Skin and soft tissue infections

The spectrum of skin and soft tissue infections seen by the primary care physician can be as benign as folliculitis to as life-threatening as NF. Cellulitis remains the most common skin and soft tissue infection seen in primary care. The ever present danger of ca-MRSA, however, has changed the way primary care physicians approach the common problem of cellulitis. The presence of risk factors for colonization with ca-MRSA and a history or examination finding of skin abscess should raise the suspicion of ca-MRSA, and antibiotic therapy should include TMP-SMZ, clindamycin, doxycycline, or minocycline. Skin abscess may occur independently of cellulitis, and often may safely be incised and drained in the primary care setting as long as timely follow-up is assured to assess for wound healing. Available evidence suggests that abscess formation without accompanying cellulitis does not require oral antibiotic therapy. Finally, although NF is rare as an outpatient clinical presentation, it is a diagnosis that the primary care physician should be familiar with. Failure to consider the diagnosis and refer may lead to significant morbidity and even mortality.