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Infections of the skin and skin structures are some of the most common infectious diagnoses and result in hundreds of thousands of medical office and emergency room visits each year. These infections often occur following a break in normal skin integrity from either trauma or skin disease (e.g., atopic dermatitis). The vast majority of these infections are caused by Staphylococcus aureus and Streptococcus pyogenes (Table 77–1). Rarely, infections in patients with burns, diabetes mellitus, or decubitus ulcers may involve gram-negative rods such as Pseudomonas or anaerobes. Hematogenous seeding of organisms into the skin can occur but is uncommon. Normal histology of the skin can be seen in Figure 77–1.

TABLE 77–1Skin and Skin Structures Infections: Appearance of Lesions, Skin Layers Involved, Common Pathogens, and Treatment Modalities

Layers of the skin and subcutaneous tissue. Note sebaceous glands (purple coils) and hair follicles with protruding hair. (Reproduced with permission from Mescher AL. Junqueira’s Basic Histology: Text & Atlas. 13th ed. New York, NY: McGraw-Hill Education; 2013.)



Impetigo is an infection of the epidermal layer of skin.


There are two modes of acquisition of impetigo, primary infection, which occurs in otherwise normal skin, or ...

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