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Chap. 28 - EMERGENCY DERMATOSES OF THE ANORECTAL REGIONS
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- By Yalçin Tüzün, Istanbul University, Sadiye Keskin, Istanbul University
- Edited by Ronni Wolf, Batya B. Davidovici, Jennifer L. Parish, Lawrence Charles Parish
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- Book:
- Emergency Dermatology
- Published online:
- 07 September 2011
- Print publication:
- 17 January 2011, pp 278-281
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- Chapter
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Summary
ALTHOUGH THERE ARE some dermatological disorders that may affect the quality of life, the life-threatening dermatoses of the anorectal region are infrequently seen. When observed, bacterial infections would be the most serious, often being life threatening. For this reason, making the correct diagnosis and providing appropriate care is significant. Some of these disorders may be treated only with surgical treatment.
Emergency dermatoses in the anorectal region are listed in Table 28.1.
STAPHYLOCOCCAL CELLULITIS
The anorectal region can be susceptible to infection with Staphylococcus aureus. The high temperature, pressure, friction, and humidity of this area encourage colonization by staphylococci. Severe involvement with furunculosis and abscesses suggests an overlap with hidradenitis suppurativa. Cellulitis and abscess formation can complicate cysts, sinuses, and fistulas.
Anorectal infections in patients with malignant disease are serious and potentially life threatening. Although some cases of anorectal cellulitis may respond to antimicrobials alone, necrotizing fasciitis and Fournier gangrene have a high risk. Swelling and fluctuation signifying abscess formation may develop. It is difficult to decide on the timing of surgery. Perianal infiltration, ulceration, or abscess occurs in 5% of hematological malignancies and may rarely be the presenting feature.
STREPTOCOCCAL DERMATITIS/PERIANAL CELLULITIS
This syndrome is mostly seen in children between the ages of 1 and 8. Boys are affected more frequently than girls. Group A β hemolytic streptococci is the main cause (rarely S. aureus). An association with acute guttate psoriasis has also been reported.
Chap. 8 - NECROTIZING SOFT-TISSUE INFECTIONS, INCLUDING NECROTIZING FASCIITIS
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- By Ronni Wolf, Hebrew University–Hadassah Medical School, Yalçin Tüzün, Istanbul University, Batya B. Davidovici, Kaplan Medical Center
- Edited by Ronni Wolf, Batya B. Davidovici, Jennifer L. Parish, Lawrence Charles Parish
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- Book:
- Emergency Dermatology
- Published online:
- 07 September 2011
- Print publication:
- 17 January 2011, pp 75-80
-
- Chapter
- Export citation
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Summary
SKIN AND SKIN structures are among the most frequent sites of human bacterial infection and account for ~10% of hospital admissions in the United States.
The terminology used for infections of skin and skin structures is often confusing. “Primary” skin infections occur in otherwise normal skin and are usually caused by group A streptococci or Staphylococcus aureus. Infections are called “secondary” when they complicate chronic skin conditions (e.g., eczema or atopic dermatitis).
A second classification system divides skin and skin-structure infections into “uncomplicated” or “complicated,” the latter defined as involving abnormal skin or wound infections occurring in a compromised host or requiring substantial surgical intervention.
A more important and, for our purposes, relevant distinction with essential management implications subdivides soft-tissue infections into “non-necrotizing” and “necrotizing” processes. This chapter reviews only the necrotizing soft-tissue infections (NSTIs) – the ones that pose real emergencies that are rapidly progressive, destructive, and highly lethal.
NSTIs can be defined as infections of any of the layers within the soft-tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. NSTIs are typically not associated with abscesses, although they can originate from an untreated or inadequately drained abscess.