Bacterial skin infections
An important chapter on a very common topic in pediatrics. Various skin infections caused by bacteria.
Although the focus is on children, there is significant overlap in adult cases as well so I recommend adults also read and understand.
What is important to remember before reading the chapter?
- The chapter focuses on infections Acute And not chronic. Refers to someone who was healthy yesterday and today has a skin infection, not people who have been carrying lesions for years.
- There are many types of infections and we all have a lot of skin. Hence there are a lot of skin infections. Some are very common, some are rare. The purpose of the chapter is to focus on infections Common And not zebras .
- It is not just bacteria that cause skin infections. Also viruses, fungi or other rare bacteria. The intent of the chapter is to focus on pollutants The bacteria Common.
Note – Acute, common and caused by bacteria.
What are the common bacteria that cause skin infections in children and adults and how does it affect treatment?
We all need to know two bacteria that are all on our skin and are the biggest culprits responsible for skin infections of all ages:
Staphylococcus aureus (Golden Staphylococcus aureus) – The most common bacterium that causes skin infections at all ages. Found for all of us on the skin and lives (mostly) with us in balance from birth to return. Only sometimes the balance is disturbed and it causes various skin infections. The bacterium is resistant to simple penicillin and its treatment requires the use of broader antibiotics. A group of antibiotics called cephalosporins, mainly of the first generation (which are actually upgraded penicillin), usually cover the bacterium in question in Israel. Antibiotics are called cephalicin (trade name cephalol or cephalitis) and as you will see it is the drug of choice for many skin infections. There are staple strains that have developed resistance to the antibiotic in question and in which one should choose antibiotics from another family.
Group A streptococcus – The same streptococcus that causes sore throats in children, although here it contaminates the skin. Group A streptococcus is a bacterium that is sensitive to various antibiotics including simple penicillin. If the bacterium is sensitive to simple penicillin then it is probably and surely sensitive to first generation cephalosporins.
Therefore – first generation cephalosporin ( Cefalexin ) Is the drug of choice for skin infections . Anyone who has been prescribed other antibiotics such as Augmentin, Zint, Resperim, Delcin and more can ask the doctor why he prescribed another antibiotic because there should be some reason for the unusual choice. Keep in mind that this antibiotic cannot be prescribed to someone who has a severe sensitivity to penicillin.
What are the different layers in the skin and what are the different infections?
Imagine a layered Hungarian cake. So is our skin from the outside in.
The upper part that is visible to all of us in the eye is called the epidermis. Superficial infection in this tissue will be called Imptigo .
The next layer is called the dermis. In this layer are also the hair follicles. Western infection The superficial part of the dermis (and of course the epidermis above it) is called Ariziples (Rose) . Western infection The deep part of the dermis and the layer of fat beneath it will be called Cellulite . Targeted infection in the hair follicle will call Polyculitis .
The next layer is already the fascia and lower muscle – infections in these deep tissues are called Psoriasis or Myositis . These are severe infections that are less common and therefore will not be discussed in this chapter.
The most common skin infection in children, and the most superficial (western epidermis only). So common and almost daily that a separate chapter was Dedicated on the site that can be read At the following link .
Infection involving the dermis and epidermis layer and to the delight of us all is not common in children. The area is warm, very sensitive to touch and there is redness with slightly raised and clear borders. Systemic signs of infection including fever are common.
The disease is more common in adults mainly due to chronic skin problems, venous insufficiency and obesity. In children I see this infection here and there, especially in adolescents with poor foot hygiene. The bacterium (group A streptococcus) enters from the injured area between the toes of the foot for example and makes the infection usually involved in the anterior calf area.
Oral or sometimes intravenous antibiotic therapy and close monitoring is required. Lifting the leg and warm compresses can help.
Those who have suffered from erysipelas once have a recurrence of recurrences, so in such a case, which is rare in children, there is room for the advice of a specialist doctor in the field of recurrence prevention.
Infection in the hair follicle area most often caused by Staphylococcus aureus. The lesions are usually small, separate from each other, with a red base and a raised central area. Common in limbs and buttocks Poor hygiene and shaving are risk factors.
Deep infection involving the dermis layer and less the epidermis. Very common in children. Similar in many characteristics to erysipelas because the area is hot and very sensitive to touch and there is redness in the area (boundaries are less clear than erysiples). Sometimes there is systemic fever.
Cellulite is very common in children and its many causes, especially damage to the integrity of the skin. Sometimes with a clear story (a sting or a cut that has become contaminated) and sometimes microlessages that no one pays attention to. Any area of the body can be involved, of course legs and arms are more common in children.
The most common bacterium is Staple Aurus.
Depending on the size of the finding and the presence of systemic signs, antibiotic treatment will be chosen, usually requiring systemic treatment. Lifting the leg and warm compresses can help. With proper care there will be no scars or long-term problems left.
Pay attention to the center of the process. Cellulite can be a response to a targeted infection and evidence of the spread of an infection beyond the same furuncle or central abscess. In these cases drainage should be considered.
Abscesses, furuncles and carbuncles
When the bacteria, usually staple aurus, dig deeper into the skin layer it can cause abscess (a pus sac with an inflammatory reaction around it, sometimes cellulite), a furuncle (an infection centered on the contaminated hair follicle) or a carbuncle (a number of coiled furuncles will show multiple heads to the lesion).
The beginning of the process can be a superficial infection that has worsened or immediately as a deep infection. It can start spontaneously for no apparent reason like an area of sabotage, rubbing or stinging.
The signs are that there is a lot of local redness and sensitivity, that is, there may be secondary cellulite. And usually a central area with a purulent head. Keep in mind that although there is a significant local infection, the child’s body temperature is often normal.
In cases of such skin infections the treatment should be given quickly in order to prevent the aggravation of the local infection.
There is a place for bathing with a disinfectant (chlorhexidine) or antiseptic, usually opening the abscess and draining the pus and considering systemic antibiotic treatment.
Recovery can leave a scar so it is important not to play with the wound too much.
Infection is very common in children and therefore will be given a separate place in this chapter.
The location of the infection is in the area where the nail connects to the skin. Sometimes after local trauma or alternatively peeling of the skin in the area.
For the most part the area is swollen, red and sensitive to touch, slightly warm locally. Without systemic fever. It is common to see the formation of pus in the area.
Most often local treatment works, including warm compresses to soften the skin and apply a local antibiotic ointment. Sometimes an opening of the area is required. Suggests not to open alone at home because there is a certain opening technique.
Oral antibiotic treatment is usually not required, except in rare cases of severe infection that has not been treated properly.
What are the principles of treating skin infections in children?
It is difficult to comprehensively prescribe treatment for all children in all infections. This is because each case is different from the one before it. Treatment depends on the child, the presence of systemic and local symptoms as well as many different factors, including the child’s state of health prior to this disease. For the purpose of the example, it is clear that in polycolitis I would prefer to treat with a local antibiotic for application while in cellulite with fever 39 I would choose a systemic antibiotic.
But it is important to know the treatment options and principles:
Compresses – Hot compresses are always good to make in an area with inflammation. It can also soften an area with pus and lead to better drainage of pus if any. Better than a hot compress is to soak the inflamed organ in water with some antiseptic.
Drainage Simple (click), semi-surgical (needle) or surgical (knife) – remember a basic law in medicine. Most often, abscesses need to be drained properly in order to see an improvement in the condition of the organ or child. This means that if there is a bag of pus that has not drained, it will usually not help to apply topical antibiotics or give oral antibiotics. It can soothe the process but usually does not cure. Now, I do not suggest parents go around with pins at home and start opening abscesses, it does not matter. But after a warm bath and softening of the skin, you can gently press on the inflamed area to see if pus breaks out, which can greatly alleviate any skin infection. Drainage with a needle or knife must be done by a specialist doctor.
Local antibiotics – With or without a band-aid, very good for targeted superficial infections. Less helpful and can never be a single treatment for significant deep infections such as cellulite, erysipelas or abscess. When there is a concern that the child will apply the antibiotic ointment on the clothes or bedding, the area should be covered with a band-aid at least three times a day to give the ointment a chance to act.
Systemic antibiotics – In some cases there is no need at all for treatment with systemic antibiotics, for example peronichia. In other cases we will usually use systemic antibiotics, for example cellulite. Therefore, in any case of significant infection, be sure and certainly if there is a fever consult a attending physician to consider systemic antibiotic treatment. Remember that the antibiotic of choice is first-generation cephalosporins ( Nipple or cephalopod ). If you have something else written for you, ask why. Keep in mind that in significant cases the doctor may also recommend intravenous antibiotic treatment in hospital. The duration of antibiotic treatment varies from case to case and the range is 5-14 days in most cases.
What to do with recurrent skin infections?
Aside from recurrent impetigo, significant recurrence of skin infections is not common in children. However a number of issues will go through the minds of pediatricians who hear about a case of recurrent skin infections.
Did the child carry a bacterium that causes recurrent skin infections? For the most part the answer is definitely yes. You can try treatment with decolonization treatment that aims to reduce the amount of bacteria on the child’s skin and prevent infections. Decolonization is summarized in the region of impetigo.
Does the child have any skin problem that causes him recurrent infections? Such as atopic or dry skin. It is quite common to see skin infections in children with atopic skin. In this case proper treatment of the skin and atopy is required in order to prevent recurrence of the infections.
Does the child repeatedly injure the skin and inject an infection unintentionally? common. A child who scratches each bite until it bleeds is more prone to infections in the bite areas. In such cases, the itching should be prevented as much as possible with the help of the wound cover or even anti-itch medication (penicillin which slightly soothes the children). Of course hand hygiene including nail trimming should also be maintained.
Does the child have any immune deficiency that exposes him to recurrent skin infections? rare.
So in conclusion, although there is a lot of information in this chapter, it is too short to describe all the types of skin infections that pediatricians encounter.
What about Periante Streptococcus? And infection around the eye (orbital cellulite)? What about recurrent abscesses in the groin area (supportive hydrodenitis)? more and more.
Therefore, for the more specific situations, the attending physician or the specific specialist should be consulted.
Only health and integrity of the skin. Dr. Effie.