Photographic Print of Skin disorders, artwork
When blood glucose levels are high, a person with diabetes is more susceptible to infection. This is believed to be why there’s a higher incidence of certain bacterial infections among people with diabetes and why these infections tend to be more serious than in the general population.
There are different kinds of bacterial infections affecting the skin. These include styes, which are infections of the glands of the eyelids; boils, which are infections of the hair follicles; and carbuncles, which are deep infections of the skin and the underlying tissue. There also are bacterial infections that affect the nails. With a bacterial infection, the areas involved generally are hot, swollen, red, and painful.
Most bacterial infections require treatment with antibiotics in the form of pills and/or creams.
The following are some of the more common bacterial infections in people who have diabetes.
2A.Impetigo and Ecthyma
Fitzpatricks Dermatology Flash Cards
Impetigo is a common, contagious, superficial skin infection that starts out as fluid- or pus-filled blisters or pimples that rupture to form erosions on the skin.
These erosions are then covered by crusts. Minor breaks in the skin may lead to an impetigo infection, or it may arise as the result of an existing skin problem, such as atopic dermatitis, contact dermatitis, psoriasis, ulcers, traumatic wounds, burns, or insect bites.
This infection most often arises on the face, arms, legs, buttocks, hands, and skin folds such as the underarms and groin.
Ecthyma has many features similar to those of impetigo and can in fact result from untreated impetigo.
The main difference is that ecthyma goes into the deeper layers of the skin, forming ulcerations, which then become covered with thick crusts.
This condition most commonly occurs on the legs and sometimes the buttocks.
Poor hygiene increases the risk of ecthyma.
Impetigo may improve on its own, or it may become chronic and widespread.
The use of oral antibiotic medicine, coupled with topical antibiotics such as bacitracin, antibacterial soaps, and good hygiene, is typically sufficient to clear the infection within a week.
Ecthyma is usually treated the same way but for a longer period of time; generally, antibiotics are taken for 10—14 days.
Since lesions (areas of damaged tissue) are deeper in ecthyma, they usually take a longer time to close, and they may heal with some degree of scarring.
2B.Folliculitis, Furunculosis, and Carbuncles
Pediatric Dermatology: Expert Consult 2-Volume Set, 4e
Folliculitis, furunculosis, and carbuncles are all infections that arise in the hair follicles.
Sweat and other conditions that cause moisture on the skin (such as high temperatures and humid weather), the shaving of hairy regions such as the underarms and legs, and the blockage of hairy areas by clothing, bandages, or casts or by lying or sitting in one spot for a long period of time can all increase the risk of an infection in the hair follicles.
Folliculitis is inflammation of the hair follicle that is characterized by the formation of a pustule (a small pimple or blister containing pus) or a group of pustules.
Furunculosis is distinguished by the development of furuncles – deep, red, hot, tender nodules – that may develop from the pustules found in folliculitis.
The nodules usually enlarge, become painful, and rupture after several days, forming abscesses (swollen areas containing pus).
Furuncles generally occur on the neck, face, underarms, and buttocks.
A carbuncle is a larger, painful, more serious lesion with a deeper base, generally occurring at the nape of the neck, on the back, or on the thighs. The area is red, swollen, and covered in pustules.
Fever and a feeling of illness may also occur with a carbuncle.
The chances of getting folliculitis may be lessened by using clean or new razors to shave, exposing areas of the skin that are typically covered, such as the back, to the air, and wearing loose, cool clothing.
Lesions usually improve on their own, but they heal faster with the use of antibiotic washes and creams.
Simple furunculosis is treated by the local application of antibiotic creams and warm, moist compresses, which relieve discomfort and promote drainage.
A carbuncle or furuncle with a significant amount of redness or swelling or an associated fever should be treated with a systemic antibiotic (one that affects the entire body), since one of the risks of these lesions is an infection of the bloodstream.
This can spread bacterial infection to many of the body’s organs, including the heart, brain, and kidneys.
When the lesions are large, painful, and fluctuant (they can be shifted and compressed), draining them via surgery is usually the best option.
In these cases, the person should receive antibiotics until all evidence of inflammation has disappeared. After the lesion is drained, the area should be covered with a thin layer of antibiotic ointment and a sterile dressing.
2C.Cellulitis and Gangrene
Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 6e
Two of the more serious and complicated bacterial infections that occur in people with diabetes include cellulitis and infectious gangrene.
Cellulitis is an infection that spreads through the deeper layers of the skin as well as the fat layer directly underneath the skin.
People who develop cellulitis usually have an open wound that acts as an entry point for bacteria, although occasionally, the skin infection originates from a bacterial infection of the blood.
Areas infected by cellulitis are typically red, warm, painful, and swollen.
The lesions feel hard to the touch, and there is no clear line between skin that is infected and skin that isn’t infected.
This condition usually affects the face and the legs are affected three times more often than the arms.
Cellulitis requires prompt medical care.
It is important that the health-care provider take a culture to determine what organism is causing the infection so that the right antibiotic is used.
Once oral or intravenous antibiotics are started, the average time for healing is 12 days, with a range of 5—25 days.
Infectious gangrene is a serious condition that usually develops on the hands or feet at the site of an injury such as a laceration, needle puncture, or surgical incision.
It can also occur in surgical incisions on the abdomen.
A surgical incision is a cut made through the skin to facilitate an operation or procedure.
Often, multiple incisions are possible for an operation. In general, a surgical incision is made as small and unobtrusive as possible to facilitate safe and timely operating conditions.
Infectious gangrene generally begins as cellulitis, which is followed by fever and other generalized symptoms as the infection rapidly spreads.
The area then becomes blue in color, and blisters appear and rupture, forming areas of black skin.
Since the mortality rate (death rate) for infectious gangrene is high, it is important that it is diagnosed early and treated aggressively.
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