Building Blocks of Clinical Practice Helping Athletic Trainers Build a Strong Foundation

Issue #2: Bacterial Infections of the Skin

Folliculitis

Definition:
•	Inflammation of a hair follicle
•	Can progress down hair follicle or into multiple follicles and result in a furuncle or carbuncle

Causes:
•	Bacterial or viral infection, chemical irritation
•	Secondary to skin injury, which introduces bacteria to the area
•	Shaving hairy areas may facilitate infection
•	Occlusion of hair-bearing areas may facilitate growth of microbes
•	Friction
•	Hyperhidrosis

Symptoms:
•	Areas are usually non-tender or slightly tender •	Area may itch
•	Erythematous perifollicular papules or pustules may develop
•	Grouped lesions

Types:
•	Most common form is staphylococcal folliculitis

Diagnosis
•	Confirmed by laboratory findings

Treatment:
•	Antiseptic washes •	Warm compress
•	Topical antibiotics
•	Moderate and severe cases may require a systemic antibiotic

Prevention:
•	Wash areas with antibacterial soap or benzoyl peroxide •	Practice good hygiene
•	Avoid sharing razors and towels

	

Picture reprinted with permission from www.aoca.org.

Carbuncles

Definition:
•	Acomplication of folliculitis, a carbuncle is several furuncles that have merged
•	Carbuncles are readily transmitted by skin-to-skin contact. Often, the direct cause of a carbuncle cannot be determined

Causes:
•	Most carbuncles are caused by the bacteria staphylococcus aureus. The infection is contagious and may spread to other areas of the body or other people

Symptoms:
•	Acarbuncle is a swollen lump or mass under the skin which may be the size of a pea or as large as a golf ball.
•	The carbuncle may be red and irritated and might hurt when you touch it
•	Pain gets worse as it fills with pus and dead tissue
•	Other signs and symptoms include itching at the site of infection, skin inflammation around the wound, general ill feeling, fever, or fatigue. Pain improves as it drains

Diagnosis:
•	Diagnosis is primarily based on the appearance of the skin
•	Skin or mucosal biopsy culture may show staphylococcus or other bacteria

Treatment:
•       Use of a warm, moist cloth several times a day on the carbuncle helps it to drain, which speeds healing
•	Never squeeze a boil or attempt to cut it open because this can spread the infection and make the condition worse. It may drain on its own but more often than not a medical professional will drain it for the patient
•	Once open, keep clean and use topical antibiotic ointments and keep covered

Continued...

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Issue #2: Bacterial Infections of the Skin continued...

Impetigo

Definition:
•	Abacterial infection caused by both streptococci and staphylococci species

Causes:
•	Infects athletes with close skin to skin contact

Symptoms:
•       Well defined, erythematous, yellow, crusted plaques distributed on the extremities and the head and neck

Diagnosis:
•	Impetigo is usually diagnosed on the basis of clinical findings
•	Bacterial culture and sensitivity are recommended (1) in cases to identify methicillin-resistant Staphylococcus aureus (MRSA), (2) if an outbreak of impetigo has occurred, or (3) if poststreptococcal glomerulonephritis is present
•	Exudate from underneath the crust is sent for culture Treatment:
•	Both topical and oral antibiotics. Individuals should be kept from sporting activities that involve skin to kin contact until 5 days after the initiation of therapy

			

Furuncles/Boils

Definition:
•	Abacterial infection (typically Staphylococcus aureus) of the hair follicle

Causes:
•	Furunculosis and carbunculosis are often caused by bacteria (germs) called Staphylococcus aureus or Staph
•	The Staph bacteria are commonly found on the skin, between the buttocks (rear end) and groin, and in the nose

Symptoms:
•	Initially, a red, swollen nodule that is exquisitely tender •	The lesion eventually develops a yellow, pus- filled
center that may have drainage. The patient may also develop a fever

Diagnosis:
•	The diagnosis is made based on symptoms
•	The drainage should be cultured to determine appropriate antibiotic therapy

Treatment:
•	Initially, warm soaks will allow lesion to drain spontaneously
•	Large or unresponsive lesions should be surgically lanced
•	Systemic antibiotics may be prescribed for large lesions and for lesions on the face

References:
Adams, B.B. (2002). Dermatological disorders of the Athlete. Sports Medicine, 32(5), 309-321.

Anderson, Hall and Martin, Foundations ofAthletic Training,3rd edition, 2005. p 738.

Cuppett and Walsh, General Medical Conditions in theAthlete, 2005, p 328-29.

Picture reprinted with permission from www.impetigodoctor.com

Ferri FF, Ellis J, Jones R. Folliculitis. MD Consult – First Consult. Retrieved December 4, 2009. http://proxy2.atsu.edu:2053/das/ pdxmd/body/174549765-4/926364596?type=med&eid=9-u1.0-_1_ mt_1014864

Wolff K, Johnson RA. Fitzpatrick’s ColorAtlas and Synopsis of Clinical Dermatology, 6th Edition. New

York: McGraw-Hill Medical, 2009. Retrieved via StatRef, December 4, 2009.

Stulburg DL, Penrod MA, Blanty RA. Common Bacterial Skin Infections.American Family Physician. 2002;66(1):119-124.