitis:
Superficial Folliculitis affects the upper area of the hair follicle and may cause red, inflamed skin, small clusters of red bumps, blisters that break open and crust over and/or itchiness and tenderness. When the symptoms occur in a male's beard, it is called pseudofolliculitis barbae. When it is caused by a fungal infection, it is known as Tinea Barbae (ringworm).
Deep Folliculitis affects the entire follicle from its deepest parts under the skin to the surface of the skin. This less-common form of folliculitis is seen in people who are undergoing chronic acne antibiotic treatment, people with HIV or people with boils and carbuncles.
Fungal infections of the human body are called mycoses and affect only the outer layer of skin. Although seen in all areas of the body, skin mycoses most frequently appear as ringworm.
Ringworm is a common fungal infection, especially among children, that appears on different parts of the body. It is characterized by ring-shaped, scaly and itchy patches of the skin. The patches may blister or ooze fluid. Ringworm is contagious and can be passed from person to person or through contact with contaminated personal care products, clothing or linens. Pets, particularly cats, can also pass on the infection.
The fungi are attracted to warm, moist environments, which is why other common forms of ringworm include:
- Tinea Barbae, which occurs on bearded areas of the face and neck.
- Tinea Corporis which occurs on the trunk and extremities
- Tinea Capitus, which occurs on the scalp.
- Tinea Cruris, also known as Jock Itch, occurs in the groin area.
- Tinea Pedis, also known as Athlete’s Foot, occurs between the toes.
To treat, be sure to keep involved areas clean and dry and start with over the counter antifungal creams. In more severe or persistent cases, your dermatologist may recommend prescription antifungal medications. In addition to keeping the area clean and dry, you can apply over-the-counter antifungal powders, lotions or creams. In more severe cases, your dermatologist may recommend prescription antifungal medications and antibiotics.
Viruses are parasitic organisms that can live and grow inside living cells. They cause either a degeneration or a proliferation of the cell. Most causes of viral skin infections are either from Human Papilloma Virus, which causes warts, or Human Herpes Virus, which causes cold sores, chicken pox, shingles, genital herpes and mononucleosis. Viruses do not respond to antibiotics. Generally, medications are prescribed to help alleviate the symptoms of the infection, such as a rash or itch. Additionally, vaccinations are used to prevent viral infections.
HSV is a group of viral infections that cause sores on the mouth (oral herpes) or genitals (genital herpes). There are two types of Herpes Simplex Virus:
Herpes Simplex Virus Type 1 is the most common form of herpes that affects most people at least once during childhood. It is passed from person-to-person through contact with saliva. It is responsible for the formation of cold sores (fever blisters) around the mouth and lips. It may also cause an enlargement of lymph nodes in the neck. Generally, this type of herpes does not need any treatment however, oral medications to treat are available. It will disappear on its own in seven to ten days.
Herpes Simplex Virus Type 2 is sexually transmitted either to the genital area or mouth. About one in five adults in the U.S. has this form of the herpes virus, although many people don’t know they have it. The infection is characterized by sores that look like small pimples or blisters, which break open quickly and ooze fluid. This is followed by a period of crusting over and scabbing until the lesions finally heal, which can take up to four weeks. The infection spreads to areas of skin that come into contact with secretions from the blisters. The lesions most frequently appear on the vagina, vulva, penis, scrotum testicles, thighs or buttocks. They may be accompanied by a fever, swollen glands, headache or painful urination. Many people with genital herpes experience sensations of itching, tingling, burning or pain in areas where lesions will develop.
Genital herpes is diagnosed through a viral culture test of the blister fluid from a lesion and blood tests. There is no known cure. Treatment is designed to reduce pain and hasten healing and includes antiviral medications. For people with more severe, prolonged or frequent outbreaks, your dermatologist may prescribe a prophylactic antiviral drug taken on a daily basis to reduce outbreaks.
On average, adults with genital herpes have about four or five outbreaks a year. The first outbreak is usually the most severe and more outbreaks occur the first year than any subsequent year. Generally, symptoms begin to appear about two weeks after transmission. The virus takes root in nerve cells, lying dormant until it re-emerges with another outbreak. Outbreaks are known to be triggered by stress, illness or excessive sunlight. It is important for people with genital herpes to avoid sexual contact during an active outbreak to reduce the risk of passing the infection on to a sex partner. However, herpes simplex virus type 2 can be transmitted a few days before the appearance of any lesions.
Impetigo is a common skin infection usually found in children and infants. It is characterized as single or multiple blisters filled with pus, which pop easily and leave a reddish, raw-looking base and/or honey-colored crust. In most children, impetigo first appears near the nose and then spreads through scratching to other parts of the face, arms or legs. The blisters tend to be itchy.
There are three forms of impetigo:
Ordinary impetigo appears as red sores that rupture quickly, ooze a fluid and then form a honey-colored crust. It primarily affects children from infancy to age two.
Bulbous Impetigo appears as fluid-filled blisters. This contagious infection is carried by the fluid that oozes from the blisters.
Ecthyma, a more serious form of impetigo that penetrates to the second layer of skin (dermis). It is characterized by sores that are painful and/or fluid or pus-filled. These lesions most commonly appear on the legs or feet. The sores break open and scab with a hard yellow-gray crust. It can also cause swollen lymph glands in the affected area.
Impetigo is generally treated with a seven-to-10-day course of prescription oral antibiotics and/or topical antibiotics. The sores tend to heal slowly, so it is important to complete the full course of medications. Please note that over-the-counter topical antibiotics (such as Neosporin) are not effective for treating impetigo.
Intertrigo is a skin inflammation that occurs in warm, moist folds of the body where two skin surfaces chafe against each other. It most commonly appears on the inner thighs, underarms, groin, the bottom of breasts in women and below the belly in obese people. Bacterial, yeast, and fungal infections can exacerbate the symptoms which include a reddish rash that can look raw and ooze and almost always itches.
Treatment for intertrigo focuses on keeping the affected area dry and exposed to air. Your dermatologist may prescribe steroidal creams, oral antibiotics or antifungal medications (depending on the cause of the infection) to relieve itching and promote healing. Applying warm, moist compresses to the area can also help relieve itching.
Lyme disease is a bacterial illness and inflammatory disease that spreads through tick bites. Deer ticks house the spirochete bacterium (Borellia burgdorferi) in their stomachs. When one of these ticks bites the human skin, it may pass the bacteria into the body.
Lyme disease was first identified in 1975 in Old Lyme, Connecticut. Cases have been reported from every state, although it is more commonly seen in the Northeast, Upper Midwest and Pacific Coast. Lyme disease has also been reported in European and Asian countries.
There are three phases to the disease:
Early Localized Phase. During this initial phase, the skin around the bite develops an expanding ring of redness. The ring may have a bull’s eye appearance with a bright red outer ring surrounding clear skin in the center. Most people don’t remember being bitten by a tick. More than one in four patients never gets a rash. The skin redness may be accompanied by fatigue, chills, muscle and joint stiffness, swollen lymph nodes and/or headaches.
Early Disseminated Phase. Weeks to months after the rash disappears, the bacteria spread throughout the body, impacting the joints, heart and nervous system. Symptoms include migrating pain in the joints, neck ache, tingling or numbing of the extremities, enlarged lymph glands, sore throat, abnormal pulse, fever, changes in vision or fatigue.
Late Dissemination Phase. Late in the dissemination of the disease, patients may experience an inflammation of the heart, which can lead to heart failure. Nervous system issues develop, such as paralysis of facial muscles (Bell’s Palsy) and diseases of the peripheral nerves (peripheral neuropathy). It is also common for arthritis and inflammation of the joints to appear, which cause swelling, stiffness and pain.
Lyme disease is diagnosed through a combination of a visual examination and a blood test for Lyme bacteria antibodies. Most cases of Lyme disease are curable using antibiotics, but the longer the delay, the more difficult it is to treat.
The best form of prevention is to avoid tick bites. Use insect repellent containing DEET. Wear long sleeves and pants when outdoors. Tuck the sleeves into gloves and pants into socks to keep your skin covered. After a hike, check the skin and look for any tick bites, especially on children. If you do find a tick, don’t panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination.
Rocky Mountain Spotted Fever
Rocky Mountain Spotted Fever is a bacterial infection transmitted by ticks. It is relatively rare, but can cause serious damage to the heart, lungs and brain. The difficulty lies in diagnosis because many people are unaware that they’ve been bitten by a tick. Three types of ticks transmit the Rickettsia rickettsii bacteria:
- Dog ticks, usually in the Eastern part of the country,
- Wood ticks, usually in the Rocky Mountain states, and
- Lone star ticks, usually on the West coast.
Rocky Mountain Spotted Fever is characterized by a rash that begins as small red spots or blotches on the wrists, ankles, palms or soles of the feet. It spreads up the arms and legs to the trunk of the body. These symptoms take between one and two weeks to appear following a tick bite. The rash is often accompanied by fever, chills, muscle ache, red eyes, light sensitivity, excessive thirst, loss of appetite, diarrhea, nausea, vomiting and/or fatigue. While there are lab tests your doctor can use to diagnose the disease, they take time to complete, so you may be placed on a course of antibiotic treatment right away.
The best way to prevent Rocky Mountain Spotted Fever is to avoid tick-infested areas. If you spend any time in areas with woods, tall grasses or shrubs, wear long sleeves and pants. Tuck pants legs into socks. Wear closed shoes, not sandals. Do a visual check of each member of your family upon returning home. And don’t forget to check your dog for ticks (if applicable). Use insect repellent containing DEET.
If you do find a tick, don't panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination. Because less than one percent of tick bites transmit this bacteria, antibiotics are not generally prescribed unless there are other symptoms present.
Scabies is a harmless but very itchy and highly contagious skin condition caused by mites that burrow into the top layer of the skin and lay eggs. Symptoms include a severe itch, often worse at nighttime, and thin burrow tracks made of tiny bumps or blisters on the skin. Humans are allergic to the mites, which is what causes the itching.
Typically, scabies appears in folds of the skin, such as the armpits, around the waist, inside the wrists, between the fingers, on the soles of feet, on the back of knees or on inner elbows. In children, they more commonly appear on the face, scalp, neck, palms and soles. Scabies is spread through direct contact with an infected person or by sharing clothing and linens. It is so contagious that frequently when one person in a family is diagnosed with scabies, all family members are treated for it. It takes about 21 days for eggs to mature and new mites to begin burrowing through the skin.
Generally a visual examination of the skin is all that is needed to diagnose scabies. However, your dermatologist may take a small scrape of the skin to examine under a microscope. The typical treatment is a prescription medicated cream applied liberally all over the body and left on overnight and repeated one week later. More significant cases are treated with an oral medication. It takes several days after treatment for the itchiness sensation to resolve.
To help prevent further spreading, be sure to clean all clothes and linen in hot water and dry with high heat. Dry clean items you cannot machine wash in this manner or place the item in a sealed plastic bag and put it away for two weeks. The mites will die without a food source for this length of time.
Shingles (Herpes Zoster)
Shingles is a painful rash that is caused by the varicella zoster virus. It usually appears as a band or strip of blisters on one side of the body that goes from the spine around the front to the breastbone. However, shingles can also appear on the neck, nose and forehead. The rash typically does not cross the midline of the body.
Shingles derives from the same virus that causes chicken pox. After having chicken pox, the virus lies dormant in nerve tissue underneath the skin. Years later, and with no known reason, it reactivates and causes shingles. Shingles is contagious. The virus develops into chicken pox for those who have not had chicken pox. So care should be taken to avoid exposing young infants to someone with active Shingles. Shingles appears most frequently among older adults (age 60+) and in people with compromised immune systems. Generally, a person only gets shingles once; it rarely recurs.
Symptoms for shingles include:
- Pain, burning, numbness or tingling on one side of the body. The pain often precedes any other symptoms.
- A rash that appears a few days after the pain. It may be itchy.
- Blisters that break open and then crust over.
- Fever, achiness or headache.
- Some people never get a rash or blisters with shingles, but simply experience the pain.
Shingles is diagnosed based on a medical history and physical examination of the telltale rash. If you suspect you may have shingles, it is important to contact your doctor as quickly as possible. Early treatment can reduce the pain and severity of the episode. Two types of medications are prescribed to treat shingles:
Antiviral drugs to combat the virus, such as acyclovir, valacyclovir and famciclovir.
Pain medicines, from oral pain pills and antidepressants to anticonvulsants and topical preparations that contain skin-numbing agents.
Shingles usually heals in about 2 to 3 weeks without any problem. However, there is a small percentage of patients (10% to 15%), predominantly over age 50, who experience pain that lasts beyond one month after the healing period. This is called postherpetic neuralgia. Catching shingles early and beginning treatment can reduce the likelihood and severity of postherpetic neuralgia. See your dermatologist for pain relief.
The U.S. Food and Drug Administration has approved a vaccine, called Zostavax, for the prevention of adult shingles. It is approved for adults age 60 or older who have had chicken pox. Essentially, the vaccine delivers a booster dose of chicken pox. The vaccine has proven to be very effective in reducing the incidence of shingles and postherpetic neuralgia.