Call-On-Doc Focus: Identifying Skin Infections

As skin infections develop, symptoms can vary can vary based on the condition, there are some shared signs like localized redness, swelling, and the formation of a rash or lesions with pus alongside systematic symptoms that indicate one is developing. Symptoms are only a small part of understanding a skin infection as they do not indicate the severity of the infection or indicate that something further may be wrong, the cause and the push to seek treatment are also still in question when noticing symptoms. Common skin infection signs to look out for include:

Swelling and Inflammation are results of the body pumping blood into an affected area. Either symptom does not necessarily imply a specific condition, as they can also be applied to sprains, acne, bone breaks, insect bites, and more. The symptom is often accompanied by the affected area additionally being warm and tender. When specific to a skin infection, a person should watch out for: 

• Localized Redness and Warmth: The affected area of the skin may appear red, feel warm to the touch, and be tender or painful.
• Painful Lesions or Blisters: Presence of painful sores, blisters filled with fluid or pus, or open wounds that are associated with infection.
• Spreading Rash: If the infection is caused by a virus or fungus, a spreading rash with distinct patterns or characteristics may develop. This rash may start in one area and gradually spread to other parts of the body, often with accompanying itching or discomfort. 

Systemic symptoms, often similar to flu-like symptoms, can sometimes accompany certain skin infections, especially when the infection is more severe or has spread beyond the skin's surface. These symptoms can include fever, chills, fatigue, muscle aches, and swollen lymph nodes. While skin infections primarily affect the skin, the presence of systemic symptoms indicates that the infection may be more widespread or have triggered a stronger immune response. In some cases, systemic symptoms may suggest a deeper or more aggressive infection, such as cellulitis or abscesses.

Lesions or Sores are possible from conditions like insect bites and sunburns, lesions and sores can also indicate an autoimmune disease or skin infection. Whereas swelling and inflammation are an internal process to kill pathogens that can result in an infection, lesions or sores are a similar process the body uses to heal, initiating cellular repair and regeneration after the initial immune response. 

Eggs, in the context of skin infections, are signs of a parasitic skin infection like lice, with eggs normally being detected on hair shafts close to the scalp as a result of their reproductive cycle. The presence of eggs, also known as nits, on the hair or skin, can indicate an ongoing infestation. Primarily isolated to parasitic skin infections, symptoms to be mindful of include: 

• Visible Nits or Eggs: Eggs or nits may be visibly attached to the hair shafts, particularly close to the scalp or in areas where parasites are likely to lay eggs. They may appear as small, oval-shaped structures that are firmly attached to the hair.
• Intense Itching: The presence of eggs is often accompanied by intense itching, especially around the scalp, neck, or other affected areas. This itching can be persistent and may worsen if the infestation is not addressed.

Irritation and itching in the context of skin infections can result from various factors, including immune responses to pathogens, inflammatory processes, or direct irritation from external sources. These symptoms are not exclusive to skin infections and can occur in response to various conditions, allergens, or irritants. However, when specific to a skin infection, a person should watch out for:

• Wound Expansion or Formation: Persistent scratching or rubbing of the skin due to itching can lead to further irritation, redness, and potentially open wounds. This can create an entry point for more bacteria or other pathogens, increasing the risk of infection.

Fluid-filled Blisters can be the result of a viral, bacterial, or fungal skin infection, while also being the primary symptom of things like contact with poison ivy, regular rubbing of the skin against another surface, allergic reactions, and more. These blisters can be painful and may rupture, leading to potential complications such as secondary infections. When a specific skin infection symptom, things to look out for and consider include: 

• Rapid Blister Formation: If multiple blisters appear suddenly and rapidly, especially in a localized area, it could indicate an aggressive infection or inflammatory response.
• Presence of Pus: If the blisters start to develop pus-filled centers or if you notice pus draining from the blisters, it strongly suggests a bacterial infection. Pus is often a sign of an immune response to bacterial presence.

Whereas each of these symptoms is often shared by other conditions unrelated to a skin infection, understanding how they play into each other will help you report it to a doctor or speed up what you need for relief. Additionally, knowing the most common skin infections can also help when gauging when to get treatment. 

Cellulitis typically starts with a break or breach in the skin's protective barrier, allowing bacteria, commonly Staphylococcus or Streptococcus species, to enter and infect the deeper layers of the skin and underlying tissues. This can occur through cuts, wounds, insect bites, or areas of skin inflammation.

General symptoms of cellulitis include localized redness, warmth, swelling, and tenderness in the affected area. The skin may appear shiny, stretched, or have a "orange peel" texture. As the infection progresses, the area may become increasingly painful, and there may be the development of fever, chills, fatigue, or swollen lymph nodes, indicating a more severe infection that may require medical attention and antibiotic treatment.

An abscess or boil typically begins as a localized area of infection, often caused by bacteria such as Staphylococcus aureus. This infection can occur in various parts of the body, including the skin, underlying tissues, or internal organs. In the context of skin infections, an abscess can develop when bacteria invade a hair follicle or sweat gland, leading to inflammation, pus accumulation, and the formation of a painful, swollen lump known as a boil. 

General symptoms of an abscess include redness, warmth, swelling, and tenderness in the affected area. The skin over the abscess may become discolored and may feel firm or fluctuant due to the collection of pus. As the abscess matures, it may eventually rupture, releasing pus and providing temporary relief, but medical attention is often necessary to fully treat the condition.

Shingles, also known as herpes zoster, is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. After a person has had chickenpox, the virus can remain dormant in nerve cells and reactivate years later as shingles. 

The initial symptoms of shingles often include pain, tingling, or burning sensations in a specific area of the skin, usually on one side of the body or face. This is followed by the development of a red rash that progresses into clusters of fluid-filled blisters. The rash is typically accompanied by itching, sensitivity to touch, and sometimes fever, headache, or fatigue. The blisters can eventually crust over and heal, but complications such as postherpetic neuralgia (persistent nerve pain) can occur, especially in older adults or those with weakened immune systems. Early recognition and treatment with antiviral medications can help reduce the severity and duration of shingles symptoms.

Herpes simplex virus (HSV) infections, commonly known as herpes, can manifest as oral herpes (cold sores) or genital herpes. The initial symptoms of a herpes outbreak often include tingling, itching, or burning sensations in the affected area. This is followed by the appearance of small, fluid-filled blisters that can be painful and may rupture, leaving open sores that can be contagious. In oral herpes, the blisters typically occur around the mouth or lips, while in genital herpes, they appear on or around the genital area. 

Other symptoms may include fever, swollen lymph nodes, and general malaise. Herpes outbreaks can recur periodically, with the frequency and severity varying among individuals. Antiviral medications can help manage symptoms, reduce the duration of outbreaks, and lower the risk of transmission to others.

Jock itch, medically known as tinea cruris, is a fungal infection of the skin in the groin area. It is caused by dermatophyte fungi, primarily Trichophyton rubrum or Trichophyton mentagrophytes. The warm, moist environment of the groin provides an ideal breeding ground for these fungi, leading to their overgrowth and the development of jock itch. 

The typical symptoms of jock itch include redness, itching, and a rash that may appear as raised, scaly patches or bumps. The rash can spread from the groin to the inner thighs, buttocks, and genitals. In some cases, the affected skin may become cracked, blistered, or have a distinct border. Jock itch is often itchy and uncomfortable, especially during physical activity or in warm weather. Treatment typically involves antifungal medications, topical creams, and keeping the affected area clean and dry to prevent recurrence.

Athlete's foot, also known as tinea pedis, is a fungal infection of the skin on the feet, primarily caused by dermatophyte fungi such as Trichophyton rubrum or Trichophyton mentagrophytes. The condition is common among athletes and individuals who frequently wear tight-fitting shoes or moist socks, as these conditions create a favorable environment for fungal growth. 

Symptoms of athlete's foot include itching, redness, and a rash that typically starts between the toes and may spread to the soles and sides of the feet. The affected skin may become dry, scaly, cracked, or blistered, leading to discomfort and pain, especially when walking or standing for extended periods. In severe cases, athlete's foot can cause inflammation, swelling, and a foul odor. Treatment often involves antifungal medications, topical creams, and proper foot hygiene to prevent the recurrence and spread of the infection.

Lice infestation, known as pediculosis, is caused by tiny parasitic insects called lice. The three main types of lice that infest humans are head lice (Pediculus humanus capitis), body lice (Pediculus humanus corporis), and pubic lice (Pthirus pubis). Lice are typically spread through close contact with an infected person or by sharing personal items such as combs, hats, or clothing. 

The primary symptoms of lice infestation include itching, especially in the affected areas such as the scalp, body, or pubic region. Scratching may lead to skin irritation, redness, and the development of sores or secondary bacterial infections. In the case of head lice, small white or yellowish eggs (nits) may be visibly attached to the hair shafts near the scalp. Body lice may cause skin rashes or darkening of the skin due to prolonged feeding and excrement deposition. Pubic lice infestation can lead to itching in the genital area and the presence of small, crab-like insects in pubic hair. Treatment typically involves topical or oral medications specifically designed to eliminate lice and their eggs, along with thorough cleaning of personal items and the living environment to prevent re-infestation.

Scabies is a contagious skin infestation caused by the Sarcoptes scabiei mite. The mites burrow into the skin to lay eggs, leading to intense itching and a rash. The primary symptoms of scabies include severe itching, especially at night, which is often more intense in areas such as the wrists, between the fingers, underarms, elbows, knees, and genital area. 

The itching is due to the body's allergic reaction to the mites and their waste products. The rash associated with scabies appears as small, red bumps or blisters, along with thin, wavy lines or tracks on the skin caused by the mites' burrowing. Scratching the affected areas can lead to secondary bacterial infections and more pronounced skin irritation. Scabies is highly contagious and can spread through close, prolonged skin-to-skin contact with an infested person. Treatment typically involves topical medications, such as permethrin cream, to kill the mites and their eggs, along with thorough washing of clothing, bedding, and personal items to prevent re-infestation.

There are many reasons why someone can get a skin infection as well as get re-infected or notice flair-ups, the most common being:

• Poor Hygiene: Inadequate or improper hygiene practices, such as infrequent handwashing, not bathing regularly, or wearing dirty clothes, can increase the risk of skin infections by allowing harmful bacteria or fungi to thrive on the skin's surface.
• Compromised Immune System: Individuals with weakened immune systems, whether due to underlying medical conditions (e.g., HIV/AIDS, diabetes) or medications (e.g., immunosuppressants), are more susceptible to skin infections as their body's ability to fight off pathogens is reduced.
• Skin Injuries: Cuts, wounds, scratches, or abrasions provide entry points for bacteria, fungi, or other pathogens to enter the skin and cause infections. Improper wound care or leaving wounds exposed can further increase the risk.
• Environmental Factors: Certain environments, such as hot and humid climates, communal living spaces (e.g., dormitories, nursing homes), or occupational settings with exposure to chemicals or irritants, can promote the growth and spread of skin infections.
• Skin Conditions: Pre-existing skin conditions, such as eczema, psoriasis, or acne, can compromise the skin's protective barrier, making it more susceptible to infections. Additionally, conditions like obesity or excessive sweating can create favorable conditions for fungal or bacterial overgrowth.
• Close Contact: Close and prolonged contact with individuals who have contagious skin infections, such as scabies, lice, or impetigo, increases the risk of transmission and subsequent infections.
• Poor Nutrition: Inadequate intake of essential nutrients, vitamins, and minerals can weaken the immune system and impair skin health, making it easier for infections to occur and persist.
• Personal Habits: Certain personal habits, such as sharing personal items (e.g., towels, razors), using unclean or contaminated skincare products, or wearing tight-fitting clothing that traps moisture, can contribute to the spread of skin infections.

When someone suspects they have a skin infection before seeking medical treatment, they can take several steps to manage the condition and reduce potential complications:

• Clean the Area: Gently wash the affected area with mild soap and water to remove dirt, debris, and bacteria. Pat the area dry with a clean towel, avoiding rubbing or irritating the skin further.
• Apply Topical Treatments: If the skin infection is minor, over-the-counter topical antiseptic creams or ointments may help reduce inflammation and prevent infection spread. Follow the product instructions carefully.
• Keep the Area Dry and Clean: Moisture can exacerbate skin infections, so keep the affected area dry and avoid wearing tight clothing that can trap moisture. Change clothes, towels, and bedding regularly.
• Avoid Scratching: As tempting as it may be, avoid scratching or picking at the infected area to prevent further irritation, spread of infection, and potential scarring.
• Use Cold Compresses: Applying cold compresses or ice packs wrapped in a cloth can help reduce swelling, pain, and itching associated with some skin infections.
• Monitor Symptoms: Keep an eye on the progression of symptoms, such as redness, swelling, pain, or the appearance of pus-filled lesions. Note any changes or worsening of the condition.
• Practice Good Hygiene: Maintain good hygiene practices, including regular handwashing, keeping nails short and clean, and avoiding sharing personal items like towels or razors.

If you or a loved one notice signs or symptoms of a skin infection, it's important to be examined by a medical provider to understand the cause and treatment options. Call-On-Doc offer same day dermatology consultations online where a board-certified dermatologist can review images of your infection and prescribe treatment in two hours or less.