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Skin Infections: Causes, Symptoms, and Treatment Options

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Skin infections are a common medical condition that affects people of all ages and backgrounds. They can be caused by a variety of factors, including bacteria, viruses, fungi, and parasites. When these microorganisms invade the skin, they can cause inflammation and infection. Skin infections can range from mild to severe, and may result in a variety of symptoms such as redness, swelling, itching, and pain.

Some of the most common types of skin infections include impetigo, cellulitis, and fungal infections. Impetigo is a highly contagious bacterial infection that is most common in children. Cellulitis is a bacterial infection that affects the deeper layers of the skin and can cause redness, swelling, and pain. Fungal infections are caused by fungi that live on the skin and can cause a range of symptoms such as itching, scaling, and redness.

If left untreated, skin infections can lead to serious complications such as sepsis, which can be life-threatening. Therefore, it is key to seek medical attention if there’s a suspicion of a skin infection. With proper diagnosis and treatment, most skin infections can be effectively treated and managed.

Types of Skin Infections

Skin infections are caused by different types of microorganisms such as bacteria, viruses, fungi, and parasites.1

Bacterial Infections

Bacterial infections are caused by various types of bacteria, such as Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa. These bacteria can enter the skin through cuts, scrapes, or insect bites. Symptoms of bacterial skin infections include redness, swelling, warmth, and pain. Types of bacterial skin infections include:

  • Impetigo: A frequently encountered infection that targets the outer layers of the skin and is notorious for its high level of contagiousness. This condition is typically brought on by gram-positive bacteria (S. aureus and S. pyogenes.) and often manifests as red, inflamed patches of skin covered by a yellowish crust on the face, arms, and legs. Impetigo seems to have a knack for affecting around 11.2% of the global population, with children bearing the brunt at 12.3% compared to adults at 4.9%.2 Impetigo can be categorized into bullous, nonbullous forms and ecthyma. Nonbullous impetigo, which accounts for approximately 70% of diagnosed cases, stands out as the most prevalent form. (Barbieri et al., 2022).
  • Cellulitis: An infection that affects the deeper layers of the skin and causes swelling, redness, and pain. The infection is caused by beta-hemolytic streptococci, particularly group A streptococcus (Streptococcus pyogenes), followed by methicillin-sensitive Staphylococcus aureus, which are common pathogens associated with cellulitis.3
  • Folliculitis: Is when the superficial part of the hair follicle becomes inflamed and can affect the opening of the follicle or the hair follicles around it and cause small, red bumps on the skin.4
  • Boils (furuncles): A painful, pus- filled lumps that form under the skin when hair follicles become infected. It is a deep folliculitis. Boils can occur anywhere on the body and are usually caused by bacteria entering the skin through a cut or hair follicle. Most boils are caused by Staphylococcus aureus5.
  • Carbuncles: Similar to boils, but larger, deeper and more severe, often with multiple openings draining pus. Carbuncles are clusters of connected boils. They often appear as a swollen, red, and painful cluster of pus-filled lumps, and cause fever and fatigue. They are caused by the same bacteria that lead to single boils. A carbuncle can initially develop from folliculitis, and if not addressed, it can evolve into a furuncle. When multiple furuncles merge, it transforms into a carbuncle. 
  • Erysipelas: A bacterial infection that causes a raised, red rash with defined borders, often on the face or legs. Erysipelas is usually caused by the bacteria Streptococcus pyogenes, and it can lead to fever, chills, and general malaise.6
  • Staphylococcal scalded skin syndrome (SSSS): A serious condition in which the skin becomes blistered and peels off, often affecting infants and young children. It is caused by the release of exotoxins from the Staphylococcus aureus bacteria. It is characterized by widespread redness, blistering, and peeling of the skin, resembling a scald or burn. According to a study, Staphylococcal scalded skin syndrome (SSSS) affects approximately 7.67 out of every million children annually in the United States, with a significantly higher rate of 45.1 cases per million in infants under 2 years old. The mortality rate for adults with SSSS exceeds 60%, whereas childhood SSSS carries a mortality rate of around 4%. These figures underscore the seriousness of the condition, especially among young children.7
  • Necrotizing fasciitis: A rare but severe infection that can rapidly and aggressively destroy skin, fat, and muscle tissue. The bacteria responsible are Streptococcus pyogenes (group A streptococcus), Staphylococcus aureus, and other bacteria like Clostridium and Bacteroides species. These bacteria can enter the body through breaks in the skin, surgical wounds, or puncture wounds.8
  • Pseudomonas skin infections: Are infections caused by the bacteria Pseudomonas aeruginosa, which can lead to a variety of skin conditions, including hot tub folliculitis and ecthyma gangrenosum. These infections are often associated with moist environments, such as hot tubs, swimming pools, and contaminated water.9

Viral Infections

Viral infections are caused by different types of viruses, such as herpes simplex virus, varicella-zoster virus, and human papillomavirus. These viruses can enter the skin through direct contact or through the bloodstream. Symptoms of viral skin infections include blisters, rash, and itching. Some common types of viral skin infections include:

  • Herpes simplex: A viral infection that causes cold sores (oral herpes)  and genital herpes. It is caused by the herpes simplex virus and is highly contagious. There are two types of HSV: HSV-1, which often causes oral herpes, and HSV-2, which typically causes genital herpes. The infection presents as painful, fluid-filled blisters or sores on the skin or mucous membranes.10 Approximately 67% of the global population under the age of 50, totaling around 3.7 billion individuals, are infected with the herpes simplex virus type 1 (HSV-1), which is responsible for oral herpes. Additionally, an estimated 491 million people aged 15–49, accounting for 13% of this age group worldwide, are infected with the herpes simplex virus type 2 (HSV-2), the primary cause of genital herpes.11
  • Varicella Zoster (Chickenpox): A highly contagious viral infection that causes a blistering rash all over the body. It is caused by the varicella-zoster virus. Chickenpox is most common in children, but can also affect adults who have not been previously infected or vaccinated. The virus is spread through respiratory droplets or direct contact with the blisters. According to the findings of the World Health Organization (WHO), it was determined that varicella gives rise to a staggering number of 4.2 million severe complications each year, inevitably leading to hospitalization. Furthermore, this unfortunate ailment claims the lives of 4200 individuals across the globe on an annual basis.12
  • Herpes Zoster (Shingles): This is a reactivation of the varicella-zoster virus, which causes a painful rash and blisters. It typically occurs in adults who have previously had chickenpox – After a person has had chickenpox, the virus remains dormant in the nerve cells and can reactivate later in life.13 According to the CDC, approximately 1 in 3 people in the United States will develop herpes zoster in their lifetime.14 The most common complication of herpes zoster is Postherpetic neuralgia.15
  • Molluscum Contagiosum: A viral skin infection caused by the molluscum contagiosum virus, resulting in small, raised, pink lesions on the skin. It is most common in children, although it can affect individuals of any age. It is highly contagious and can be spread through direct skin-to-skin contact, as well as through contact with contaminated objects such as towels, clothing, or toys. Scratching or picking at the molluscum lesions can lead to bacterial infections causing additional discomfort.16
  • Human Papillomavirus (HPV): HPV can cause various skin conditions, including common warts, plantar warts (on the soles of the feet), and flat warts.17 HPV is incredibly common, with nearly all sexually active individuals likely to encounter it at some point in their lives. It’s so widespread that it’s considered the most common sexually transmitted infection in the world. Approximately 291 million women worldwide are estimated to be carrying HPV DNA, with 32% of them infected with HPV16, HPV18, or both.18 HPV is classified into low-risk and high-risk types. Low-risk types can cause warts, while high-risk types are associated with an increased risk of cancer, particularly cervical cancer.19 The most serious complication of HPV is its link to various cancers, including cervical, vaginal, vulvar, penile, anal, and throat cancers.20
  • Measles: A highly contagious viral infection that can cause a red, blotchy rash, along with other symptoms such as fever and cough. Rubeola primarily affects children, although it can occur in individuals of any age.21 It can lead to a range of complications, particularly in young children and individuals with weakened immune systems. The most severe complications of measles affect the central nervous system (CNS). These include acute demyelinating encephalomyelitis (ADEM), measles inclusion body encephalitis (MIBE), and subacute sclerosing panencephalitis (SSPE), with the latter two being fatal in all cases.22
  • Hand, Foot, and Mouth Disease: This viral infection, commonly caused by coxsackievirus A16 and enterovirus 71, leads to the development of painful or blisters on the hands, feet, and in the mouth, along with fever and other flu-like symptoms. HFMD is a common illness, particularly in young children, and outbreaks often occur in childcare settings and schools.23

Fungal Infections

Fungal infections are caused by different types of fungi, such as dermatophytes, yeasts, and molds. These fungi can enter the skin through direct contact or through the bloodstream. Symptoms of fungal skin infections include itching, redness, and scaling. Some common types of fungal skin infections include:

  • 24Athlete’s foot (Tinea Pedis): A fungal infection that affects the feet and causes itching, burning, and scaling. It is often caused by the fungus Trichophyton. It is estimated that around 15-25% of the population may experience athlete’s foot at some point in their lives. Athlete’s foot is classified as a dermatophytosis, which refers to a fungal infection of the skin, hair, or nails.25
  • Ringworm (Tinea Corporis): A fungal infection that affects different parts of the body and causes a circular rash. Despite its name, ringworm is not caused by a worm but by various fungi, including Trichophyton and Microsporum. It is a prevalent skin condition that can affect individuals of all ages but it is particularly common in children and individuals who have close contact with infected animals.26 Approximately 20% to 25% of people are estimated to encounter a ringworm infection at some point in their lives, according to experts.27
  • Candidiasis: A fungal infection that affects moist areas of the body, such as the armpits and groin, the skin, nails and mucous membranes. It can manifest as a red, itchy rash with surrounding scales, and in some cases, it can cause white patches in the mouth (oral thrush) or vaginal yeast infections.28 Yeast infections are common, with a significant portion of the population experiencing them at some point in their lives. Vaginal yeast infections, in particular, affect a large number of women. Approximately 75% of women will experience a vaginal yeast infection at some point in their lives.29
  • Jock Itch (Tinea Cruris): Jock itch is a fungal infection that affects the groin area, inner thighs, and buttocks, leading to a red, itchy rash. It is also caused by the fungus Trichophyton. Jock itch is a prevalent condition, particularly among males, athletes, and individuals who sweat heavily. It is also considered a type of ringworm infection, caused by the same group of fungi that cause other types of tinea infections, such as athlete’s foot and ringworm.30
  • Tinea Versicolor: This fungal infection causes patches of discolored skin, often on the areas of the skin that are rich in sebaceous glands, such as the chest, back and upper arms. It is caused by the yeast Malassezia furfur and can result in lighter or darker patches on the skin. Tinea versicolor is a common skin condition that affects individuals of all ages, but it is more prevalent in adolescents and young adults. It is classified as a superficial fungal infection of the skin.31
  • Intertrigo: Intertrigo is a fungal or bacterial infection that occurs in skin folds, such as under the breasts, in the groin, or between the buttocks. It can cause redness, itching, and discomfort due to the warm, moist environment in these areas. Intertrigo is a common condition, particularly among individuals who are overweight, have diabetes, or have limited mobility. It can occur in people of all ages, including infants and the elderly.32

Parasitic Infestations

Parasitic infestations are caused by different types of parasites, such as lice, scabies, and bedbugs. These parasites can enter the skin through direct contact or through contaminated objects. Symptoms of parasitic skin infestations include itching, redness, and bumps. Some common types of parasitic skin infestations include:

  • Scabies: A contagious parasitic infestation that causes intense itching and a pimple-like rash, often in the webbing between the fingers, wrists, elbows, and other areas of the body. It is caused by the Sarcoptes scabiei mite. The mite burrows into the skin and lays eggs. Scabies is a common condition worldwide, affecting people of all ages and socioeconomic backgrounds. 33It’s estimated that over 200 million people around the world are dealing with scabies at any given moment, and more than 400 million people are affected by it each year.34 It is particularly prevalent in crowded living conditions, such as nursing homes, prisons, and refugee camps. Children and sexually active young adults are also at higher risk of contracting scabies. Scabies can be classified into two types: typical scabies and crusted (Norwegian) scabies. Typical scabies is the more common form but crusted scabies carries a higher mortality rate (33).
  • Lice infestation (Pediculosis): A parasitic condition that causes itching and small bumps on the scalp, pubic area, and body, caused by lice, small insects that infest the scalp (head lice), body (body lice), or pubic area (pubic lice or “crabs”). Lice infestations cause itching and visible nits (lice eggs) attached to the hair shafts. It is common, especially among school-aged children who are in close contact with each other. Head lice are the most prevalent type of lice infestation, affecting millions of people worldwide each year.35
  • Bedbugs: Are small, reddish-brown insects that feed on the blood of humans and animals. They are nocturnal and typically hide in cracks and crevices during the day, coming out at night to feed on their hosts. Bedbug infestations have become increasingly common in recent years, particularly in urban areas and places with high population density. Bedbugs belong to the Cimicidae family and are classified as Cimex lectularius (the common bedbug) and Cimex hemipterus (the tropical bedbug).36
  • Cutaneous Larva Migrans: Also known as “creeping eruption,” this parasitic skin infection is caused by hookworm larvae that burrow into the skin, leading to an itchy, winding rash. It is commonly acquired from contaminated soil or sand. CLM is most prevalent in tropical and subtropical regions, particularly in areas with poor sanitation and where humans come into contact with contaminated soil or sand. Cutaneous larva migrans is caused by the larvae of animal hookworms, primarily Ancylostoma braziliense and Ancylostoma caninum, which are parasites of dogs and cats.37
  • Leishmaniasis: Leishmaniasis is a parasitic disease transmitted by the bite of infected sandflies. It can cause skin sores, usually painless at first but can become ulcers with raised edges. The disease is prevalent in areas with poor housing conditions, limited access to healthcare, and where sand fly vectors thrive. Leishmaniasis can be classified into three main forms: cutaneous leishmaniasis, mucocutaneous leishmaniasis, and visceral leishmaniasis. Cutaneous leishmaniasis is the most common form and primarily affects the skin, causing localized sores and ulcers.38
  • Guinea Worm Disease: Also known as dracunculiasis, is a parasitic infection caused by the nematode Dracunculus medinensis. It occurs when people consume water contaminated with water fleas carrying Guinea worm larvae. The larvae mature into long worms that can emerge through the skin, causing painful blisters. Guinea worm disease was historically widespread in parts of Africa and Asia, particularly in communities with limited access to safe drinking water.39

Common Symptoms

Itching

One of the most common symptoms of skin infections is itching. This is caused by the body’s immune response to the infection. Itching can be mild or severe, and can be accompanied by a rash or other skin changes. Scratching the affected area can lead to further irritation and can increase the risk of spreading the infection.40

Redness

Redness is another common symptom of skin infections. This is caused by inflammation and increased blood flow to the affected area. The redness can be localized or widespread, and can be accompanied by swelling or warmth. In some cases, the skin may feel hot to the touch.41

Pain

Pain is a common symptom of skin infections, especially in more severe cases. The pain can be mild or severe, and can be accompanied by other symptoms such as itching or redness. Pain can be a sign that the infection is spreading or becoming more serious.42

Discharge

Some skin infections can cause discharge from the affected area. This can be pus, blood, or other fluids. For instance, S. aureus is the predominant bacteria found in abscesses, making it the primary infectious culprit. Discharge can be a sign that the infection is spreading or becoming more serious. It is important to keep the affected area clean and dry to prevent further infection. 43

Diagnosis Methods

Physical Examination

The initial stage in identifying a skin infection involves conducting a physical examination. During this assessment, the healthcare provider will search for observable indicators of infection, such as redness, swelling, and the presence of pus. Additionally, they will inquire about symptoms like pain, itching, and fever. It’s also crucial to consider the location of the infection, as certain types of infections are more prevalent in specific areas of the body.44

Laboratory Tests

Based on the information provided earlier, laboratory tests play a crucial role in confirming the diagnosis of a skin infection. One common method involves taking a swab of the affected area and sending it to a laboratory for analysis. This helps in identifying the specific type of bacteria or fungus responsible for the infection. Additionally, blood tests may be conducted to check for indicators of infection in the body.45

Imaging Techniques

In some cases, imaging techniques may be used to help diagnose a skin infection. X-rays, CT scans, and MRIs can help identify infections that have spread beyond the skin and into deeper tissues or organs.46

Biopsy

A biopsy may be done if the infection is not responding to treatment or if there is concern that it may be a more serious condition. A small sample of tissue will be taken from the affected area and sent to a lab for analysis. This can help identify the specific type of infection and guide treatment.47

Treatment Options

Topical Medications

When it comes to treating skin infections, topical medications are often the first line of defense. These medications are applied directly to the affected area and can help to reduce inflammation, relieve itching, and fight off bacteria, viruses, and fungi.48 Some common topical medications include:

  • Antibacterial creams: These creams contain antibiotics that can help to fight off bacterial infections such as impetigo and cellulitis.49
  • Antifungal creams: These creams contain antifungal agents that can help to treat fungal infections such as ringworm and athlete’s foot.50
  • Antiviral creams: These creams contain antiviral agents that can help to treat viral infections such as herpes and shingles.51

Oral Antibiotics

In some cases, topical medications may not be enough to treat a skin infection. In these cases, oral antibiotics may be necessary. Oral antibiotics are taken by mouth and can help to fight off bacterial infections that have spread beyond the skin. Some common oral antibiotics include:

  • Penicillin: This antibiotic is often used to treat bacterial infections such as strep throat and cellulitis.52
  • Tetracycline: This antibiotic is often used to treat bacterial infections such as acne and rosacea.53
  • Macrolides: These antibiotics are often used to treat bacterial infections such as pneumonia and bronchitis.54

Antiviral Therapy

Antiviral therapy is used to treat viral infections such as herpes and shingles. This type of therapy can include medications such as acyclovir, valacyclovir, and famciclovir. These medications work by blocking the replication of the virus, which can help to reduce symptoms and prevent the infection from spreading.55

Antifungal Treatments

Antifungal treatments are used to treat fungal infections such as ringworm and athlete’s foot. These treatments can include medications such as terbinafine, clotrimazole, and miconazole. These medications work by inhibiting the growth of the fungus, which can help to reduce symptoms and prevent the infection from spreading.56

Prevention Strategies

Skin infections can be prevented by following simple yet effective strategies. We can reduce the risk of skin infections by practicing good hygiene, getting vaccinated, controlling the environment, and taking protective measures. Here are some prevention strategies that we can adopt:

Hygiene Practices

Maintaining good hygiene is essential to prevent skin infections. We should always wash our hands with soap and water before and after handling food, using the bathroom, or touching any contaminated surfaces. We should also take a shower or bath regularly and keep our skin clean and dry. If we have any cuts or wounds, we should clean them with soap and water and apply an antiseptic.57

Vaccinations

Receiving a vaccination is an additional method to effectively guard against skin infections. Vaccinations have the ability to shield us from a range of skin infections including chickenpox, shingles, and HPV. It is advisable to seek guidance from a healthcare professional to identify which vaccinations are suitable for us depending on our age, health condition, and other relevant factors.58

Environmental Controls

Controlling the environment can also help prevent skin infections. We should avoid sharing personal items such as towels, razors, and clothing. We should also keep our living spaces clean and dry, especially if we have pets. If we work in environments where skin infections are common, such as healthcare facilities or gyms, we should take extra precautions such as wearing gloves or using disinfectants.59

Protective Measures

Taking protective measures can also reduce the risk of skin infections. We should wear appropriate clothing and footwear to protect our skin from cuts, scrapes, and insect bites. We should also avoid contact with contaminated surfaces and avoid touching our face, especially our mouth, nose, and eyes (59).

Complications of Skin Infections

Cellulitis

Cellulitis is a common complication of skin infections that occurs when bacteria penetrate the skin’s deeper layers. This can cause redness, swelling, and pain in the affected area. In severe cases, cellulitis can lead to abscess formation, sepsis, and even death. Patients with weakened immune systems, such as those with diabetes or HIV, are at higher risk of developing cellulitis.60

Abscess Formation

Abscess formation is another common complication of skin infections that occurs when pus accumulates in a localized area. Abscesses can be painful and may require drainage to prevent the infection from spreading. If left untreated, abscesses can lead to cellulitis, sepsis, and other serious complications.61

Systemic Spread

In some cases, skin infections can spread to other parts of the body, leading to systemic infections. This can occur when bacteria enter the bloodstream or lymphatic system. Systemic infections can be life-threatening and require immediate medical attention. Symptoms of systemic infection may include fever, chills, rapid heartbeat, and confusion.62

Scarring

In addition to the physical symptoms of skin infections, scarring can also be a complication. Scarring can occur as a result of severe infections or as a result of surgical intervention to treat the infection. Scarring can be permanent and may require additional medical treatment to reduce its appearance.63

Special Populations

Infants and Children

Skin infections are common in infants and children due to their underdeveloped immune systems and increased exposure to pathogens. The most common skin infections in this population include impetigo, diaper dermatitis, and molluscum contagiosum.64 It is important to diagnose and treat these infections promptly to prevent complications such as cellulitis and sepsis.

Immunocompromised Individuals

Immunocompromised individuals, such as those with leukemia or undergoing chemotherapy, are at a higher risk of developing severe and recurrent skin infections. These infections can be caused by a wide range of pathogens, including bacteria, viruses, and fungi.65 It is important to closely monitor and manage these infections in this population to prevent further complications.

Elderly Patients

Elderly patients are more susceptible to skin infections due to age-related changes in their skin, such as decreased elasticity and thinner skin. Common skin infections in this population include cellulitis, shingles, and fungal infections.66 It is important to educate elderly patients on proper skin care and hygiene to prevent these infections.

Diabetic Patients

Diabetic patients are at a higher risk of developing skin infections due to poor circulation and nerve damage. Common skin infections in this population include cellulitis, diabetic foot infections, and fungal infections.67 It is important to closely monitor and manage these infections in diabetic patients to prevent further complications.

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