Bacterial Skin Infections: Causes, Symptoms & Treatment
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Sep 24, 2024
- 12 min read
Updated: Jun 23
Skin Infections - Abscesses(boils) - Staph Infections - Impetigo - Nail Infections - Acne - Cat Scratches
Recognizing Bacterial Skin Infections: Causes, Symptoms & Treatment
When you first get a wound, slight redness, minor swelling, and serosanguinous drainage appear. The latter is NOT pus. It is typically a transparent liquid with a pink tinge. It is one of the first steps of the healing process.
However, an open wound can allow bacteria, viruses, and fungi to enter the body and cause a skin infection. Once the offending agent enters the skin, white blood cells move into the area to fight off the foreign agent. This is when the symptoms of infection arise.
Infections typically develop 24-72 hours after you get a break in your skin (although they sometimes begin before or after that time). If the skin lesion is getting infected, you will notice several things.
If infection is developing, you might notice the following signs and symptoms:
More swelling
Increasing tenderness
Increasing heat of surrounding skin
Redness around the wound (sometimes people confuse the pink tissue from healing with the redness of infection)
Over the Counter Approaches to Infection
If you suspect a skin infection, continue with the above measures and add:
Use a warm, moist pack 3-4 times a day (can use a moderately warm to moderately hot washcloth).
Elevate the area, if possible, as much as possible.
Do not squeeze or poke with anything to break it open.
Use ibuprofen as directed over the counter to reduce swelling.
Considered Natural Remedies for Bacterial Skin Infections
Note: If you use topical remedies, you may want to do a small skin patch test first - use it on a small area of your body to be sure it does not cause an allergic reaction.
Most of these are in the form of poultices, extracts, creams, diluted oils, teas, or gels when applied to wounds.
Nettle (also known as "stinging nettle")
If things are getting worse, you may notice:
Increased inflammation: swelling, redness, warmth
The presence of purulent drainage (or pus) - a thick, milky drainage that may be yellowish, tan, grayish, green or brown, or a combination of these. There may or may not be an odor. Signs that your body is making more white blood cells to fight infection.
If you notice red streaks from the wound, you may develop a serious problem: The infection is spreading, and you need to seek healthcare as soon as possible.
Fever
See a Healthcare Provider
Prescriptive Treatment for a Skin Infection
Do not neglect a worsening skin infection, especially if you have underlying risk factors. A healthcare provider may culture the pus and send it to the lab to see what bacteria is growing in the wound. If they suspect an infection, they will also give you an antibiotic.
ABSCESSES "BOILS" -STAPH-
We see abscesses ("boils") quite frequently, and they behave differently from other skin infections. First, about 50% (if not more) of patients with these think they have "spider bites." An abscess really does not look like a spider bite at all (see "insect bites" below). Bites do not usually get infected and are often itchy. An abscess is a red, firm, raised, frequently very tender pus-filled lump, most often caused by staph (staphylococci). You often cannot see the pus that is accumulating under the skin. They can be very small in the early stages. Usually, when we see a patient with one of these, the lesion is about the size of a quarter, and the patient comes in because they cannot stand the pain anymore.
Some people get staph infections more than others. Unlike other skin infections, staph has some odd characteristics: Often, staph infections seem to run in families. One family member may contract staph, bring it home, and then spread it to others in the household (who have similar immune systems and, therefore, susceptibility)
About a third of us have staph colonies living deep within the recesses of our nasal cavities. Others carry it elsewhere on our bodies. From time to time, when a person's immune system is compromised, Staph will take advantage of the situation and spread. This is particularly true of people
with chronic conditions like diabetes, older age, cardiovascular disease, lung disease, HIV, immune modulators, chronic steroid use, and various other risk factors.
In addition, it is not uncommon for illicit drug users to develop repeated staph infections.
According to the CDC, these people are at least 16 times more likely to be colonized with staph than others. While the sharing of drug paraphernalia often causes this, other factors, such as close contact, can cause staph.
No matter what the cause is, in many cases, once you have had staph, it is easier to get staph again when your immunity is down. So...take care of yourself.
Treatment and Remedies for Staph Infections
General Approaches
If you think you may have a staph infection:
Soaking the wound in an Epsom Salt solution or using a warm Epsom Salt poultice (wrapped in cloth) for 15 minutes several times a day may help draw out the infection.
Apply warm, moist packs for 20-30 minutes 4 times daily.
Use an anti-inflammatory - Ibuprofen - as directed for pain and swelling
For a boil, consider using ichthammol ointment as directed. It is called a "drawing ointment," which helps the infection surface and resolve. This can be purchased over the counter at most drug stores and pharmacies. This ointment is pretty nasty-looking, black, thick, and sticky, but I have had a couple of patients swear by it.
It is recommended that you DO NOT pick, stab, or squeeze it (although MANY people try this) - Resist that temptation. This can cause it to spread under the skin!
Over-the-Counter Treatment
Wash 2-3 times a day with PLAIN soap and water. You can use chlorhexidine soap.
(Hibiclens) which will decrease the colonization and transmission of staph on your body. Only wash with a small amount on the wound.
Ichthammol Ointment - This is considered a "drawing salve". Made from shale oils, it chemically draws out infection from - often bringing the infection to a head that resolves on its own. It also has antibiotic, anti-inflammatory, and antifungal properties. It is not pretty stuff as it is a black ointment but seems to work in many cases. I have had good reviews from a few patients about this, including one from a dermatologist.
Natural Remedies Which May Fight Staph
In a paste, poultice, or essential oil, try -
Prescriptive Treatments for Staph
Suppose your wound is worsening (increase in swelling, redness, warmth, fever, or failure to improve after two weeks) despite your efforts to treat it. In that case, you must visit a healthcare provider so they can start you on an antibiotic. Progressive worsening of a staph infection can become very serious and even life-threatening.
The provider often sends a culture (swab) of the wound drainage to a lab to determine the bacteria causing the infection. The lab will then check to see what antibiotic will be effective against the particular bacteria in your wound and will be sure you are taking the best one. There are resistant strains of staph, the best known being MRSA (methicillin-resistant Staphylococcus). This is not only dangerous but can be challenging to treat.
If the lesion is not severe, a topical antibiotic like Bactroban (mupirocin) may be used, but otherwise, an oral antibiotic like Doxycycline, Bactrim (sulfamethoxazole-trimethoprim), or minocycline may be given.
IN SOME CASES, YOU WILL NEED INJECTABLE ANTIBIOTICS OR DRAINAGE OF THE PUS THROUGH an I+D (INCISION AND DRAI AGE). While this sounds horrible, relief from the pressure and associated pain will alleviate some suffering.
Staph is highly contagious. If you have a known or suspect case, be extremely careful with close contact and be sure not to share things with others you have touched. Wash hands often and maintain cleanliness (i.e., wash hands).
IMPETIGO
Impetigo is another rash caused by strep or staph. It is recognized by a rash-like area with tiny bumps that eventually rupture and ooze. One type forms yellow crusts on the skin on a reddened base. The other type is "bullous," or typically localized blistering areas on the skin. Impetigo may affect anyone of any age, but is most common in young children (facial) and adolescent athletes (extremities, trunk). It is very contagious and usually comes from direct contact with an infected person or an inanimate object, but it is usually the former. In fact, if a young athlete has it, they will be excluded from sports until they have been on antibiotics for several days. (see photos below).
Like staph infections (above), impetigo can also be caused by MRSA (methicillin-resistant Staphylococcus).
For any of these cases, washing with a simple (no antibacterial) soap and water twice daily is essential.
Treatment and Remedies for Impetigo
To begin with, it is best to clean any sores like this gently with soap and water two to three times a day. If there are yellow/brownish crusts, try to gently, gradually wash them away. Soaking with a warm, moist cloth may help loosen them up.
Over-the-Counter Treatment of Impetigo
Plain soap NOT antibacterial) or Chlorhexidine (Common brand: Hibiclens) soap - wash two to three times a day, gently removing crusts
Bacitracin ointment may help as well. It is an antibiotic ointment typically found in pharmacies.
Natural Remedies Which May Help With Impetigo
There are several home remedies you can try if this is not severe.
In poultice, essential oils or paste:
If these approaches or treatments are ineffective and/or the infection is worsening, it is VERY important to seek medical attention so that it does not spread. This can lead to deeper infections within your body that can be serious (sepsis).
Prescription Treatment of Impetigo
If all else has failed or you want to cut to the chase and eliminate the impetigo, you can discuss this with a healthcare provider.
The provider can treat you with one of the following antibiotic treatments:
Topical - Mupirocin, retapamulin, or ozenoxacin - these usually work quite well
(For recurrent bouts of impetigo, you can use mupirocin nasal gel for 5-7 days each month).
Oral - Keflex (cephalexin) or dicloxacillin
For suspected MRSA, oral Bactrim (Trimethoprim-sulfamethoxazole), Doxycycline or clindamycin can be used.
This condition is considered contagious for 24 hours after starting the antibiotic.
NAIL INFECTIONS
When the skin on the edge of your finger or toenail gets red, hot, swollen, and painful—possibly with pus—it is likely due to a localized staph infection (occasionally due to fungus). These are called a paronychia. They are common, particularly in people who pick at their nails, bite them, have dry skin or ingrown nails, and frequently immerse their hands in water.
Treatment and Remedies for Nail Infections
Conventional Over-the-Counter Treatment
While it is tempting to squeeze, pick, and poke at these, doing so may spread the infection under the skin and cause more irritation. When the infection begins, if it is not too severe, the best approach is to soak the finger (or toe) in warm water for 15 minutes three to four times a day. This helps lessen pain and increases circulation to the infection so white blood cells can get in to fight off the bacteria.
Some people suggest adding Epsom Salt to the water, but that is not necessary and may even dry out the skin too much.
Keep the extremity elevated as much as possible.
Try an anti-inflammatory like ibuprofen (common: Motrin, Advil) (as directed over-the-counter) as directed - and if not contraindicated
If it is not getting better, continues to get worse, or has been present for a long time (several days to weeks), you should see a healthcare provider for a proper diagnosis and treatment. Depending on the cause, they will likely give you an oral antibiotic or antifungal. Occasionally, they will drain the wound.
ACNE
According to the American Skin Association, acne is caused by many things. Overall, it is caused by the blocking of pores or skin follicles with dead skin and oils. The inflammation of nearby cells, increased oil production, or bacterial infiltration of a follicle can cause it. Some factors, like polycystic ovarian syndrome (PCOS) and adolescence, cause the production of more oil on the skin because of hormones, which leads to the development of acne. Certain cosmetics, gels, or lotions, as well as increased humidity and warmth, can also cause acne to develop. As acne advances, it can produce severe scarring.
Acne can also be caused by chronic skin picking - dermatillomania or excoriation disease. This involves compulsive picking of the skin.
Treatment and Remedies for Acne
Conventional OTC Treatment of Acne
For any acne, it is important that you wash your face gently every day with a mild soap and water. Secondly, DO NOT PICK your face. Your pimples may be unsightly, but your hands are dirty, and you are spreading microscopic bacteria from your hands to your face. Also, squeezing causes the bacteria to spread under the skin. If you are lucky, changing your make-up or your environment may also help (decrease overall humidity, warmth, and sweating). Steam may help to open your pores so that impurities escape. Studies also show that significantly cutting back on sugar may help as well.
For typical comedonal acne, there are two primary over-the-counter treatments: Salicylic acid and benzoyl peroxide. Salicylic acid helps clean out pores in the skin and dry out pimples. Benzoyl peroxide does this and also kills bacteria. This is the component of many over-the-counter medications - creams, pads, washes, lotions, and gels. Benzyl peroxide takes several days to work and can dry out your skin excessively if you have sensitive skin. If this happens, you will need to stop using it.
Note: Benzyl peroxide recently received negative reviews, indicating it as a possible cause of cancer. Most sources say this is not likely and may break down into the cancer-causing chemical benzene at high temperatures. Much of this (and related potential problems) has not been scientifically proven. If you are concerned, there are other products you can use.
For other types of acne like inflammatory, nodular/cystic acne, your best bet would be to see your healthcare provider who can prescribe topical and oral antibiotics, isotretinoin, retinoids, birth control pills, or anti-androgenic agents if it seems to be a hormonal issue, and a host of other, stronger medications and combination drugs. Some medicines work very well for this, but they may have some potential untoward side effects. For example, using antibiotics for extended periods may contribute to antibiotic resistance.
Considered Natural Remedies for Acne
Comedonal and inflammatory acne:
Probiotics - There is mounting evidence that consuming probiotics may help balance the skin's pH, thereby helping with acne. Other herbal approaches include:
Aloe vera can be applied to the skin, either directly from the plant or in gel form. It serves as an antibacterial and anti-inflammatory. Reported: Fair results
Tea tree oil - has antibacterial properties
Lemon juice may help
Diluted apple cider vinegar
Dietary changes: Less sugar and carbs - according to the American Diabetes Association, "refined, highly processed carbohydrate foods and those with added sugar. These include sugary drinks like soda, sweet tea, and juice, refined grains like white bread, white rice and sugary cereal, and sweets and snack foods like cake, cookies, candy, and chips. This is overall good practice anyway!
Prescriptive Treatment of Acne
Hormonal Therapy (for hormone-related acne)
Oral Antibiotics-tetracycline, minocycline, doxycycline (6-8 weeks). There is a risk of antibiotic resistance if taking these for an extended period.
Retinoids (common: adapalene/Differin) can be topically applied, or isotretinoin can be taken orally (familiar brand name: Accutane) for severe acne. Barring any complications or contraindications, they can be used until the acne is gone. They are best taken with antibiotics and are absolutely contraindicated in pregnancy and in those considering getting pregnant.
Topical Antibiotics - Erythromycin, clindamycin topical (these topicals can be expensive)
Adapalene (and others)-also over-the-counter
The above are also used in various combinations
CAT SCRATCHES and "CAT SCRATCH FEVER"
Most people think that a cat scratch is, well, just a cat scratch. Usually, you clean it up with some soap and water, maybe put an antibiotic ointment on it, and patch it up with a Band-Aid, and you are done. It is very important to recognize these bacterial skin infections: causes, symptoms & treatment. Once in a while, those cat scratches can evolve into a very nasty bacterial infection. According to the CDC, one-third of cats typically carry bacteria in their blood called Bartonella. While you can get this from a domesticated cat, it is more likely to be spread from a feral cat scratch. This bacterium does not make the cat sick, but it can make a person VERY sick if scratched. Of particular concern are scratches that occur on the joints because they can get very infected very fast. Symptoms can take anywhere from several days to three weeks after getting scratched.
What to watch for? Watch the area of the cat scratch for more inflammation. There may be a little blister-type lesion at the site; a fever or a rash may occur; red streaks can develop near the wound, and axillary (armpit) lymph nodes near the scratch may become swollen and tender. A headache or fatigue may also occur.
You must clean the wound well with soap and water as soon as it occurs and twice a day after that until it is gone.
Treatment and Remedies for Cat Scratches
Conventional OTC Treatment
After washing with soap and water, apply Vaseline or an antibiotic ointment like (common: Neosporin, Bacitracin) and cover with a Band-Aid or other sterile dressing (some dermatologists prefer Vaseline because of localized inflammation that is sometimes caused by topical antibiotics like Neosporin)
Prescriptive Treatment By a Healthcare Provider
If you do develop signs of infection at the site (increasing inflammation, warmth, tenderness, pus) or other signs and symptoms of cat scratch fever, if the scratch is terrible, continues to worsen, or does not go away, it is important to check in in with your healthcare provider, especially if you have risk factors.
Depending on the extent of the infection, they may or may not give you an antibiotic. If you have not had a tetanus shot in ten years, your provider would likely recommend this as well.
