Skin and soft tissues. Management of four common infections in the nursing home patient

Common skin and soft tissue infections in nursing home patients include herpes zoster, cellulitis, pressure ulcer infections, and scables. Treatment of shingles with an oral antiviral should be started within 24 hours of symptom onset. Dissemination and bacterial superinfection require antibiotic therapy. Use of corticosteroids to prevent post-herpetic neuralgia remains controversial. Cellulitis is most often caused by Staphylococcus aureus and beta-hemolytic streptococci (groups A and B). Therapy for cellulitis is empiric; gram-negative bacilli should be covered in diabetic patients. Most pressure ulcers never become infected; for those that do, empiric therapy should cover S aureus, gram-negative bacilli, and anaerobes. Topical treatment of scables with 5% permethrin cream or 1% lindane lotion is recommended.