How to Treat Common Skin Infections

Drs. Wong and Borno are assistant professors of pharmacy practice at Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York.

Bacteria can cause different types of skin infections. Three common skin infections that you and your doctor may encounter are: (1) cellulitis, (2) folliculitis, and (3) impetigo. Keep in mind that skin infections vary in presentation and treatment. Therefore, it is important to talk to your doctor to obtain an appropriate diagnosis and treatment plan.

Cellulitis

Cellulitis is an infection that involves the outer layers of the skin. It is commonly caused by bacteria known as beta-hemolytic streptococcus or Staphylococcus aureus. You may experience pain, swelling, tenderness, warmth, and redness in the infected area. If you have a severe case of cellulitis, you may experience fever, tiredness, and a lowering of blood pressure. If left untreated, pus may form and cells may die in the infected skin area. Cellulitis can involve any part of the body but most often affects the leg. It typically results from an injury to the skin, such as scratches or animal bites—these allow bacteria to enter the body and cause an infection. An additional cause of cellulitis is skin breakdown around the anal area, typically seen in children. This can lead to redness, swelling, and painful bowel movements.

Oral antibiotics are used to treat mild cellulitis; more severe cases must be treated with intravenous antibiotics in a hospital. Antibiotics that may be used include cephalosporins, dicloxacillin, clindamycin, or vancomycin. Swelling can be lessened by elevating the affected area, such as the legs or arms. To stop cellulitis from occurring again, it is important to keep applying lotion to the skin and to maintain good skin cleanliness.

Folliculitis

Folliculitis is a general term used to describe an infection of the hair follicles commonly caused by Staphylococcus aureus, resulting in red pimples. You may experience redness, tenderness, or swelling of the affected area. It also can spread to the deeper parts of the hair follicles and pus can form, also known as furuncles or boils. Carbuncles is a term used to describe a group of infected hair follicles. Folliculitis, furuncles, and carbuncles can be seen on any part of the body with hair, such as the face, scalp, thighs, underarms, and groin area. This includes areas that are bearded or shaved.

Mild folliculitis can be treated with topical antibiotics, such as erythromycin, clindamycin, or mupirocin. More severe infections, such as carbuncles and larger furuncles, may require a surgical cut and drainage of the affected area. After drainage, it is important to clean the area with antibacterial soap; then you should apply the antibiotic ointment to the affected area of the skin. If needed, your doctor may prescribe oral antibiotics such as cephalosporins or dicloxacillin. Keep in mind that your doctor may recommend monthly treatments with mupirocin ointment if you have folliculitis that occurs repeatedly.

Impetigo

Impetigo is a contagious skin infection commonly caused by Staphylococcus aureus. Although this infection may occur in adults, it is most often seen in children aged 2 to 5 years and is usually spread through direct contact with another person who has the infection. You may experience tenderness, itching, sores, or blisters that can rupture and form honey-colored crusts. It can affect different parts of the body such as the face, arms, or legs. It also can affect moist parts of the body, such as the armpits, neck folds, and diaper areas.

Impetigo can be treated with a topical ointment or oral antibiotic. Mupirocin is a typical ointment that may be prescribed by your doctor. Oral antibiotics such as penicillins or cephalosporins are used for more severe infections. To prevent the spread of the infection to other parts of the body, avoid scratching the blisters or sores. Because impetigo is commonly seen in children, it may be helpful to cut the fingernails and cover the affected areas of the body with bandages or gauze. It also is important to prevent the spread of infection to other individuals in close contact by not sharing things such as blankets, linens, toys, or clothing.

What about MRSA Infections?

MRSA stands for methicillin-resistant Staphylococcus aureus. It is a form of Staphylococcus aureus or "staph" bacteria that is resistant to certain antibiotics. It is transmitted by directly contacting an infected person, touching contaminated surfaces, or sharing personal items that have been in contact with infected skin. MRSA is a large problem in hospitals or health care facilities (like dialysis centers and nursing homes). MRSA also can infect people in the community, however, such as children at day care centers and children who are involved in sports that involve close contact. This is known as community-associated MRSA or CA-MRSA.

MRSA infections can appear like a pimple or boil, with redness, swelling, pain, or pus. Serious infections may spread into the blood and cause blood infections. If you experience a MRSA infection, your doctor may drain the infected area and prescribe antibiotics such as linezolid, clindamycin, or doxycycline. Do not try to drain the wound yourself! This can worsen the infection or spread it to others.

To prevent the spread of MRSA, here are some helpful tips:

• Cover your wound with clean, dry bandages until the affected area is completely healed.
• Maintain good hand hygiene—you and those in close contact with you should wash hands frequently with soap and water.
• Do not share personal items, such as linens and clothing, with others.

General Management of Skin Infections

With antibiotic treatment, signs and symptoms of skin infections begin to improve after approximately 2 to 3 days. If your skin infection does not improve or gets worse (especially if you develop a fever or the infection spreads), notify your doctor right away. If you are prescribed topical or oral antibiotics, be sure to finish the full course of antibiotics unless otherwise directed. Keep in mind that the length of treatment will differ depending on the type and severity of the infection. Lastly, as is true among all skin infections, you should keep the affected area or wound clean with good skin hygiene.