Management of common bacterial infections of the skin.
OBJECTIVE
Bacterial skin infections commonly encountered in the community include impetigo, folliculitis/furunculosis, simple abscesses, erysipelas and other nonnecrotizing cellulitis. The review focuses on recent epidemiological, bacteriological and therapeutic advances.


RESULTS
Impetigo and erysipelas occur in about 20 and 1 person/1000/year, respectively. Main risk factors for erysipelas are toe-web intertrigo and lymphedema. The true incidence of furunculosis is unknown, whereas outbreaks in small communities are reported worldwide. Staphylococcus aureus is the predominant pathogen for impetigo and furunculosis, and methicillin-resistant strains play a growing role in both diseases. Erysipelas are mainly caused by streptococci, whereas local complications (i.e. abscesses or blisters) may be due to staphylococci, including methicillin-resistant strains in involved geographic areas. Recent trends for treating impetigo and furunculosis predate community-acquired methicillin-resistant S. aureus. For outbreaks of furunculosis, stringent decolonization measures are showing promise, whereas there is no validated therapeutic regimen for chronic furunculosis. Current trends for erysipelas involve ambulatory treatments and reduced duration of antibiotics.


CONCLUSIONS
Despite better epidemiological or bacteriological knowledge of common bacterial skin infections, the exact role of methicillin-resistant staphylococci needs regular surveys in involved geographic areas. Antibiotic treatment must be active on staphylococci and, to a lesser degree, on streptococci.
Bernard
Philippe
P
Department of Dermatology, Robert Debré Hospital, Reims, France. pbernard@chu-reims.fr
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections / Q000382:microbiology; D004886:Erysipelas / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005667:Furunculosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007169:Impetigo / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016106:Methicillin Resistance; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000472:pathogenicity; D013291:Streptococcus / Q000472:pathogenicity
D000900:Anti-Bacterial Agents