The document discusses various types of skin and soft tissue infections including abscesses, cellulitis, erysipelas, boils, carbuncles, and necrotizing fasciitis. It defines each condition, describes common causative organisms, symptoms, signs, risk factors, investigations and treatment approach. Abscesses are localized collections of pus that require incision and drainage along with antibiotics. Cellulitis is a non-suppurative skin infection treated with elevation and antibiotics. Erysipelas is a streptococcal infection of skin lymphatics on the face or legs. Boils are hair follicle infections treated with antibiotics and incision if abscess forms. Carbuncles are clusters of bo

1. Dr. Md. Majedul Islam
FCPS(Surgery)
Assistant Professor, MoMCH
Abscess, Cellulitis, Erysipelas,
Boil, Curbancle

2. Abscess
 Def: Localized collection of pus lined by
pyogenic membrane in tissues or
confined space .
 Pus: Localized collection of
1. Dead & dying leucocytes
2. Fibrin exudates
3. Necrotic tissue debris & Organism

3. Abscess

4. Pyogenic membrane: Inner layer of
abscess cavity composed of -
1. granulation tissue
2. Fibrin exudates
3. Dead & dying leucocytes

5. Pyogenic membrane

6. Pyogenic Organisms:
 Staphylococcus Aureus – Thick creamy
pus
 Streptococcus Pyogens – Serosanguinus
Pus
 Pseudomonas – Bluish/greenish Pus
 Cold Abscess : M.Tuberculosis
For deep seated abscess: -
 Streptococcus pneumoniae
 E.coli
 Bacteroids

7. Symptoms:
 Fever, Malaise
 Throbbing pain
 Sense of illness
Sign:
 General – High Grade fever(swinging
rise of temp), rigor
 Local – Hot, red, tender swelling,
 Brawny edema with induration for deep
abscesses.
 In cold Abscess – above symptom and signs are
not present.

8. Investigation:
 CBC – Neutrophilic leucocytosis
 USG – Fluid filled cystic cavity.
 Clinically abscess confirmed by –
Aspiration of pus

9. Treatment:
 Incision & drainge(Pus sent for Culture
& sensitivity)
 Antibiotic
 Regular dressing

10. Fate of Abscess
 Spontaneously Burst.
 Antibioma(Antibiotic taken without
draining the abscess)
 Spread :
Locally – lymphangitis, lymphadenitis
Distally – Bacterimia, pyemia,
septicaemia

11.  Cellulitis
 Def: Non suppurative spreading infection of
skin and subcutaneous tissue is called
Cellulitis
 Organism : Streptococcus Pyogens
 Coomon site: Leg, hand, neck(Ludwig’s
angina)
 C/F: Shiny, hot, red and tender skin with
widesread swelling.
 Treatment:
1. Rest and elevate the affected limb(reduce
the edema)
2. Antibiotic

12. Cellulitis

13. Erysipelas(cutaneous
lymphangitis)
 Def: Streptococcal infection of the skin
lymphatics(superficial lymphatics)
 Site: Face, leg
 Risk factor: DM, Obese, Alcoholism, poor hyegine
 C/F: Rosy rash spot, well demarcated raised
edematous area with vesicle(no pus).
 Treatment: Antibiotic

14. Erysipelas

15. Boil/Furuncle
 Def: It is an acute staphylococcal infection of hair
follicle with perifolliculitis
 Site: Neck, chest, buttock, thigh.
 C/F: Painful indurated sweeling where central soft
area with discharging of pus.
 Treatment:
1. Antibiotic
2. Washing of wound and surrounding skinwith
antiseptic solution.
3. If pus , then incision and drainge.

16. Boil

17. Carbuncle(clusters of boil)
 Def: Infective gangrene of skin and subcutaneous
tissue with multiple pus discharging sinuses.
 Organism: Staphylococcus Aureus
 Site: Nape of the neck, Back
 Risk factor: DM, Obesity, Male(More hair follicle)
 C/F: Initially indurated subcuatenous tissue and
reddening of overlying skin later pus discharged
though multiple opening.
 Rx:
 Excision of the gangerenous tissue
 Antibiotic (according to C/S)
 Regular Dressing
 Reconstruction by skin graft or flap.

18. Carbuncle

19. Necrotising fasciitis
 commonly known as flesh-eating disease
 Meleney’s synergistic gangrene(Abdominal
wall) and Fournier’s gangrene(Scrotum or
perineum)
 Def: Necrotising fasciitis is a dangerous and
rapidly spreading Polymicrobial, synergistic
infection of the fascial planes leading to necrosis
of the subcutaneous tissues and overlying skin.
 Organism: most commonly a streptococcal
species (group Aβ haemolytic) in combination
with Staphylococcus, Escherichia coli,
Pseudomonas, Proteus, Bacteroides or
Clostridium;

20.  Risk Factor: diabetes; smoking; penetrating trauma;
pressure sores; immunocompromised states;
intravenous drug abuse; skin damage/infection
(abrasions, bites and boils).
 C/F:
1. oedema stretching beyond visible skin erythema,
2. disproportionate pain in relation to the affected area
3. associated skin vesicles and soft-tissue crepitus.
4. patients may be febrile
5. and tachycardic, with a
6. very rapid progression to septic shock.
Treatment:
1. Urgent resuscitation,
2. antibiotics and
3. surgical debridement

21. Necrotising Fasciitis