Bacterial Skin Diseases

Microbial diseases of the skin are usually transmitted by contact

with an infected individual. Although the skin normally provides a barrier
to infection, when it is penetrated by microorganisms, infection develops.
Diseases of the eye are considered with the skin diseases because both
occur at the surface of the body.

Staphylococcal infections. Staphylococci are Gram‐positive cocci

occurring in clusters. The best known pathogen in this group
is Staphylococcus aureus. This organism invades the hair follicles and
causes folliculitis, also referred to as pustules. A deeper infection of the
skin tissues is referred to as a boil, abscess, or furuncle. These lesions
are usually filled with pus. A large lesion progressing from a boil is known
as a carbuncle. Infections such as these are easily transmitted by skin
contact as well as by fomites.

Toxin‐producing strains of S. aureus cause scalded skin

syndrome. Usually found in young children and babies, this disease is
characterized by vesicles on the body surface, which cause the skin to
peel and give a scalded appearance. Penicillin or erythromycin antibiotics
are used to treat this and other staphylococcal skin diseases.

Scarlet fever. Scarlet fever is caused by Streptococcus pyogenes,

a Gram‐positive bacterium occurring in encapsulated chains. Most cases
of scarlet fever begin as infections of the respiratory tract, followed by
spread of the bacteria to the blood. The bacteria produce an erythrogenic
toxin that causes the typical skin rash. Penicillin is used for therapy.
Complications include damage to the heart valves known as rheumatic
heart disease or damage to the joints, which is called rheumatic fever.

Erysipelas. Erysipelas is a skin disease caused by Streptococcus

pyogenes and other pathogenic streptococci. Small, bright, raised lesions
develop at the site of streptococcal entry to the skin and grow with
sharply defined borders. Penicillin therapy is employed.

Impetigo contagiosum. Impetigo contagiosum is a contagious skin

infection accompanied by pus. It is caused by species of streptococci,
staphylococci, and others. The disease commonly occurs in children and
is easily transmitted among them. Penicillin therapy is often
recommended.

Madura foot. Madura foot is a general name for infections of the

feet due to many microorganisms. Among the causes are species of soil
bacteria belonging to the genera Nocardia, Actinomyces,
and Streptomyces. These and other bacteria enter the tissues and cause
granular lesions that spread and eventually invade the bone and
muscle. Sulfurlike granules represent accumulations of microorganisms
in the pus, and antibiotic therapy is necessary to prevent spread of the
disease.

Gas gangrene. Gas gangrene is a disease of the deep skin and

wounds as well as the blood. Several species of Clostridium cause gas
gangrene, including Clostridium perfringens, C. novyi, and C. septicum.
These anaerobic rods are transferred to the wound in their spore form.
They germinate and grow in the dead, anaerobic tissue of a wound,
putrefying the proteins and fermenting the carbohydrates to produce gas.
The gas causes the tissue to expand, and as the cells die from lack of
oxygen, gangrene begins. Bacterial toxins pass through the bloodstream
to cause illness throughout the body, and degeneration of the muscle
fibers occurs. Aggressive antibiotic therapy and removal of dead tissue
are useful therapies.

Cat scratch fever. Cat scratch fever may accompany a skin wound

following a cat scratch. Although the causative agent has not been
isolated with certainty, it is believed to be a species of Rochalimaea
or Afipia. Patients display a pustule at the skin site of entry and swollen
lymph nodes on one side of the body. Treatment with antibiotics may or
may not be successful. Mild fever and conjunctivitis often accompany the
disease.

Rat bite fever. Rat bite fever may be caused by either Spirillum

minor or by Streptobacillus moniliformis. The former is a flagellated
spiral bacterium; the latter is a Gram‐negative rod in chains. Both species
are transmitted during a bite by a rat, either wild or laboratory. Rat bite
fever is associated with skin lesions, intermittent fever, and a skin rash.
Arthritis may also be present.

Viral Skin Diseases

Rubella. Rubella (German measles) is a viral disease of numerous
organs caused by an RNA virus and accompanied by a mild skin rash
called an exanthem. First appearing on the body trunk, the rash spreads
to other areas. Pregnant women may transmit the virus across the
placenta to the developing embryo or fetus, and congenital rubella
syndrome may develop in the newborn. Damage to the eyes, ears, and
heart often result. Immunity can be rendered by an injection of attenuated
rubella virus in the MMR vaccine.

Measles. Measles is also called rubeola. It is caused by an RNA

virus normally transmitted by respiratory droplets during the coughing
stage. Red spots with white centers occur on the cheeks, gums, and lips
and are a diagnostic sign for the disease. These spots are called Koplik
spots. The measles skin rash appears as a blush first on the forehead,
then on the upper extremities, trunk, and lower extremities. Prevention is
rendered by inoculation with attenuated measles viruses in the MMR
vaccine. Complications of the disease may include measles encephalitis
or subacute sclerosing panencephalitis (SSPE).

Chickenpox. Chickenpox is also called varicella. The disease is

closely related to an adult disease called herpes zoster (shingles). The
responsible virus is a DNA‐containing virus of the herpesvirus group. It is
also known as the VZ virus.

Chickenpox is a highly contagious disease. Transmitted primarily by

respiratory droplets, the disease is accompanied by teardropshaped
lesions filled with fluid. The lesions begin on the scalp and trunk and then
spread to the face and limbs. Prevention is possible with injections of
inactivated VZ virus in the chickenpox vaccine.

Shingles occurs in adults and is believed to be a recurrence of

infection by the virus that causes chickenpox. Presumably, the virus has
remained latent in ganglia of the nervous system until it is reactivated.
The disease is characterized by painful lesions surrounding the body
trunk. The disease is highly contagious. Acyclovir may be recommended
for therapy.

Smallpox. Smallpox is a viral disease caused by a large, boxlike,

DNA‐containing virus having a complex shape. At one time, smallpox was
a major cause of death in the world. It was accompanied by pus‐filled
lesions covering the body surface, and usually it resulted in death.
Immunity was rendered by an injection of cowpox (vaccinia) viruses, as
first recommended by Edward Jenner in 1798. Smallpox has apparently
been eradicated on the earth and has not appeared in humans since
October 26, 1977. It is the first infectious disease ever to be eradicated.

Cowpox. Cowpox, also known as vaccinia, is caused by a DNA virus

similar in shape to the smallpox virus. In barnyard animals, the virus
causes a disease accompanied by lesions of the skin. These lessons also
occur when humans are infected. Immunizations with cowpox viruses for
smallpox protection are no longer given.

Molluscum contagiosum. Molluscum contagiosum is a skin disease

caused by a DNA‐containing poxvirus. The disease is accompanied by
flesh‐colored, painless lesions scattered over the skin surface. The
disease is transmitted by skin contact.

Warts. Warts are considered an infectious disease caused by a

number of papilloma viruses, which contain DNA. Warts vary in
appearance, and are generally benign. However, certain types of warts
can be forerunners of malignancies. Cases of genital warts are very
widespread, and certain strains of virus are related to cervical cancers.
Genital warts are transmitted by sexual skin contact. Other kinds of
warts, such as dermal warts, occur in the epithelial cells of the skin
tissues.

Fungal and Parasitic Skin Diseases

Athlete's foot and ringworm. Both athlete's
foot and ringworm are caused by various species of fungi belonging to
the genera Trichophyton, Microsporum, and Epidermophyton. These
fungi are often called dermatophytes, and their diseases are referred to
as dermatomycoses. Both diseases are accompanied by fluid‐filled
lesions occurring on the body surface. The diseases are spread by
fragments of fungal hyphae. Athlete's foot is also called tinea pedis,
while ringworm may be called tinea corporis (ringworm of the
body), tinea cruris (ringworm of the groin), or tinea capitis (ringworm of
the scalp). Many pharmaceutical ointments are available to prevent
spread of the disease, and the antibiotic griseofulvin is available by
prescription.
 Sporotrichosis. Sporotrichosis is caused by the fungus Sporothrix
schenckii. The fungus is transmitted during skin wounds associated with
thorns of rose or barberry bushes, as well as by contact with sphagnum
moss. The disease is accompanied by a nodular mass at the site of entry;
then it spreads to the lymphatic vessels and swelling (edema) follows.
Hard, knotlike growths are found beneath the body surface. Potassium
iodide and amphotericin B may be used for therapy.

Blastomycosis. Blastomycosis is a fungal disease due

to Blastomyces dermatitidis. This fungus is transmitted from the lungs of
an infected patient or from a wound. In a wound it causes pus‐filled
lesions and multiple abscesses. A systemic form of blastomycosis may
develop, with involvement of other organs. Amphotericin B is used for
severe cases.

Candidiasis (yeast disease). The fungus Candida albicans is

commonly found in the normal flora of numerous body tracts, but in
compromised individuals, it may cause a superficial infection known
as candidiasis or yeast disease. Yeast disease occurs in the vaginal
tract and is accompanied by internal discomfort, pruritis (itching
sensations), and sometimes, a discharge. Yeast disease often follows the
destruction of lactobacilli in the vaginal tract. It can be treated with such
drugs as miconazole, ketoconazole, and itraconazole.

Candida albicans may also cause infection in other skin locations.

For example, thrush is a form of candidiasis in which patches of
inflammation occur on the tongue and mucous membranes of the mouth.
A skin infection called onchyosis occurs in individuals whose hands are
in contact with water for long periods.

Swimmer's itch. Swimmer's itch is a skin infection due to tissue

invasion by species of the flatworm Schistosoma. The schistosomes are
not pathogenic of themselves, but they induce an allergic reaction that
brings on the skin irritation and itching associated with the disease.
Transmission occurs during swimming in contaminated waters.

Dracunculiasis. Dracunculiasis is a skin disease caused by the

round‐worm Dracunculus medinensis. In this disease, the roundworms
live in skin lesions and emerge through the lesions. In tropical countries,
dracunculiasis is widespread, and relief from the disease consists of
removing the roundworms through openings made in the lesions.