Dermatologic manifestations of infection in the compromised host

The skin occupies an important position in the prevention and evaluation of infection in patients who are immunocompromised. The skin can provide a portal of entry for both locally invasive and disseminated infection; and, not infrequently, skin lesions may be the first sign of disseminated infection from other primary sites. The first clinical principle in approaching this problem is that the skin must be protected from trauma, maceration, or alteration in its normal microbial flora. The second principle is that any lesion, no matter how innocuous, should be carefully evaluated in this patient population. Since the gross morphology of the lesion is so frequently modified by the altered inflammatory response of the immunocompromised patient, an aggressive biopsy approach is essential for diagnosis and therapy.