title: Staging of necrotizing fasciitis based on the evolving cutaneous features.
abstract: BACKGROUND
  Necrotizing fasciitis is a severe soft-tissue infection characterized by a fulminant course and high mortality. Early recognition is difficult as the disease is often clinically indistinguishable from cellulitis and other soft-tissue infections early in its evolution. Our aim was to study the manifestations of the cutaneous signs of necrotizing fasciitis as the disease evolves.
  
  
  METHODS
  This was a retrospective study on patients with necrotizing fasciitis at a single institution. Their charts were reviewed to document the daily cutaneous changes from the time of presentation (day 0) through to day 4 from presentation.
  
  
  RESULTS
  Twenty-two patients were identified. At initial assessment (day 0), almost all patients presented with erythema, tenderness, warm skin, and swelling. Blistering occurred in 41% of patients at presentation whereas late signs such as skin crepitus, necrosis, and anesthesia were infrequently seen (0-5%). As time elapsed, more patients had blistering (77% had blisters at day 4) and eventually the late signs of necrotizing fasciitis characterized by skin crepitus, necrosis, and anesthesia (9-36%) were seen. A clinical staging system was developed based on our observations. Stage migration from early to late stage necrotizing fasciitis was evident with majority of patients in stage 1 at day 0 (59%), whereas by day 4, majority had developed into stage 3 (68%).
  
  
  CONCLUSIONS
  This study has demonstrated the continuum of cutaneous manifestations as necrotizing fasciitis evolves. This will help in the early recognition and intervention of this devastating condition.
authors.affiliation: Division of Dermatology, Changi General Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore. yishiw@hotmail.com
authors.forename: Yi-Shi
authors.initials: YS
authors.lastname: Wang
authors.forename: Chin-Ho
authors.initials: CH
authors.lastname: Wong
authors.forename: Yong-Kwang
authors.initials: YK
authors.lastname: Tay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000209:etiology; D015897:Comorbidity; D018450:Disease Progression; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D018461:Soft Tissue Infections / Q000150:complications / Q000473:pathology*