They can appear anywhere on the body in a variety of morphologies. When examining the color of skin, health care practitioners should note that the natural color of a patient's skin can change the appearance of colors. The cause of seborrheic keratosis is unknown, but genetic mutations read more . Examples of supportive care for skin conditions may include: Many skin conditions require close follow-up care, particularly if symptoms begin to worsen and/or if treatment (such as antibiotics) is ineffective. Induration Skin Hardening Signs and Causes. The immune system works to fight off the bacteria and old, spent white blood cells collect in the skin. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Clinicians recorded whether fluctuance was present for each subject initially and after 48 hours. Condyloma, thrombosed or prolapsed hemorrhoids, anal skin tags, or fissures can be identified from external inspection. Violet skin may result from cutaneous hemorrhage or vasculitis Overview of Vasculitis Vasculitis is inflammation of blood vessels, often with ischemia, necrosis, and organ inflammation. Superficial and small abscesses respond well to drainage and seldom require antibiotics. Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for debridement. ( See Figure 1.) tony bloom starlizard. As can be seen, each of these tissue types is distinct, with identifiable characteristics and treatment considerations. Atrophy may be caused by chronic sun exposure, aging, and some inflammatory and neoplastic skin diseases, including cutaneous T-cell lymphoma Cutaneous T-cell Lymphomas (CTCL) Mycosis fungoides and Szary syndrome are uncommon chronic T-cell non-Hodgkin lymphomas primarily affecting the skin and occasionally the lymph nodes. Enter search terms to find related medical topics, multimedia and more. Treatment depends read more involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts. Treatment depends on the cause. Home; Service. Red skin (erythema) can result from many different inflammatory or infectious diseases. Urticaria also may be accompanied by angioedema, which results from mast cell and basophil activation read more (wheals or hives) is characterized by elevated lesions caused by localized edema. The presence of fluctuance was assessed to determine if the use of Irrisept reduced or eliminated the need for oral antibiotics in uncomplicated abscesses. 1. Her tetanus vaccination is up-to-date. Vasculitis can affect any blood vesselarteries, arterioles, veins, venules, or capillaries read more , and infections (eg, meningococcemia, Rocky Mountain spotted fever Rocky Mountain Spotted Fever (RMSF) Rocky Mountain spotted fever (RMSF) is caused by Rickettsia rickettsii and transmitted by ixodid ticks. The primary underlying causes of skin induration include: The precise physiological process that results in many conditions that cause skin induration includes the inflammatory process and infiltration of the skin by certain types of cancer cells. Diagnosis of skin induration is made by palpation (feeling the area) and assessing whether the raised area has a hard, resistant feeling. The recommended duration of antibiotic therapy for hospitalized patients is seven to 14 days. These include Patch testing Biopsy Scrapings Examination read more .). Used of an abnormal mass such as a tumor or abscess. For an abscess, the treatment of choice may be antibiotics, incision, or drainage. For inflammatory disorders, like scleroderma or lichen sclerosus, immunosuppressants or steroid creams can be used. Infections can be classified as simple (uncomplicated) or complicated (necrotizing or nonnecrotizing), or as suppurative or nonsuppurative. . Sterile aspiration of infected tissue is another recommended sampling method, preferably before commencing antibiotic therapy.22, Imaging studies are not indicated for simple SSTIs, and surgery should not be delayed for imaging. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Cutaneous larva migrans is caused by Ancylostoma species, most commonly dog or cat hookworm Ancylostoma braziliense read more ). The Laboratory Risk Indicator for Necrotizing Fasciitis score uses laboratory parameters to stratify patients into high- and low-risk categories for necrotizing fasciitis (Table 4); a score of 6 or higher is indicative, whereas a score of 8 or higher is strongly predictive (positive predictive value = 93.4%).19, Blood cultures are unlikely to change the management of simple localized SSTIs in otherwise healthy, immunocompetent patients, and are typically unnecessary.20 However, because of the potential for deep tissue involvement, cultures are useful in patients with severe infections or signs of systemic involvement, in older or immunocompromised patients, and in patients requiring surgery.5,21,22 Wound cultures are not indicated in most healthy patients, including those with suspected MRSA infection, but are useful in immunocompromised patients and those with significant cellulitis; lymphangitis; sepsis; recurrent, persistent, or large abscesses; or infections from human or animal bites.22,23 Tissue biopsies, which are the preferred diagnostic test for necrotizing SSTIs, are ideally taken from the advancing margin of the wound, from the depth of bite wounds, and after debridement of necrotizing infections and traumatic wounds. Lesions spontaneously resolve but frequently read more . Skin and soft tissue infections (SSTIs) are a group of heterogeneous conditions affecting the epidermis, dermis, subcutaneous tissue, or superficial fascia.Uncomplicated infections are most commonly caused by gram-positive pathogens (Streptococcus, Staphylococcus) that infiltrate the skin after minor injuries (e.g., scratches, insect bites). Exactly what causes scleroderma is unknown. They are caused read more or peripheral arterial disease Peripheral Arterial Disease Peripheral arterial disease (PAD) is atherosclerosis of the extremities (virtually always lower) causing ischemia. The hardening of a normally soft tissue or organ, especially the skin, due to inflammation, infiltration of a neoplasm, or accumulation of blood. Cellulitis often. Vasculitis can affect any blood vesselarteries, arterioles, veins, venules, or capillaries read more . 1. Ulceration can be a complication. The search included systematic reviews, meta-analyses, reviews of clinical trials and other primary sources, and evidence-based guidelines. e.g. Umbilicated lesions have a central indentation and are usually viral. The immune system works to fight off the bacteria and old, spent white blood cells collect in the skin. The term maculopapular is often loosely and improperly used to describe many red rashes; because this term is nonspecific and easily misused, it should be avoided. (See also Overview of Rickettsial read more , other rickettsioses). Perianal infections, diabetic foot infections, infections in patients with significant comorbidities, and infections from resistant pathogens also represent complicated infections.8. 718-302-0040. grandma's home essential oils Examples include freckles, flat moles, tattoos, and port-wine stains Capillary Malformations Capillary malformations are present at birth and appear as flat, pink, red, or purplish lesions. Indurated areas commonly appear on the hands and face but can also be found on the chest, back, abdomen, breasts, or buttocks. Diagnosis read more , physical trauma with or without vascular compromise (eg, caused by decubitus ulcers Pressure Injuries Pressure injuries are areas of necrosis and often ulceration (also called pressure ulcers) where soft tissues are compressed between bony prominences and external hard surfaces. Koebner phenomenon describes the development of lesions within areas of trauma (eg, caused by scratching, rubbing, or injury). We do not control or have responsibility for the content of any third-party site. Under sterile conditions . Purpura is a larger area of hemorrhage that may be palpable. 2023 Dotdash Media, Inc. All rights reserved. Zosteriform describes lesions clustered in a dermatomal distribution similar to those of herpes zoster Herpes Zoster Herpes zoster is infection that results when varicella-zoster virus reactivates from its latent state in a posterior dorsal root ganglion. Orange skin is most often seen in hypercarotenemia, a usually benign condition of carotene deposition after excess dietary ingestion of beta-carotene. Common manifestations read more . Last Editorial Review: 3/29/2021. Treatment is usually unnecessary. (See also Evaluation of the Dermatologic Patient Evaluation of the Dermatologic Patient History and physical examination are adequate for diagnosing many skin lesions. Significant tenderness present Systemic symptoms including fever, chills, and lymphadenopathy are unusual 4 . Up to 5% of normal patients may exhibit this sign, which is a form of physical urticaria. Diagnosis read more , some drug eruptions, some dermatophyte infections Overview of Dermatophytoses Dermatophytoses are fungal infections of keratin in the skin and nails (nail infection is called tinea unguium or onychomycosis). A recent article in American Family Physician provides further details about prophylaxis in patients with cat or dog bites (https://www.aafp.org/afp/2014/0815/p239.html).37, Simple SSTIs that result from exposure to fresh water are treated empirically with a quinolone, whereas doxycycline is used for those that occur after exposure to salt water. Plaques may be flat topped or rounded. Treatment. Elevation of the affected extremity (to help reduce any swelling). Use to remove results with certain terms For example, diabetes increases the risk of infection-associated complications fivefold.14 Comorbidities and mechanisms of injury can determine the bacteriology of SSTIs (Table 3).5,15 For instance, Pseudomonas aeruginosa infections are associated with intravenous drug use and hot tub use, and patients with neutropenia more often develop infections caused by gram-negative bacteria, anaerobes, and fungi. Multiple factors contribute, including read more and granuloma annulare Granuloma Annulare Granuloma annulare is a benign, chronic, idiopathic condition characterized by papules or nodules that expand peripherally to form a ring around normal or slightly depressed skin. Common manifestations may include arthralgias and read more . Nikolsky sign is epidermal shearing that occurs with gentle lateral pressure on seemingly uninvolved skin in patients with toxic epidermal necrolysis Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous hypersensitivity reactions. Diagnosis is by read more (eg, tinea [ringworm]), and secondary syphilis Secondary syphilis Syphilis is caused by the spirochete Treponema pallidum and is characterized by 3 sequential symptomatic stages separated by periods of asymptomatic latent infection. The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Cellulitis presents as skin breakdown followed by unilateral painful erythema that is warm to the touch. o [ abdominal pain pediatric ] induration ( 2 cm in diameter), or tenderness; and (4) evidence of lobulated fluid at time of enrollment Clinical cure: at the 1-week follow-up visit if there was resolution of the following signs and symptoms: purulent wound drainage, erythema, fluctuance, localized warmth, pain/tenderness, and edema/induration Patients with necrotizing fasciitis may have pain disproportionate to the physical findings, rapid progression of infection, cutaneous anesthesia, hemorrhage or bullous changes, and crepitus indicating gas in the soft tissues.5 Tense overlying edema and bullae, when present, help distinguish necrotizing fasciitis from non-necrotizing infections.18, The diagnosis of SSTIs is predominantly clinical. May or may not have surrounding cellulitis. There is no specific read more . Diagnosis is by skin biopsy read more . Fluctuant means a boggy-like feeling and indurated means firm and hardened. Erosions can be traumatic or can occur with various inflammatory or infectious skin diseases. . Nodules are firm papules or lesions that extend into the dermis or subcutaneous tissue. Antibiotics should be used in adjunct, and . Diagnosis is by clinical evaluation and biopsy. Induration is characteristic of panniculitis Panniculitis Panniculitis describes inflammation of the subcutaneous fat that can result from multiple causes. 2. Particular body parts are affected (eg, palms or soles, scalp, mucosal membranes). Introduction Anatomy and Pathophysiology Patient Assessment Indications Contraindications Equipment Patient Preparation Techniques Aftercare Future Advances in Abscess Management Decolonization and Prevention Complications Summary References Full Chapter Figures Tables Videos Supplementary Content Introduction Anatomy and Pathophysiology Most physical exams are done in the prone or left lateral decubitus position, revealing erythema, induration, fluctuance, tenderness, and spontaneous drainage. injury will be revealed. Moving in waves. (See also Overview of Effects of Sunlight.) Symptoms and signs are pain and a tender and firm or fluctuant swelling.
