Skin infections are one of the leading causes of outpatient or even inpatient admission worldwide nowadays. It is also one of the most neglected parts of the body, so only severe cases lead the patient to visit the dermatologist. According to the study done by the US Statistical Health and Pharma Market, only 15 – 16% of people visit a dermatologist per year. Skin diseases caused by bacteria, viruses, fungi, contact with various metals or chemicals, or even drugs and other autoimmune or systemic diseases can lead to reactions from very minor to fatal.
MRSA Skin Infection
The incidence and prevalence of skin infections are increasing so rapidly, and one of the main reasons for this is that two-thirds of the population are unaware of their skin problems, and two-thirds of the aware population do not seek medical advice.
Skin is a natural barrier against all bacteria, viruses, or microbial organisms, but due to different pathologies, people develop skin infections because of the defense mechanism of the body against foreign organisms.
What causes our immune system to react?
- Scars
- Cuts
- Burns
- Scratches
- Pinpricks
- Trauma
- Autoimmune diseases
- Contacts with different metals
- Allergies due to dust or pollen
- Allergies from animals’ fur or clothes
- Skin manifestations of systemic diseases
These cause cytokines to be released from the body, and reactions occur.
Common Skin Infection Organisms
Among all the skin infections that occur throughout the world, bacterial skin infections have the highest prevalence. Staphylococcus, Streptococcus, and coryneform bacteria are some of the major bacteria that lead to skin infections through various pathologies. Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading cause of mortality in skin infections. Impetigo, folliculitis, abscesses, cellulitis, necrotizing fasciitis, acne, warts, leprosy, boils, and erythema are some of the common skin infections caused by these organisms.
How are skin infections treated?
Doctors see skin infections by looking for a few important diagnostic symptoms like edema, redness, itch, numbness, or a significant history. As the incidence of these infections is increasing by one hundred thousand cases per year, researchers aimed to study the use of antibiotics and their effects on these infections. The use of antibiotics in skin infections is recommended only by licensed physicians. Doctors all around the world prescribe antibiotics for their respective skin diseases. Diagnosing the causing infectious agent can be difficult, so only an experienced, well-trained doctor should prescribe the antibiotics to avoid mistakes in the treatment, which can lead to fatality.
Generally in skin infections, topical antibiotics in the form of ointments or creams are used initially after the diagnosis but if the infection is chronic and severe, if the infections are related to systemic diseases, or if the skin infection itself leads to systemic manifestations, then oral or even intravenous use of antibiotics is recommended.
Some of the common and most widely used antibiotics, also the most effective ones, are erythromycins, tetracycline, dicloxacillin, cephalosporin, clindamycin, beta-lactams, cefazolin, trimethoprim-sulfamethoxazole, and even vancomycin, which is a broad-spectrum antibiotic.
Antibiotics help in the treatment of these skin infections very rapidly, and the curability rate is usually at eighty percent, but still, why are skin infections the fourth most common cause of hospital admissions? Researchers have demonstrated in various studies that inappropriate and improper use of antibiotics is more dangerous than not using antibiotics at all.
Every treatment has its mechanism of action through which it works on the body and helps reduce the infection. The antibiotics have their route of administration, mechanisms of action, and duration to work in the body against the bacteria. If used improperly, they will not work and may even worsen the outcome. Even when 1st line antibiotics don’t work, we must think about 2nd line antibiotics and resistance. Side effects of the antibiotics must be considered while giving them, as the side effects will sometimes be so serious that they may lead to mortality too.
The Controversial Mismanagement of Antibiotics
The main issue with Antibiotics is their overuse, especially when used without a prescription. For this reason, people do not get complete information about the antibiotics that they are using, which can lead to antibiotic resistance. Incomplete duration, inadequate dosage, and overdosing can all lead to the bacteria becoming resistant even to the strongest antibiotics. Antibiotic resistance leads to frequent recurrence of the infection, and as a result, people may also require hospital admission for a longer duration.
Doctors must also consider the fact that what’s best for the patient and their current skin issues may not be antibiotic use. For example, an abscess needs incision and drainage first, then they can opt for antibiotics if needed. Acne requires diet modifications and topical ointments. Autoimmune or other systemic diseases may require steroids rather than antibiotics. Viral skin infections require antiviral medications. Contact dermatitis and allergies require lifestyle modification and eradication of the irritant substances. So the usage of antibiotics becomes limited to those skin infections that are chronic or are caused by growing bacteria.
Antibiotic resistance could increase global healthcare costs by more than one trillion dollars per year by 2050. As a result, new policies are strongly needed to overcome this global crisis caused due to antibiotic misuse, especially in skin infections. Researchers have demonstrated that the proper use of antibiotics has significantly lowered the incidence and even the prevalence of serious as well as chronic skin infections. As such, a campaign to make people aware of the dangers of antibiotic misuse is necessary to avoid unnecessary deaths and serious health complications.
References
Lim JS, Park HS, Cho S, Yoon HS. Antibiotic Susceptibility and Treatment Response in Bacterial Skin Infection. Ann Dermatol. 2018 Apr;30(2):186-191. https://doi.org/10.5021/ad.2018.30.2.186
