Staph Skin Infection Pictures
Staph (pronounced ’staff’) skin infection may appear as
- a red bump or pus-filled blister (folliculitis)
- a boil (furuncle)
- infected cystic acne, hydradenitis suppurativa, pilonidal cyst
- a vesicle which may burst and crust over (impetigo)
- erythema (cellulitis)
- skin scalding (staphylococcal scalded skin syndrome)
- an infected wound or burn
Drainage of pus from lesions is common.
What Causes Staph Skin Infections?
Staph infections are mainly caused by bacterium Staphylococcus aureus, and rarely by S. epidermidis, or S. saprophyticus. In staph carriers, S. aureus, lives in the nose and on the skin, and less commonly in the mouth, mammary glands, urinary, intestinal, and upper respiratory tracts (1). Staphylococcal infections usually remain localized at the portal of entry. What is Staphylococcus aureus?
Who is at Risk for Staph Infections?
Persons at most risk are:
- staph carriers (many individuals carry S. aureus in the nose, throat or skin at some point; 20-30% are colonized persistently, especially health care workers, persons with diabetes, and patients on dialysis)
- newborn infants
- breastfeeding women
- obese persons
- people living in crowded communities or hot climates
- those with skin injuries, surgical wounds
- persons with piercings and fresh tatoos
- persons with skin diseases like atopic dermatitis or seborrhea
- persons with weak immune system, diabetes, cancer, vascular, blood, or lung disease
- patients receiving oral steroids or chemotherapy
Are Staph Skin Infections Contagious?
Staph skin infections are pretty contagious. They can spread by:
- skin to skin contact with infected person
- sharing razors, towels, clothes, bed linens, sport equipment (athletes!), toys
- walking barefoot or using sits around swimming pools
- contact with infected pets
- auto-infection by nose picking and skin scratching
- sneezing - when droplets from the nose of infected person (or staph carrier) fall on injured skin
Folliculitis
Staphylococcal folliculitis affects hair follicles on the face, scalp, neck, trunk or limbs (but not hands, soles and mucous membranes while there are no hair follicles). Folliculitis usually appears as a group of red bumps, which may develop into pus-filled blisters (Picture 1). Itchiness or pain are main symptoms, follicles may open and drain pus. Low grade fever may be sometimes present. Folliculitis barbae is a folliculitis of beard in men. Stye or hordeolum is folliculitis affecting one or more hair follicles on the edge of upper or lower eyelid.
Picture 1. Folliculitis
(source: Samuel Freire da Silva, M.D., Atlasdermatologico)
Boil - Skin Abscess
Boil or skin abscess is a collection of pus in the skin from various causes. Boils may appear as red colored nodules which are tender, itchy or painful. Boil often opens at some point of growth and drains pus.
Furuncle develops from infected hair follicle, when adjacent skin tissue is involved. Most commonly it appears on the neck (Picture 2), arms or legs as a red nodule up to 1 cm in size, and usually after some time opens and drains pus. Furuncle may be itchy and painful, low grade fever may be present. Furuncle usually heals on its own. When more furuncles join they form a carbuncle. Carbuncles most often appear on the nape of the neck in persons with lowered immunity, friction of clothing, or bad hygiene (9).
Picture 2. Furuncle on the neck
(source: Samuel Freire da Silva, M.D., Atlasdermatologico)
Cystic Acne are large collections of oil traped in sebaceus glands, mostly occuring on the face in teenagers. Pictures of Cystic Acne
Hydradenitis suppurativa are boils occurring in armpits, groin, anal area or under breasts and inner thighs - areas which are often rubbed, and are rich in sweat and oil glands. The condition usually appears in puberty, it worsen with time and may persist for years. Sebaceous glands produce excessive oil due to increased hormonal activity. Sweat glands may be clogged due to excessive sweating and shed skin cells. Hair follicles may be infected by staphylococci. When all these disorders merge, they result in a group of tender red nodules, under-skin lumps filled with pus, and black-heads. Hormone changes, stress, obesity and excessive sweating may aggravate symptoms. Antibiotics and isotretinoine may help in some cases, but surgical removal of nodules or skin transplantation may often be required (8). Pictures of Hydradenitis Suppurativa
Pilonidal cyst arise from irritated and infected hair follicles in area between buttocks, often due to prolonged sitting (trips). Surgery is often required to remove the cyst completely. Picture of Pilonidal Cyst
Cellulitis - Deep Skin Infection
Cellulitis is infection of under-skin tissue, which appears as a red, swollen, warm, tender skin patch of various size (Picture 3). Infection usually starts when Staphylococcus aureus (or Streptococcus group A, or rarely other bacteria) enter through the skin wound and spread under the skin. Legs and arms are most commonly affected. Fever is usually present, and local lymph nodes may be swollen (2). Cellulitis always need to be treated - oral antibiotics are usally prescribed.
Picture 3. Cellulitis on a shoulder in a child (source: phil.cdc.gov)
Superficial skin infection mostly caused by streptococci, and only rarely by staphylococci, is called erysipelas (2).
Impetigo
Impetigo is a crust-forming staph infection of the skin, mainly occurring in pre-school children. In adults it may follow other skin disorders like atopic dermatitis. It is highly contagious and easily spreads to other parts of the skin. Except in severe cases, it is not painful and does not leave scars. Fever is not common, but local lymph nodes may be affected. Infection usually heals on its own in 2-3 weeks (3). It most often occurs in summer and autumn.
Impetigo contagiosa starts like red bumps which rupture, ooze fluid or pus, and form honey colored crusts. It mostly appears around the child’s nose and mouth (Picture 4).
Picture 4. Impetigo
(source: Samuel Freire da Silva, M.D., atlasdermatologico)
Bullous impetigo mostly appears in infants as vesicles of various size on the trunk or limbs. Picture of Bullous Impetigo. Ecthyma is severe form of impetigo with thick crusts. It affects deeper layers of the skin, it’s painful, it may develop into ulcer and leave scars. Picture of Ecthyma
Complications of impetigo are rare and include scars, permanent hypo- or hyper-pigmented skin patches, and cellulitis.
Paronychia
Paronychia is an infection of the skin folds of the nails (Picture 5). Acute paronychia is usually caused by staph, other bacteria or herpes virus; chronic paronychia is usually caused by fungi. It may occur due to nail biting, finger sucking, wearing artificial nails, ingrown toenail, or constantly having wet hands (bartenders, dentists etc). It appears as a painful, red swelling around the nail or as red bumps or blisters. Nail may change color or become detached. Soaking affected finger in warm water few times a day may help to relieve pain. Paronychia heals on its own, and if it doesn’t, cutting and draining pus is needed. Sometimes a part of the nail has to be removed (4). Rarely infection spreads toward tendons and bones, or bacteria may reach bloodstream.
Picture 5. Acute paronychia
source: Wikipedia
Wound Staph Infection
Staph is the most common external cause of wound infections. In surgical wounds E.coli and enterococci are often involved.
Symptoms and Signs of Wound Infection
Wound infection may develop from 48 hours - 30 days after injury or surgery.
Mild wound infection symptoms and signs may include (5):
- skin around the wound becomes increasingly red (cellulitis), swollen, warm and painful
- pus or cloudy fluid is draining from the wound
- a crust may form on the wound edges, or existing crust is increasing in size
Pictures of Mild Wound Infection
Symptoms and signs of severe wound infection:
- a red streak (from inflamed lymphatic vessel) is spreading from the wound toward the local lymph nodes which may be swollen and tender
- body temperature over 100°F (37.8°C)
- wound doesn’t heal in 10 days
- bad wound odor
- bluish or black gangrenous tissue around the wound
Treatment of Infected Wounds
Open infected wounds should be cleaned with soap and water (boil a water, add 2 teaspoons of salt per liter and cool it down to room temperature). Oral antibiotic should be taken as prescribed by a doctor. With this treatment symptoms should improve in 1-2 days, and completely disappear in one week. To relieve pain, limb with a wound should be soaked in the warm water, or warm moist compresses used three times a day for 20 minutes. Acetaminophen or ibuprofen can be used if temperature exceeds 39°C.
Closed wounds should be heated with a heating pad three times a day, to enhance antibiotic delivery to infected area. Sutured wounds should not be soaked in water, and cleaning of the wound should not be done in the first 24 hours after stitching.
Treatment of Infected Burns
In mild burns topical antibacterial ointments like mupirocin (Bactroban) can be used to prevent infection. In severe burns systemic antibiotics and surgical treatment is needed.
How to Prevent Wound Infection?
Wound should be cleaned as soon as possible with the warm water and soap, and soaked in warm water for 20 minutes 3 times a day. Applying an over-the-counter antibiotic ointment may help prevent infection.
Staphylococcal Scalded Skin Syndrome (SSSS)
Scalded skin syndrome is extensive red rash, like scald, caused by toxins released by Staphylococcus aureus. It mostly appears in children under 5 years of age who don’t have enough antibodies to fight staph toxins. SSSS in newborns is sometimes called pemphigus neonatorum. Connections between skin cells are cleaved by staph toxins, what results in scalding.
Disease may start as a common staph skin infection like impetigo, from where toxins are released. Fever, irritability and skin redness may follow in a couple of days, and then red blisters, paper-like skin wrinkling and scalding appear in one or more skin areas.
Diagnosis is by skin biopsy. Treatment by intravenous and later by oral antibiotics usually results in complete healing in 5-7 days without consequences (7). The most dangerous complications are dehydration and sepsis. SSSS in adults with lowered immunity may be followed by life threatening pneumonia and sepsis.
SSSS is highly contagious and it often outbreaks as epidemic in kindergartens. In this case children should stay at home.
Treatment of Staph Skin Infections
Mild staphylococcal folliculitis or furuncle may disappear in a few days or couple of weeks with good hygiene, showering, and wearing fresh airy clothes.
In persistent skin infection, like carbuncles, oral antibiotics like dicloxacillin or cephalosporin are effective. If MRSA is diagnosed, clindamycin, trimethoprim-sulfamethoxazole, levofloxacin, minocycline, or linezolid may be used (2). Boils with an opening (cap) may be soothed with warm compresses, then surrounding skin cleaned with an alcohol, pus squeezed from the boil, skin cleaned again, and covered with a sterile cotton gauze. Gauze has to be changed and underlying skin cleaned every day until the boil heals completely. Large abscesses may require surgical drainage.
In infected wounds, stitches or foreign bodies have to be removed. Any dead tissue (necrosis) has to be surgically removed.
Extensive skin infections like in staphylococcal scalded skin syndrome (SSSS) require intravenous antibiotics. Antibiotics should be chosen on the basis of antibiotic susceptibility of staphylococci as determined by culture results.
Remedies in Staph Skin Infections
Topical antibacterial treatment. Fusidic acid (Fucidin®) and mupirocin (Bactroban®) are available as an ointment. Triple-antibiotic (neomycin, polymyxin and bacitracin) mixtures can be found in pharmacies. Treatment should last up to 10 days, 2-3 times a day; longer use should be avoided to prevent bacterial resistance. Some ointments may have slight irritating effect (dry skin, burning, rash).
To help boils burst, apply a soft cloth soaked in warm salt water to the affected area for about 30 minutes few times a day. Prepare the salt water by adding 2 teaspoon of salt to 1 liter of water, boiled and cooled down to room temperature. Warm compresses made with white vinegar or Burow’s solution (5% aluminum subacetate) may help relieve itching (3).
To prevent spreading infection to other skin areas, antibacterial soaps, bath additives, and creams containing chlorhexidine, triclosan, and povidone-iodine, can be used.
To reduce itching, especially in children, emollients may be used.
To cure nasal staph carriage, nasal mupirocin ointment, or oral rifampin may be used (4,2). Nasal swabs should be taken from the patient and his/her family members to identify staph carriers.
Laser hair removal helps in recurrent folliculitis.
How to Prevent Staph Skin Infections?
People prone to get recurrent staph skin infections should:
- regularly wash their hands, avoid nose picking, nails biting, and skin scratching
- use electric razor instead of blades, or shave less frequently
- wear fresh, comfortable, airy clothes
- clean athletic equipment, sits beside pools before using
- not share razors, towels, clothes, bed lining with others
- treat any underlying diseases like diabetes or dermatitis
References:
- http://www.merck.com/mmhe/sec17/ch190/ch190r.html STAPH CARRIERS
- http://www.skininfection.com/AboutSkinInfection/CellulitisAndErysipelas.html CELLULITIS AND ERYSIPELAS
- http://www.mayoclinic.com/health/impetigo/DS00464 IMPETIGO
- http://www.nlm.nih.gov/medlineplus/ency/article/001444.htm PARONYCHIA
- http://www.med.umich.edu/1libr/pa/pa_infectio_hhg.htm WOUND INFECTION
- http://www.emedicine.com/med/topic2422.htm INFECTION OF SURGICAL WOUNDS
- http://www.dermnetnz.org/bacterial/scalded-skin-syndrome.html SSSS
- http://www.mayoclinic.com/health/hidradenitis-suppurativa/DS00818/DSECTION=symptoms HYDRADENITIS SUPPURATIVA
- http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000825.htm CARBUNCLE
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