infection cutanées recommandations

2. Impétigo
*The term “impetigo” refers to vesiculopustular skin lesions and
secondarily crusted, due to a superficial, non-follicular infection of
the skin, initially affecting the skin epithelium (epidermis). There
are two clinical forms: the usual non-bullous form (around 70% of
cases) and bullous impetigo which mainly affects young children
(aged less than 2 years).
* MSSA +++, β-hemolytic Streptococcus +/-

5. Locolized, uncomplicated impetigo :
a surface skin affected < 2% of the total body surface (1% =
surface of a palm of the hand), less than six lesions, and without
rapid extension
Severe forms of impetigo:
Ecthyma , surface skin affected > 2%, > 6 lesions, with rapid extension

6. Treatment
• Limited disease:
• • Warm water soaks
• • Mupirocin topical ointment q8h x 5d
• Extensive disease: Obtain culture
• • Cephalexin 1000 mg PO q8h (if no MRSA suspected) OR
• • TMP/SMX DS 1 tab PO q12h* OR
• • Doxycycline 100mg PO q12h (if MRSA confirmed)

7. Purulent Skin/SoftTissue Infections
• 1- cutaneous abscess :
Cutaneous abscesses are collections of pus within the dermis and
deeper tissues
To be considered a simple abscess, induration and erythema should be
limited only to a defined area of the abscess and should not extend
beyond its the borders of the abscess. Additionally, simple abscesses
should not have extension into deeper tissues or multiloculated
extension.
S.Aureus +++

8. • Treatment:
Incision/Drainage is essential for clinical cure
Gram stain and culture of pus
Antibiotic therapy should be prescribed for abscesses greater than 5 cm, in
an area difficult to drain (e.g., face, hand, and genitalia), if there is lack of
response to incision and drainage alone, if there are multiple localizations
and in patients with immunosuppression
• One of the following oral antibiotics
Amoxicillin-clavulanate 1 g every 8 h or Cephalexin 500 mg every 6 h
• In patients at risk for CA-MRSA including immunocompromised status,
personal or household contact with MRSA infection or colonization in the
past 12 months, with prior antibiotic use for 5 days duringnthe last 90 days
or who do not respond to first line therapy add one of the following oral
antibiotics
• Minocycline 100 mg every 12 h
• Doxycycline 100 mg every 12 h
• TMP/SMX DS every 12 h
5-7 days

9. 2- Furuncles and Carbuncles
• Furuncles also named “boils” are superficial infections with
suppuration of the hair follicle, usually caused by S. aureus. They
extend through the dermis into the subcutaneous tissue, where form
a small abscess. Furuncles can occur anywhere on hairy skin.
• A group of infected hair follicles with pus is named carbuncle.
Carbuncles are larger and deeper than furuncles

10. furuncle
carbuncles

11. • Treatment :
Uncomplicated furuncle :
Local care only
No manipulation of the boil (limits the risk of complications)
Daily grooming care (washing with soap and water)
Incision of the extremity to evacuate the bubble (large boil)
Protection of the lesion with a dressing
No antibiotic therapy (local or general)

12. • Complicated furuncle :
carbuncle
appearance of peri-lesional dermohypodermitis;
secondary abscess
presence of systemic signs (fever)
Same as cutaneous abcesses

13. Necrotizing SSTI
• NSTIs are life-threatening, invasive, soft-tissue infections with a necrotizing
component involving any or all layers of the soft-tissue compartment, from
the superficial dermis and subcutaneous tissue to the deeper fascia and
muscle
• NSTIs have been described according to their anatomical locations (i.e.,
Fournier’s gangrene) and the depth of infections: dermal and subcutaneous
components (necrotizing cellulitis), fascial component (necrotizing
fasciitis), and muscular components (necrotizing myositis)
• Although many specific variations of NSTIs have been described, the initial
approach to diagnosis, antibiotic treatment, and surgical intervention is
similar for all forms

14. • Risk factors :
diabetes mellitus, renal insufficiency, arterial occlusive disease, Intravenous drug
abuse, body mass index (BMI) > 30 kg/m2, age < 65 years, liver disease,
Immunosuppression
• Clinical manifestations:
Patients with NSTI usually present with severe pain, which is out of proportion to the
physical findings:
Local signs :
• Edema
• Erythema
• Severe and crescendo pain out of proportion
• Skin bullae or necrosis (at a later stage)
• Swelling or tenderness
• Crepitus
The triad of swelling, erythema, and disproportionately severe pain should raise the
suspicion of NSTI

15. Systemic signs
• Fever
• Tachycardia
• Hypotension
• Shock