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Skin and Soft Tissue Infections


Skin and soft tissue infections (SSTIs), which include infections of skin, subcutaneous tissue, fascia, and muscle, encompass a wide spectrum of clinical presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis. Diagnosing the exact extent of the disease is critical for successful management of a patient of soft tissue infection.

The various types of SSTIs, listed according to clinical presentation and anatomic location, include the following:

  • Impetigo

  • Folliculitis

  • Furuncles

  • Carbuncles

  • Erysipelas

  • Cellulitis

  • Necrotizing fasciitis, also known as hemolytic streptococcal gangrene, Meleney ulcer, synergistic gangrene, and Fournier gangrene (when localized to the scrotum and perineal area)

  • Pyomyositis

SSTIs may be caused by any of a formidable number of pathogenic microorganisms, and they may be either monomicrobial or polymicrobial. The following are the most important pathogens:

  • Staphylococcus aureus (the most common pathogen)

  • Streptococcus pyogenes

  • Site-specific infections - Indigenous organisms (eg, gram-negative bacilli in perianal abscesses)

  • Immunocompromised hosts and complicated SSTIs - Multiple organisms or uncommon organisms (eg, Pseudomonas aeruginosa, beta-hemolytic streptococci, Enterococcus)

  • Polymicrobial necrotizing fasciitis - Mixed infection with both aerobes (eg, streptococci, staphylococci, or aerobic gram-negative bacilli) and anaerobes (eg, Peptostreptococcus, Bacteroides, or Clostridium)

  • Monomicrobial necrotizing fasciitis: S pyogenes

Classification of SSTIs

For the purposes of this article, SSTI may be divided into the following categories:

  • Uncomplicated SSTI

  • Nonnecrotizing complicated SSTI

  • Necrotizing fasciitis

Uncomplicated SSTIs include superficial cellulitis, folliculitis, furunculosis, simple abscesses, and minor wound infections. These infections respond well to either source control management (ie, drainage or debridement) or a simple course of antibiotics. These infections pose little risk to life and limb.

Complicated SSTIs involve the invasion of deeper tissues and typically require significant surgical intervention. The response to therapy is often complicated by underlying disease states. Complicated SSTIs include complicated abscesses, infected burn wounds, infected ulcers, infections in diabetics, and deep-space wound infections. They are often limb- or life-threatening.

Methicillin resistant Staphylococcus Aureus, MRSA,  can cause severe and deadly  infections that can be transmitted through contact when they involve the skin  and that require special Antibiotics such as vancomycin. They sometimes recur and can be quite difficult to treat. In some instances unfortunately they manage to invade the bloodstream and can damage your heart valves, your joints, your spine, your lungs or any prosthetic devices in your body.  

Necrotizing fasciitis is a progressive, rapidly spreading, inflammatory infection that is located in the deep fascia and is associated with secondary necrosis of the subcutaneous tissues. The inflammation of the deep fascia causes thrombosis of the dermal vessels, and it is this thrombosis that is responsible for the secondary necrosis of the overlying subcutaneous tissue and skin.

It is imperative to distinguish necrotizing infections from nonnecrotizing infections. Early diagnosis and intervention may save a life; delayed diagnosis and treatment may lead to loss of a limb or a life.

Predisposing factors

Factors predisposing to the development of SSTIs include the following:

  • Breach in the epidermis

  • Dry and irritated skin

  • Immunocompromised status - Malnutrition, hypoproteinemia, burns, diabetes mellitus, AIDS

  • Chronic venous insufficiency

  • Chronic lymphatic insufficiency

  • Chronic neuropathy


Any abscess, however small, must be drained for complete resolution. Any ulcer covered with dead and necrotic tissue must be debrided to promote growth of healthy granulation tissue and healing.

Necrotizing fasciitis is a surgical emergency; early surgical treatment optimizes outcomes for these patients.

Consult a doctor for medical advice or visit us at PEOPLE CARE INSTITUTE for more information


Note: The information you see here is general and describes what usually happens with a medical condition, but doesn't apply to everyone. This information IS NOT  a substitute for professional medical advice, so please  make sure to contact a healthcare provider if you have a medical problem. 

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