Friday, October 17, 2008

SKIN INFECTIONS


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Over the last 10 to 20 years there have been increasing changes in the bacteria normally present on the skin surface. They are becoming resistant to antibiotics (methicillin resistant Staph Aureus - MRSA) & this resistance as well as the problems they cause are different than what is seen with bacteria that become resistant from exposure to medications in hospitals. You can think of this as an infection from yourself vs. an infection that comes from someone else or some surface contact (door knobs, tables etc). The flesh eating bacteria that has been mentioned in the media is due to bacteria that produce a chemical that kills tissue at deeper as well as superficial levels. These bacteria may or may not be antibiotic resistant. If caught early enough all are easily treated.



The people who are currently at risk live in crowded conditions, participate in contact sports, frequently use antibiotics, inject drugs or medications, have diminished immunity(transplant patients, AIDS patients), are homosexual and/or shave body hair. The surface skin barrier is either weakened or breached by trauma after which these surface bacteria can travel into deeper layers of the skin where they multiply and cause damage. It has recently come to light that NFL and NBA players have been catching MRSA skin infections from a combination of skin injuries and unsanitary locker rooms.

The early signs are what looks like a spider or insect bite, a pimple or redness of the skin. When first seen by a doctor or in the emergency room the doctor's first instinct is to prescribe the most common antibiotics used against skin surface bacteria however these do not work. Within a few days it is obvious things are getting worse. That is when you need to see the doctor right away to change antibiotics because if allowed to progress the dead or dying tissue at the center of the process will not see any antibiotic because it has no blood supply. After that even if you change antibiotics you will not get better. That is where the plastic surgeon comes in. He or she will have to surgically remove all of the non-surviving tissue at surgery and then once the infection has cleared or responded to the appropriate antibiotic close the remaining wound.

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