Lymphedema Skin Infections

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Related Terms: Skin infections, Mycetoma fungus, Staphylococcal skin infections, Cellulitis, Lymphangitis, Erisypelas, Cutaneous Abscesses, Necrotizing Subcutaneous Infections, Infections Affecting the Feet, Scalded Skin Syndrome, Folliculitis, Furuncles, Hidradenitis Superativa, Paronychial Infections, Erythrasma, Fungal Infections, Skin Rashes

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Discussion

Because of the compromised condition of a lymphovenous limb, we are often susceptible to a large number of skin complications. These may include various skin growths such as skin tags, warts, dermatofibromas, lymphangiomas, rashes, fungal infections, superficial bacterial infections infections which include as impetigo, folliculitis, carbuncles, furuncles and boils and weeping sores.

With lymphedema, some types untreated skin conditions can lead to serious consequences including systemic infections (sepsis), gangrene, amputation and even death. Good skin health is critical to our overall good health.

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Foot Infections

Infections Affecting the Feet

Any time a break in the skin occurs, bacteria, fungi, and other pathogens can enter and cause an infection. The foot is an especially rich source of bacteria and invading microorganisms, because your shoes provide them a perfect environment in which to live. Therefore, any time you notice a lesion, ulcer, cut, or sore on your feet, you need to take prompt action to prevent infection. A foot ulcer is the most likely source of infection in the foot. When an ulcer becomes infected, microorganisms can eat through layers of skin and bone tissue to create a deep hole. When the infection spreads or becomes too deep, amputation may be needed.

SYMPTOMS

Symptoms of an infected ulcer include fever, redness, swelling, warmth around the wound, and any sort of drainage or oozing of pus-like material.

RISKS

An infected ulcer can eat away at your soft tissue and make its way into the bone. If the infection is deep, a part of the foot or even the entire foot or leg may have to be removed to save your life.

WHAT TO DO

If you notice any signs of infection in a foot ulcer, notify your doctor or podiatrist right away. You need to be seen at once before the infection spreads further. You may notice signs of infection even if you don't have an open sore or ulcer. If you notice any redness, swelling, or oozing around your toenail, for example, or at the site of a cut or splinter, you also need to call your doctor right away.

TREATMENT

Your doctor will probably first culture material from the sight of infection. You will probably be treated with an antibiotic depending on what sort of organism is causing the infection. This could be an antibiotic or an and fungal agent that can be taken orally, one that is applied topically, or both.

Your doctor will also conduct blood tests to check your blood glucose level and your white cell count. You may also be examined by X ray to make sure there is no sign of bone infection. If the infection is not severe, you will be treated on an outpatient basis, but you should be seen every 2 or 3 days for the first week or so. Most infections will show some improvement in a few days. If you have a soft-tissue infection, you will probably need to take antibiotics for 2 weeks. If the infection has reached the bone, you may need antibiotic therapy for 6 weeks or longer. Make sure to take the prescribed antibiotics for the entire time, even if you think it is getting better. If the infection gets worse, contact your provider immediately, even if you are scheduled for an appointment soon. Signs of a worsening infection include fever or an elevation in an existing fever, increased pain, redness, warmth, or pus formation.

Besides antibiotics, your doctor takes other steps to encourage the healing of your infected ulcer. For an ulcer to heal, it has to be covered with a healthy layer of tissue, with no dead cells in the way. To ensure this, your doctor may perform a surgical debridement. This means all dead tissue will be removed from the wound. This needs to be done frequently as the wound is healing. Do not attempt to do this yourself!

Your doctor may give you instructions for dressing the wound. You may be given an antibiotic solution or ointment. After cleaning the site of infection, you can either apply the ointment directly or soak a piece of clean gauze in antibiotic solution and apply it to the wound. You will probably want to cover the wound with clean sterile gauze in between dressings.

Also make sure not to walk on your infected foot. If you need to get around, consider using a pair of crutches or even a wheelchair. If you notice any swelling, keep your leg elevated.

While your infection is healing it is important to keep your blood glucose levels under control. This may be a bit of a catch-22 situation. Infection can upset your blood glucose levels, but too much glucose in the blood can impair healing and promote infection. Therefore, test your blood glucose levels frequently and treat hyperglycemia or hypoglycemia if necessary.

PREVENTION

To prevent ulcers or other areas of the foot from becoming infected, make sure to keep any open sore clean and dry. Your doctor may suggest treating any ulcer with antibiotic ointment or solution to prevent

infection. Make sure you avoid walking or further irritating the ulcer. Keep a close eye on the wound for any further changes in its appearance. Also, while your ulcer is healing, keep your blood glucose levels as close to normal as possible.

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Nail Infections

The most common nail infection among people with diabetes is onychomycosis. This infection is caused by a fungus and most frequently affects the nail of the big toe. If you can tolerate the unsightly appearance of the toe, it may not seem like that big of a deal. But if left untreated, a fungal toenail can lead to ulceration and infection of the toe itself, which can have serious consequences for someone with diabetes.

SYMPTOMS

The primary symptom of onychomycosis is an unsightly toe. Your toenail may become thick, rough, and yellow. Debris from the infection may collect under the top edge of the nail. After awhile, the entire nail may become soft and crumbly and may even fall off.

WHAT TO DO

Talk to your doctor or podiatrist if you notice any of the symptoms of onychomycosis. Before treating, your doctor will need to accurately diagnose the problem and identify the fungus responsible. This can be done by taking a sample of debris from the nail edge, examining it under a microscope, and culturing it.

TREATMENT

Fungal infections are traditionally difficult to cure. Your doctor may prescribe an oral medication such as terbinafine (Lamisil) or itraconazole (Sporanox). However, these and some other antifungal drugs have side effects. Make sure to discuss these potential side effects with your doctor before taking any new medication. These drugs are newer and have a higher success rate than traditional therapies. You will probably have to take the drug for up to 12 weeks. Following this regimen, 80 percent of nails are successfully treated. However, the condition may reoccur, especially if you discontinue treatment early. Don't be surprised if it takes your new toenail up to 2 years to grow out normally once the fungus has been destroyed.

PREVENTION

To prevent fungal infections, make sure you keep your feet clean and dry. Keep your toenails well trimmed and wear correctly fitted shoes. Visit your podiatrist regularly for a routine foot examination.

Diabetes Digest

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Skin Infections

Matthew L. Lanternier, MD and Karen Brannon, MD
Department of Family Medicine, University of Iowa College of Medicine, and
Private Practice, Muscatine, Iowa

Bacterial Infections.

Impetigo. Usually caused by group A beta-hemolytic streptococci and/or coagulase-positive Staphylococcus aureus. Appear as small vesicles with yellowish crusts, or purulent-appearing bullae, which may be localized or widespread on the skin and develop over days. There is often associated adenopathy but minimal systemic signs. Itching, pain, and tenderness may occur. Moderately contagious. Treatment is with Mupirocin 2% ointment BID or systemic antibiotics (dicloxacillin 500 mg QID x 10 days, cephalexin 500 mg QID x 10 days, or erythromycin 500 mg QID x 10 day), daily bathing with antibacterial soap, and attention to personal hygiene. Need to monitor for the development of post streptococcal glomerulonephritis.
Ecthyma. Considered a deeper extension of impetigo with the same etiology except it may also be caused by Pseudomonas. It is characterized by a hemorrhagic crust with erythema or induration that develops over weeks. Treatment includes systemic antibiotics (see I A above) as well as debridement of the epidermis, which becomes necrotic. Scars may occur after healing. Usually occurs in debilitated patients, such as poorly controlled diabetics, but may occur in anyone.
Erysipelas. Presents as a well-demarcated tender, rapidly advancing erythematous plaque; there is pain associated with the lesion. The patient may have fever and leukocytosis. The usual organism is beta-hemolytic streptococci. Treat as per cellulitis. Patients may have multiple recurrences especially on a dependent extremity or after axillary dissection for breast carcinoma.
Cellulitis. Usually caused by Group A beta-hemolytic streptococci or S. aureus, it is a potentially suppurative inflammation of the dermis and subcutaneous tissue. Cellulitis usually follows trauma, a break in the skin or an underlying dermatosis. Presents with local erythema, tenderness, warmth induration, and tenderness. The border is not well defined. There may be streaks of lymphangitis with involvement of the regional lymph nodes. Systemic symptoms are common, and bacteremia and septicemia may follow. Treatment is with systemic antibiotics (if mild, dicloxacillin or cephalexin 500 mg QID x 7-10d, or if severe, nafcillin 1.5 g IV Q4h or vancomycin 1.5 g/day initially, then switch to oral). Alternative antibiotics include amoxicillin/clavulanate, erythromycin, clarithromycin, or azithromycin. The application of local heat, elevation, and immobilization can also be of benefit. For necrotizing fasciitis and synergistic gangrene, early wide surgical excision and debridement is necessary in addition to IV antibiotics.
Erythrasma and related disorders. Superficial intertriginous skin infections caused by Corynebacteriae organisms. It is often confused with fungal infections. Presents with skin color changes (e.g., reddish brown) and a slightly raised patch of affected skin. The bacteria produce porphyrins so the skin is coral-pink under Wood’s lamp. Preferred treatment is oral erythromycin with topical clindamycin 2% as an alternative. It will respond to miconazole and clotrimazole, but the recurrence rate is high. These organisms also cause trichomycosis axillaris and pitted keratolysis. The former leads to foul axillary odor and hyperhidrosis and the latter to painful burning of the feet with pits on calloused areas. Good hygiene, antiperspirants, and topical erythromycin are used to treat both.
Folliculitis (including sycosis barbae [barber’s itch], pseudofolliculitis, and "hot tub" folliculitis) is a common problem with predisposing factors such as maceration, friction, and the use of irritant chemicals. Usually caused by S. aureus but occasionally by Klebsiella, Pseudomonas (hot tub folliculitis), Aerobacter, or C. albicans. Appears as a pustule with a central hair (follicle) with surrounding erythema. The patient may notice tenderness, pruritus, and pain. Particularly severe cases may result in scaring and the destruction of the hair follicle. Treatment includes antiseptic washes (e.g., Phisoderm or pHisoHex), which may also be used for prophylaxis. Systemic antibiotics such as dicloxacillin, cephalexin, or erythromycin 500mg QID x 7-10 days are an alternative. Mupirocin 2% ointment may be used for isolated areas. Use a fluoroquinolone to cover Pseudomonas (e.g., levofloxacin) for hot tub folliculitis. Complications can include cellulitis, furunculosis, and alopecia.
Furuncle (boil) is an acute, localized perifollicular abscess of the skin and subcutaneous tissue caused by coagulase-positive S. aureus, resulting in a red, hot, very tender inflammatory nodule that exudes pus from one opening. A carbuncle is an aggregate of connected furuncles and characteristically is painful and has a number of pustular openings. This can be an acute or chronic problem with lesions commonly on areas of friction such as buttocks, axillae, breasts, and the nape of the neck. Treatment involves systemic antibiotics (see I D above), local heat, and rest. Incision and drainage is generally required. Prevention is often difficult. Improved personal hygiene, use of antibacterial soaps (e.g., Phisohex, Phisoderm), frequent hand washing, daily bathing, and change of clothing are important. Elimination of carrier states in the nose and perineum by the use of topical mupirocin and systemic antibiotics is often possible.

Viral Infections

Warts (verruca vulgaris) focal areas of epithelial hyperplasia caused by the human papilloma viruses (HPV). Lesions are most common on the hands, feet, anogenital area (condylomata), and face. They are infectious and auto-inoculable. Common in children, the elderly, or in patients with immunologic deficiencies or atopic dermatitis. Treatment is with keratolytic agents (salicylic/lactic acid/podophyllin preparations), cryotherapy, curettage, laser, or electrodesiccation. Recurrences are common and no one treatment is uniformly effective. Cimetidine has been used to treat warts, but controlled trials show that there is no benefit.
Herpes Simplex types I and II are DNA viruses. The early lesions are multiple 1-2 mm diameter yellowish, clear vesicles on an erythematous base. The vesicles can ulcerate and become quite painful. Classic type I herpes occurs around the mouth and type II occurs on the genitalia, but either type I or type II can occur anywhere on the skin. Diagnosis can be made from clinical appearance, serologic antibody titers of acute and convalescent sera, Tzanck smear (Wright’s stain of material obtained from the base of the lesion showing multinucleated giant cells), biopsy, and/or viral culture. A prodrome of pain, discomfort, or tingling is often reported a week to 10 days before seeing the lesions. Treatment is symptomatic with cool compresses, analgesics, and topical drying agents (i.e., Burow’s solution) for the oozing, weeping stages. Antivirals (e.g., acyclovir and others) have only a modest effect on recurrent genital herpes unless used prophylactically on a daily basis . If used during the prodrome, antivirals may shorten duration of lesions, reduce severity of symptoms, and shorten length of viral shedding. Discuss with patients about asymptomatic shedding of virus and the need for safer sex (e.g., use condoms). Some clinical infection syndromes are listed below:
1. Gingivostomatitis. Occurs periorally in children and young adults.
2. Keratoconjunctivitis. Ophthalmology consult is warranted. Usually heals without scarring.
3. Vulvovaginitis
4. Herpes gladiatorum. Occurs on the head, neck, or shoulder. Common in wrestlers.
5. Eczema herpeticum. Occurs in those with underlying skin disorders, most commonly in atopic dermatitis. Children more than adults. Consists of disseminated umbilicated vesicles confined to eczematous skin, which evolve into punched out erosions that may become confluent.
6. Hepatoadrenal necrosis and encephalitis
7. Herpetic whitlow. Occurs on distal portion of fingers.
8. Cold sores (herpes labialis)
Herpes zoster (shingles). Reactivation of latent varicella-zoster virus present in the sensory ganglia.
1. Classic description is that of grouped vesicles on an erythematous base in one unilateral dermatome. Thoracic nerve dermatomes are most commonly involved followed by the major branches of the trigeminal nerve.
2. Symptoms consist of pain, dysesthesia, and pruritus. Healing requires 2 to 3 weeks, and the afflicted persons are infectious until the lesions have crusted over (may transmit chicken pox to those who are not immune). Persons of any age can be affected, but the disease is more common and more severe in the elderly.
3. Diagnosis is via clinical presentation, although Tzanck smear, biopsy, and viral culture may be performed.
4. Treatment is oral acyclovir 800 mg 5 x a day for 7-10 days, which is effective if treatment is initiated within 2 days of the onset of the rash. Reduce the dose for all antivirals if CrCl is <60 ml/min. Alternatively, famciclovir 500 mg PO TID for 7 days can be used and may be more effective at preventing postherpetic neuralgia. Val- acyclovir 1000 mg PO TID for 7 days is another alternative. Steroids are ineffective. Capsaicin creams can be used for pain relief after the lesions have healed. Amitriptyline 25-150 mg QHS may be useful in the treatment of postherpetic neuralgia. Other options include lidocaine patches (Lidoderm), carbamazepine, gabapentin, etc. For recurrent herpes zoster, if more than one dermatome is involved or bilaterally, consider malignancy or other causes of immunosuppression.
Molluscum contagiosum. Caused by a DNA pox virus. Appear as pearly papules up to 5 mm in diameter having a central dimple (umbilication). Multiple lesions are usually present. The central core (molluscum body) can be expressed with a blade. The lesions are infectious and auto- inoculation is common. Children are most commonly affected. Spon-taneous resolution may occur, but there is often an eczematous reaction before to its resolution. Treatment can be limited to simple superficial curettage without anesthesia. The removal of the molluscum body, application of 50% trichloroacetic acid, or liquid nitrogen cryotherapy are equally efficacious.

Fungal Infections (Dermatomycoses).

Candidiasis. Caused by Candida albicans. Seen as thrush (see Chapters 11 and 12 for infants and immunosuppressed patients, respectively), diaper dermatitis, perineal infections, and intertriginous dermatitis. Diagnosis is by clinical exam, and microscopic examination of skin scraping in 10% KOH reveals yeast forms and budding hyphae. Treat with topical imidazole (miconazole, clotrimazole) creams BID to affected areas for superficial fungal infections. Invasive disease can be treated with fluconizole 400 mg IV QD for 7 days and then PO for 14 days after the last positive blood culture. This may be doubled in patients who deteriorate. An alternative is amphotericin B. Persons who present with recurrent infections should be investigated for an underlying illness such as diabetes mellitus, hypoparathyroidism, Addison’s disease, malignancies, or HIV. Use of steroids and antibiotics are also predisposing factors.
Dermatophytoses (tinea). These fungi, belonging to the genera Trichophyton, Microsporum, and Epidermophyton, infect the stratum corneum of epidermis, hair, and nails. Commonly referred to by the locus of infection, i.e., tinea unguium (nails), tinea pedis (foot, "Athlete’s foot"), tinea cruris (perineum, "jock itch"), tinea corporis (body, ringworm), tinea barbae (beard), tinea manus (hand), and tinea capitis (scalp and hair). Lesions can appear as grayish, scaling patches which can be quite pruritic and may lead to auto-inoculation or scalp alopecia. Skin scraping in 10% KOH will demonstrate fungal hyphae. Infected hairs when examined under black light will fluoresce a green-yellow color. Treatment of selected areas is as follows:
1. Tinea corporis (body, ringworm), tinea cruris (perineum, jock itch), tinea pedis (foot, athlete’s foot). Topical tolnaftate (Tinactin--OTC) or clotrimazole (Lotrimin) TID until clear, and then 1 to 2 weeks longer.
2. Tinea capitis (scalp and hair). Micronized griseofulvin is usually used for up to 4 to 8 weeks. Itraconazole, fluconazole, and terbinafine may work also. Adjunctive therapy includes selenium sulfide shampoo Q2-3 days.
3. Tinea unguis or onychomycosis (nails). Griseofulvin 500 mg BID for a period of 4 to 6 months or itraconazole 200 mg BID for 4 months (1 week on, 3 weeks off), latter regimen is very expensive. An alternative is terbinafine 250 mg PO QID for 12 weeks or BID for 1 week of the month for 3 or 4 months. Success rates are about 75% but may recur. The newer nail-paint preparations are expensive and have a very poor success rate.
Tinea (pityriasis) versicolor appears as slightly pigmented, superficial, and tan scaling plaques of various sizes, primarily on the neck, trunk, and proximal arms. With sun exposure, the infected regions do not tan and appear hypopigmented. Usually caused by Malassezia furfur. Diagnosis is via clinical exam and KOH preparations of skin scraping. Treatment can be with topical imidazoles twice daily or washing with zinc or selenium shampoos daily for 2-3 weeks. Although not FDA approved, ketoconazole 400 mg can be given as a single dose. Have the patient exercise to a sweat and not shower for at least 4 hours afterwards. This has up to a 97% success rate in a single dose. Alternatives are ketoconazole 200 mg PO QD for 7 days or either fluconazole or itraconazole 400 mg PO QD for 7 days.

University of Iowa Family Practice Handbook

Virtual Hospital

http://www.vh.org/adult/provider/familymedicine/FPHandbook/Chapter17/02-17.html

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Fungal Nail Infection

Fungal infection of nails is common. The infection causes thickened and unsightly nails which sometimes become painful. Medication usually works well to clear the infection, but you need to take it for several weeks.

Who gets fungal nail infections?

About 3 in 100 people in the UK will have a fungal nail infection at some stage. Toenails are more commonly affected than fingernails. It is more common in people over 55, and in younger people who share communal showers such as swimmers or athletes.

How do you get a fungal nail infection?

In many cases there is no apparent reason. Fungus germs (fungi) are common and an infection can occur 'out of the blue'.
Spread from a fungal skin infection. For example, athlete's foot is a fungal skin infection of the toes. This may spread to the toenails if the skin infection is not treated early.
Fingernail infection may occur after a toenail infection has become established. The fungus may spread to a finger if you scratch your itchy toes and toenail.
Fingernail infections are also more likely to occur if you wash your hands frequently, or have them in water a lot. For example, if you are a cook or a cleaner. Constant washing may damage the protective skin at the base of the nail. This may allow fungi to enter.
A nail that has recently been damaged is also more likely to become infected.

What are the symptoms of a fungal nail infection?

Often the infection is just in one nail, but several may be affected. At first the infection is usually painless. The nail may look thickened and discoloured (often a greeny-yellow colour). This may be all that occurs and, although unsightly, it often causes no other symptoms.

Sometimes the infection becomes worse. White or yellow patches may appear where the nail has come away from the skin under the nail (the nailbed). Sometimes the whole nail comes away. The nail may become soft and crumble. Bits of nail may fall off. The skin next to the nail may be inflamed or scaly. If left untreated, the infection may eventually destroy the nail and the nailbed, and may become painful. Walking may become uncomfortable if a toenail is affected.

What is the treatment for a fungal nail infection?

Not treating
This is an option if the infection is mild or causing no symptoms. For example, a single small toenail may be infected and remain painless. Also, some people may prefer not to take medication as, although rare, there is a small chance of serious side-effects from antifungal medication. The option to treat can be reviewed at a later date if the infection becomes worse.

Medication
Antifungal tablets will usually clear a fungal nail infection. But, you need to take the tablets for 6-12 weeks, sometimes longer. The medication will also clear any associated fungal skin infection such as athlete's foot. About 9 in 10 people treated will be cured with medication. One reason for treatment to fail is because some people stop their medication too early.

Antifungal nail paint
This is an alternative, but tends not to work as well as medication taken by mouth. It may be useful if the infection is just towards the end of the nail. This treatment does not work well if the infection is near the skin, or involves the skin around the nail. The nail paint has to be put on exactly as prescribed for the best chance of success. You may need six months of nail paint treatment for fingernails, and up to a year for toenails.

What to look out for with treatment nail

The fungi that are killed with treatment remain in the nail until the nail grows out. Fresh, healthy nail growing from the base of the nail is a sign that treatment is working. After you finish a course of treatment, it will take several weeks for the old infected part of the nail to grow out and be clipped off. The non-infected fresh new nail continues growing forward. When it reaches the end of the finger or toe, the nail will look normal again.

It may take 3 months or more for the new nail to grow back fully. Fingernails grow faster than toenails, so it may appear they are quicker to get back to normal. Consult a doctor if there does not seem to be any healthy new nail beginning to grow after a few weeks of treatment. However, the infection can still respond to treatment even after you finish a course of medication. This is because the antifungal medication stays in the nail for about 9 months after you stop taking medication.

What can I do to help?

Take medication as directed, and do not give up without discussing this with a doctor. Side-effects are uncommon with modern medication, but tell a doctor if you notice any problems with treatment.

Tips on nail care if you have a nail infection, with or without taking medication, include the following.

Keep your nails cut short, and file down any thickened nail.
Use a separate pair of scissors to cut the infected nail(s) to prevent contaminating the other nails. Do not share nail scissors with anyone else (for the same reason).
Avoid injury and irritants to your nails. For example, if fingers are affected use cotton and vinyl gloves for wet work. Use heavy cotton gloves for dry work.
If toenails are affected, wear properly fitted shoes with a wide toebox.
Keep your feet as cool and dry as much as possible.

Preventing fungal nail infections

Treat athlete's foot as early as possible to prevent it spreading to the nail. Athlete's foot is common and may recur from time to time. It is easy to treat with a cream which you can buy from pharmacies, or get on prescription. The first sign of athlete's foot is itchy and scaling skin between the toes.

Patient UK

http://www.patient.co.uk/showdoc.asp?doc=23068885

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Types of Skin Infections

Skin Infections

University of Maryland

http://www.umm.edu/dermatology-info/otherb.htm

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Mycetoma Fungus

http://www.dermnetnz.org/index.html

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Staphylococcal skin infections

http://www.umm.edu/dermatology-info/staph.htm

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Cellulitis

Diffuse, spreading, acute inflammation within solid tissues, characterized by hyperemia, WBC infiltration, and edema without cellular necrosis or suppuration.

http://www.merck.com/mmpe/sec10/ch119/ch119b.html#sec10-ch119-ch119b-625

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Acute Lymphangitis

Acute inflammation of the subcutaneous lymphatic channels, usually caused by S. pyogenes.

http://www.merck.com/mmpe/sec10/ch119/ch119k.html?qt=lymphangitis&alt=sh

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Erysipelas

A superficial cellulitis with marked lymphatic vessel involvement caused by group A (or rarely group C or G) -hemolytic streptococci.

http://www.merck.com/mmpe/sec10/ch119/ch119c.html?qt=erysipelas&alt=sh

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Cutaneous Abscesses

Localized collections of pus causing fluctuant soft tissue swelling surrounded by erythema.

http://www.merck.com/mmpe/sec10/ch119/ch119d.html?qt=Cutaneous%20Abscesses&alt=sh

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Necrotizing Subcutaneous Infections

(Necrotizing Fasciitis; Synergistic Necrotizing Cellulitis)

Severe infections, typically from a mixture of aerobic and anaerobic organisms that cause necrosis of subcutaneous tissue, usually including the fascia.

http://www.merck.com/mmpe/sec10/ch119/ch119l.html#sec10-ch119-ch119l-701

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Staphylococcal Scalded Skin Syndrome

(Ritter-Lyell Syndrome)

Acute, widespread erythema and epidermal peeling caused by staphylococcal exotoxin

http://www.merck.com/mmpe/sec10/ch119/ch119m.html?qt=Staphylococcal%20Scalded%20Skin%20Syndrom&alt=sh

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Folliculitis

Superficial or deep bacterial infection and inflammation of the hair follicles, usually caused by S. aureus but occasionally caused by other organisms such as P. aeruginosa (hot-tub folliculitis).

http://www.merck.com/mmpe/sec10/ch119/ch119e.html?qt=Folliculitis&alt=sh

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Furuncles

(Boils)

Acute, tender, perifollicular inflammatory nodules resulting from infection by staphylococci

http://www.merck.com/mmpe/sec10/ch119/ch119f.html?qt=Furuncles&alt=sh

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Hidradenitis Suppurativa

Painful local inflammation of the apocrine glands resulting in obstruction and rupture of the ducts.

http://www.merck.com/mmpe/sec10/ch119/ch119h.html?qt=Hidradenitis%20Suppurativa&alt=sh

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Carbuncles

A cluster of furuncles with subcutaneous spread of staphylococcal infection, resulting in deep suppuration, often extensive local sloughing, slow healing, and a large scar

http://www.merck.com/mmpe/sec10/ch119/ch119f.html?qt=Carbuncles&alt=sh

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Paronychia Infections

http://www.merck.com/mmpe/sec10/ch125/ch125d.html?qt=Paronychia%20Infections&alt=sh

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Erythrasma

A superficial skin infection in intertriginous areas, caused by Corynebacterium minutissimum

http://www.merck.com/mmpe/sec10/ch119/ch119g.html?qt=Erythrasma&alt=sh

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EXCERPT FROM AN ARTICLE FROM

THE LYMPHOEDEMA ASSOCIATION OF AUSTRALIA

SKIN FUNGAL INFECTIONS

Fungal infection is a 'ringworm' and looks like red patches of skin, often with white flakey skin over this area, and if under nails, the condition of these is affected and they become hardened, distorted and often yellowed.

One of the points that did emerge from the pilot questionnaire was that fact that a significantly larger proportion of patients with lymphoedema of the arm reported the presence or occurrence of this, than did those with lymphoedema of the leg. I would have expected the opposite to be the case. The result had to make me wonder if this were a) that people with lymphoedema of the arm are sometimes more mobile and able to check between the toes for this than those with lymphoedematous legs or b) that those with lymphoedema of the legs are already aware of this risk and are, or have been, using an anti-fungal cream or powder prophylactically. The latter should ask someone, such as the family physician, to regularly check for this.

I would like to point out that this does not just occur between toes, where it is most common, and possibly under the nails (if it has been present long term), but can easily be transferred to other warm, moist areas e.g. groin (including the vulva or around the scrotum) and under the breasts. Consider how you dry yourself after bathing e.g. the top part of the body is usually dried first, then the lower trunk, the legs and finally between the toes. As this part of the towel is in your hands, you often finish up by redrying those areas that are harder to dry i.e. between the legs and under the breasts. This can immediately transfer any fungal infections that may be present between the toes.

People often think that smelly feet are just smelly feet, but it is usually a sign of infection and infection smells. Transmission of this problem occurs through wearing the same shoes, clothes or in some cases the same rubber gloves, walking barefooted or resting feet etc on the same surfaces e.g. carpets and shower floors. It can frequently be transmitted or contracted in public areas e.g. footbaths at swimming pools.

Tinnea can also be transferred from your partner, so if he or she has this problem, this too should be rectified.

Fungal infections, in themselves will exacerbate any lymphoedema already present by increasing inflammation and its sequelae. Quite apart from this they affect the integrity of the skin and thereby provide a site for easy entry of bacteria. This will then cause a further inflammatory response and again worsen the lymphoedema. Whereas for minor tinea, a topical application (powder or cream) is usually satisfactory, for long term infections where it is deep seated or for toes which are difficult to apply them between, an oral anti-fungal may be necessary. This must be obtained with a doctor’s prescription and needs to be taken for at least 6 months (or longer) depending on the drug prescribed. I cannot stress enough how important it is for you to avoid these infections if at all possible.

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Skin Rashes

Lymphedema and Skin Rashes

Another important part of lymphedema skin care is to keep meticulus
care of the skin. Learn early to recognize skin rashes, understand the pathophysiology and treat them quickly

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Skin Rashes

http://www.medicinenet.com/rash/article.htm

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Rashes

http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm

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Rashes

General Health Encyclopedia - adam.com

http://www.healthcentral.com/mhc/top/003220.cfm

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see also

LYMPHEDEMA ANTIBIOTICS

Antibiotic Therapy, Types of Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

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Lymphedema People Additional Bacterial Infection Pages

Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

Necrotizing Fasciitis

http://www.lymphedemapeople.com/thesite/lymphedema_and_necrotizing_fasciitis.htm

Carbuncles, Furuncles, Boils

http://www.lymphedemapeople.com/thesite/lymphedema_carbuncles.html

Lymphadenitis

http://www.lymphedemapeople.com/thesite/lymphedema_lymphadenitis.htm

Preventing Hospital Infections

http://www.lymphedemapeople.com/wiki/doku.php?id=preventing_hospital_infections

Infectious Disease Doctor

http://www.lymphedemapeople.com/wiki/doku.php?id=infectious_disease_doctor

Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

Lymphadenopathy

http://www.lymphedemapeople.com/thesite/lymphedema_lymphadenopathy.htm

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Related Lymphedema People Related Medical Blogs and Pages:

Bacterial Infections

http://bacteriainfections.blogspot.com

Antibiotics

http://antibioticinformation.blogspot.com/

Cellulitis

http://cellulitisinfections.blogspot.com/

MRSA Information

http://mrsainformation.blogspot.com/

Antibiotic Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=34

Antibiotic Therapy, Types of Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

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Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe:

AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

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For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

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Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

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All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

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All About Lymphedema

For our Google fans, we have just created this online support group in Google Groups:

Homepage: http://groups-beta.google.com/group/All-About-Lymphedema

Group email: All-About-Lymphedema@googlegroups.com

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Lymphedema Friends

http://groups.aol.com/lymphedemafriend

If you an AOL fan and looking for a support group in AOL Groups, come and join us there.

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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet? Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more. Come and take a stroll!

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema

Arm Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema

Leg Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema

Acute Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema

The Lymphedema Diet

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet