Supportive care for conditions involving skin induration can vary greatly, depending on the underlying cause. KALYANAKRISHNAN RAMAKRISHNAN, MD, ROBERT C. SALINAS, MD, AND NELSON IVAN AGUDELO HIGUITA, MD. INTRODUCTION. Treatment is incision and drainage. Medical Definition of Induration. Cellulitis, abscess, or both are among the most common skin and soft tissue infections [].Cellulitis (which includes erysipelas) manifests as an area of skin erythema, edema, and warmth; it develops as a result of bacterial entry via breaches in the skin barrier [].A skin abscess is a collection of pus within the dermis or subcutaneous space. Atrophy is thinning of the skin, which may appear dry and wrinkled, resembling cigarette paper. Indistinct margins of involvement Lymhangitis is often absent (infection is in deep fascia rather than skin) Rapidly progressive despite use of antibiotics Fever may be present in only 40% of the cases due to masking effect of NSAIDs, steroids and antibiotics. The diagnosis is based on clinical evaluation. Examples include: Not only is there an underlying skin condition that can cause infections that exhibit skin induration, but there is also a causative microorganism. Monday to Friday. All read more , rubella Rubella ( See also Congenital Rubella.) The area becomes firm, but not as hard as bone. An excoriation is a linear erosion caused by scratching, rubbing, or picking. Warmth. Diagnosis is usually obvious by examination. 2. Copyright 2023 American Academy of Family Physicians. According to guidelines from the Infectious Diseases Society of America, initial management is determined by the presence or absence of purulence, acuity, and type of infection.5, Topical antibiotics (e.g., mupirocin [Bactroban], retapamulin [Altabax]) are options in patients with impetigo and folliculitis (Table 5).5,27 Beta-lactams are effective in children with nonpurulent SSTIs, such as uncomplicated cellulitis or impetigo.28 In adults, mild to moderate SSTIs respond well to beta-lactams in the absence of suppuration.16 Patients who do not improve or who worsen after 48 hours of treatment should receive antibiotics to cover possible MRSA infection and imaging to detect purulence.16, Adults: 500 mg orally 2 times per day or 250 mg orally 3 times per day, Children younger than 3 months and less than 40 kg (89 lb): 25 to 45 mg per kg per day (amoxicillin component), divided every 12 hours, Children older than 3 months and 40 kg or more: 30 mg per kg per day, divided every 12 hours, For impetigo; human or animal bites; and MSSA, Escherichia coli, or Klebsiella infections, Common adverse effects: diaper rash, diarrhea, nausea, vaginal mycosis, vomiting, Rare adverse effects: agranulocytosis, hepatorenal dysfunction, hypersensitivity reactions, pseudomembranous enterocolitis, Adults: 250 to 500 mg IV or IM every 8 hours (500 to 1,500 mg IV or IM every 6 to 8 hours for moderate to severe infections), Children: 25 to 100 mg per kg per day IV or IM in 3 or 4 divided doses, For MSSA infections and human or animal bites, Common adverse effects: diarrhea, drug-induced eosinophilia, pruritus, Rare adverse effects: anaphylaxis, colitis, encephalopathy, renal failure, seizure, Stevens-Johnson syndrome, Children: 25 to 50 mg per kg per day in 2 divided doses, For MSSA infections, impetigo, and human or animal bites; twice-daily dosing is an option, Rare adverse effects: anaphylaxis, angioedema, interstitial nephritis, pseudomembranous enterocolitis, Stevens-Johnson syndrome, Adults: 150 to 450 mg orally 4 times per day (300 to 450 mg orally 4 times per day for 5 to 10 days for MRSA infection; 600 mg orally or IV 3 times per day for 7 to 14 days for complicated infections), Children: 16 mg per kg per day in 3 or 4 divided doses (16 to 20 mg per kg per day for more severe infections; 40 mg per kg per day in 3 or 4 divided doses for MRSA infection), For impetigo; MSSA, MRSA, and clostridial infections; and human or animal bites, Common adverse effects: abdominal pain, diarrhea, nausea, rash, Rare adverse effects: agranulocytosis, elevated liver enzyme levels, erythema multiforme, jaundice, pseudomembranous enterocolitis, Adults: 125 to 500 mg orally every 6 hours (maximal dosage, 2 g per day), Children less than 40 kg: 12.5 to 50 mg per kg per day divided every 6 hours, Children 40 kg or more: 125 to 500 mg every 6 hours, Common adverse effects: diarrhea, impetigo, nausea, vomiting, Rare adverse effects: anaphylaxis, hemorrhagic colitis, hepatorenal toxicity, Children 8 years and older and less than 45 kg (100 lb): 4 mg per kg per day in 2 divided doses, Children 8 years and older and 45 kg or more: 100 mg orally 2 times per day, For MRSA infections and human or animal bites; not recommended for children younger than 8 years, Common adverse effects: myalgia, photosensitivity, Rare adverse effects: Clostridium difficile colitis, hepatotoxicity, pseudotumor cerebri, Stevens-Johnson syndrome, Adults: ciprofloxacin (Cipro), 500 to 750 mg orally 2 times per day or 400 mg IV 2 times per day; gatifloxacin or moxifloxacin (Avelox), 400 mg orally or IV per day, For human or animal bites; not useful in MRSA infections; not recommended for children, Common adverse effects: diarrhea, headache, nausea, rash, vomiting, Rare adverse effects: agranulocytosis, arrhythmias, hepatorenal failure, tendon rupture, 2% ointment applied 3 times per day for 3 to 5 days, For MRSA impetigo and folliculitis; not recommended for children younger than 2 months, Rare adverse effects: burning over application site, pruritus, 1% ointment applied 2 times per day for 5 days, For MSSA impetigo; not recommended for children younger than 9 months, Rare adverse effects: allergy, angioedema, application site irritation, Adults: 1 or 2 double-strength tablets 2 times per day, Children: 8 to 12 mg per kg per day (trimethoprim component) orally in 2 divided doses or IV in 4 divided doses, For MRSA infections and human or animal bites; contraindicated in children younger than 2 months, Common adverse effects: anorexia, nausea, rash, urticaria, vomiting, Rare adverse effects: agranulocytosis, C. difficile colitis, erythema multiforme, hepatic necrosis, hyponatremia, rhabdomyolysis, Stevens-Johnson syndrome, Mild purulent SSTIs in easily accessible areas without significant overlying cellulitis can be treated with incision and drainage alone.29,30 In children, minimally invasive techniques (e.g., stab incision, hemostat rupture of septations, in-dwelling drain placement) are effective, reduce morbidity and hospital stay, and are more economical compared with traditional drainage and wound packing.31, Antibiotic therapy is required for abscesses that are associated with extensive cellulitis, rapid progression, or poor response to initial drainage; that involve specific sites (e.g., face, hands, genitalia); and that occur in children and older adults or in those who have significant comorbid illness or immunosuppression.32 In uncomplicated cellulitis, five days of treatment is as effective as 10 days.33 In a randomized controlled trial of 200 children with uncomplicated SSTIs primarily caused by MRSA, clindamycin and cephalexin (Keflex) were equally effective.34, Inpatient treatment is necessary for patients who have uncontrolled infection despite adequate outpatient antimicrobial therapy or who cannot tolerate oral antibiotics (Figure 6). The condition is linked with significant illness and mortality rates. Target (bulls-eye or iris) lesions appear as rings with central duskiness and are classic for erythema multiforme Erythema Multiforme Erythema multiforme is an inflammatory reaction, characterized by target or iris skin lesions. Inpatient treatment is recommended for patients with uncontrolled SSTIs despite adequate oral antibiotic therapy; those who cannot tolerate oral antibiotics; those who require surgery; those with initial severe or complicated SSTIs; and those with underlying unstable comorbid illnesses or signs of systemic sepsis. Simple infection with no systemic signs or symptoms indicating spread, Infection with systemic signs or symptoms indicating spread, Infection with signs or symptoms of systemic spread, Infection with signs of potentially fatal systemic sepsis, Immunocompromise (e.g., human immunodeficiency virus infection, chemotherapy, antiretroviral therapy, disease-modifying antirheumatic drugs), Collection of pus with surrounding granulation; painful swelling with induration and central fluctuance; possible overlying skin necrosis; signs or symptoms of infection, Cat bites become infected more often than dog or human bites (30% to 50%, up to 20%, and 10% to 50%, respectively); infection sets in 8 to 12 hours after animal bites; human bites may transmit herpes, hepatitis, or human immunodeficiency virus; may involve tendons, tendon sheaths, bone, and joints, Traumatic or spontaneous; severe pain at injury site followed by skin changes (e.g., pale, bronze, purplish red), tenderness, induration, blistering, and tissue crepitus; diaphoresis, fever, hypotension, and tachycardia, Infection or inflammation of the hair follicles; tends to occur in areas with increased sweating; associated with acne or steroid use; painful or painless pustule with underlying swelling, Genital, groin, or perineal involvement; cellulitis, and signs or symptoms of infection, Walled-off collection of pus; painful, firm swelling; systemic features of infection; carbuncles are larger, deeper, and involve skin and subcutaneous tissue over thicker skin of neck, back, and lateral thighs, and drain through multiple pores, Common in infants and children; affects skin of nose, mouth, or limbs; mild soreness, redness, vesicles, and crusting; may cause glomerulonephritis; vesicles may enlarge (bullae); may spread to lymph nodes, bone, joints, or lung, Spreading infection of subcutaneous tissue; usually affects genitalia, perineum, or lower extremities; severe, constant pain; signs or symptoms of infection. The four classical signs of inflammation, originally recorded by the Roman encyclopedist Celsus in the 1st century A.D. Stevens DL, Bisno AL, Chambers HF, et al. 168 The rash appears in crops, each consisting of a small number of individual lesions during febrile episodes. druid hill park crime; james stevens obituary michigan; dave ramsey real estate investing Certain chemicals given off by bacteria and white blood cells also accumulate under the skin forming pus. Surgical Infection Society (SIS): Guidelines for the treatment of complicated skin and soft tissue infections, update (2021) Association for the Advancement of Wound Care.Most uncomplicated bacterial skin infections that require antibiotics need 5-10 days of. These may be caused by burns, bites, irritant contact dermatitis Irritant contact dermatitis (ICD) Contact dermatitis is inflammation of the skin caused by direct contact with irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Fluctuance can be described as a tense area of skin with a wave-like or boggy feeling upon palpation; this is the pus which has accumulated beneath the epidermis. Panniculitis is an inflammation within the fat tissue of the body. The neutrophil count is an important prognostic factor; severely neutropenic patients are prone to develop indurations without fluctuance and should be nonoperatively managed, whereas leukemic patients with borderline neutrophil counts may present with fluctuant lesions amenable to surgical drainage ( 12 ). Certain chemicals given off by bacteria and white blood cells also accumulate under the skin . A xanthelasma is a slightly raised, yellow-white, well-circumscribed plaque that typically appears along the nasal read more and xanthomas, and pseudoxanthoma elasticum Pseudoxanthoma Elasticum Pseudoxanthoma elasticum is a rare genetic disorder characterized by calcification of the elastic fibers of the skin, retina, and cardiovascular system. The act or process of becoming hardened. Diagnosis is clinical. Nodules are firm papules or lesions that extend into the dermis or subcutaneous tissue. Data Sources: A PubMed search was completed using the key term skin and soft tissue infections. A complete blood count, C-reactive protein level, and liver and kidney function tests should be ordered for patients with severe infections, and for those with comorbidities causing organ dysfunction. Sherry Christiansen is a medical writer with a healthcare background. . Diagnosis is by examination. Serpiginous lesions have linear, branched, and curving elements. Induration Skin Hardening Signs and Causes. Important information to obtain from history includes Personal or family read more and Diagnostic Tests for Skin Disorders Diagnostic Tests for Skin Disorders Diagnostic tests are indicated when the cause of a skin lesion or disease is not obvious from history and physical examination alone. According to a Baylor University Medical Center study, staphylococcus aureus is responsible for the majority of skin and soft tissue infections. Symptoms and signs are pain and a tender and firm or fluctuant swelling. Orange skin is most often seen in hypercarotenemia, a usually benign condition of carotene deposition after excess dietary ingestion of beta-carotene. It can occur in classic, AIDS-associated, endemic (in Africa), and iatrogenic (eg, after organ transplantation) read more and hemangiomas, can appear purple. Plaques are palpable lesions > 10 mm in diameter that are elevated or depressed compared to the skin surface. Psoriasis Psoriasis Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Cutaneousmetastasisoccurs when cells from a cancer in the body spread to theskin. If present, consider sepsis, necrotizing infection, and lymphadenitis. This photo shows a small hyperpigmented read more . Fluctuant means a boggy-like feeling and indurated means firm and hardened. There is no evidence that any pathogen-sensitive antibiotic is superior to another in the treatment of MRSA SSTIs.
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