When Benign Infections of the Skin Turn Deadly


By Barry C. Fox, M.D.University of Wisconsin

Sometimes, seemingly benign infections of the skin can turn deadly. Even a small number of germs in the wrong place at the right time can lead to a serious infection. Group A Streptococcus and Staphylococcus aureus are two germs that have the potential to cause virulent skin and bloodstream infections.

An image of a young woman suffering from acne on her face.
Acne can be managed by hot compresses. (Image: sruilk/Shutterstock)

Reason Behind Jim Henson’s Death

Most people are familiar with the untimely death in 1990 of Muppets creator Jim Henson. His illness started off with a sore throat. The strep moved from his throat into his lungs, causing pneumonia. Unfortunately, the strep bacteria broke out into the pleural space between the lung and the chest wall. 

This would make it hurt every time he tried to take a deep breath since it irritates the muscles that control respiration. The bacteria attacked the blood vessels in the lung and the pleural space and got into the bloodstream. 

Bacteria in the blood is called Bacteremia, also known as blood poisoning, and when serious bacteria create an immune response, the condition is known as sepsis. When this happens, it can lead to leaky blood vessels and clots. This can impair blood flow and damage major organ systems to the point where the patient dies. Unfortunately, this happened to Mr. Henson.

This is a transcript from the video series An Introduction to Infectious DiseasesWatch it now Wondrium.

Staph aureus and Outbreak of Septic Infections

Another outbreak of septic infections presented itself in the late 1970s and early 1980s when large numbers of younger women were severely ill with the Sepsis syndrome. They were hospitalized in the intensive care unit. When cultures of the blood were taken, the physicians were surprised they could not find germs in the blood, and they were a bit stumped. 

What they then finally decided, after seeing many similar cases, was that something drastically changed that was causing this new phenomenon to occur. Soon, a common hypothesis was proposed since it was noted that all the women were users of tampons and that vaginal cultures showed Staph aureus.

There was a new type of tampon being marketed at the time, with super-absorbency that could be left in place for an extended period of time. It turns out that one of the ingredients of the super-absorbency tampon was magnesium, and this was responsible for a change in the biological properties and growth of Staph aureus that favored this toxin formation.

TSS or Toxic Shock Syndrome

Staph aureus can elaborate a protein toxin that can cause bloodstream infections in place of the actual bacteria. This toxin can initiate Sepsis syndrome as well, and hence the term toxic shock syndrome, or TSS, came about. 

An image of 'Staphylococcus aureus' that populates a cracked skin.
Staphylococcus aureus can cause TSS or toxic shock syndrome. (Image: Juan Gaertner/Shutterstock).

TSS can also be caused by Group A Strep since there are areas of similarity between the toxin structure shared by both Staph and Strep. It’s important to report that TSS from tampon use is a rarity today because of educational efforts and quick diagnoses. Still, TSS can happen due to skin infections, burns, and occasionally after surgery.

Sepsis accounts for approximately 9-10 percent of all deaths in the United States, and approximately 10 percent of all admissions to hospital intensive care units are from Sepsis. However, with efforts geared toward the early recognition of Sepsis and intensive care unit support, the fatality rate has been reduced by 50 percent over the past two decades, from 35 to 18 percent.

Learn more about malaria and tuberculosis: global killers.

Living Beings on Skin

Bacterial infections can wreak havoc with all layers of the skin. For example, the top layer of the human skin, the epidermis, is covered by millions of bacterial germs, the most common of which is Staphylococcus epidermidis. All human beings have this germ, and unlike its cousin, Staph aureus, Staph epidermidis usually just minds its business happily living on the skin without causing disease.

30 percent of human beings actually also carry Staph aureus on their skin at any moment in time. It’s important to know that at any point in time, about 5 percent of human beings carry streptococcal germs that could cause skin infections. 

No matter how frequently they shower or bathe, there are always residual bacteria that stick to the top layers of the skin. Cleaning the skin does result in numerical reductions in surface bacteria, but within hours, the bacteria will replicate to reach their normal levels. Each person has his own natural equilibrium of skin bacteria.

Learn more about how bacteria can cause disease.

How Infections Invade Skin Layers

It’s useful to classify infections by the depth of invasion into the skin layers. Infections of the sweat glands are called folliculitis. One 21st-century skin disease from recreational activities is known as Pseudomonas bacterial folliculitis, which is an infection of the skin at the base of the hair follicles.

Acne is a common occurrence infection of the epidermis. It’s virtually impossible to get teenagers to resist the temptation to squeeze a pimple on their faces. But since their face is a highly vascular area with many pathways to the deeper parts of the brain, this is not advised. 

Now, infections that extend slightly deeper into the skin, into the dermis layer, are known as skin abscesses, furuncles, or carbuncles. Typically, these infections begin as folliculitis in the epidermis layer, but the process then extends into the next layer of the skin. 

How to Manage Infections of the Skin

Most of these infections can be managed with hot compresses, which increase the circulation to the area and enhance the body’s normal inflammatory response. If the abscess is larger, a minor surgical procedure known as an incision and drainage may be required.

A close-up view of a skin abscess caused by bacterial skin infection.
An acne can turn into an abscess when the bacteria extends deeply into the skin. (Image: Zay Nyi Nyi/Shutterstock)

Most skin abscesses also do not require antibiotic therapy. To explain more, if the diameter of the redness from one side of the abscess to the other is less than 5 cm, antibiotics are usually not required. A topical antibiotic can be considered.

For all infections of the skin, it’s important to know that bacteria cannot penetrate through intact skin. Hence, there has to be a portal of entry for bacteria to enter the surface or deeper layers of the skin. Many times, it may just be a hair follicle or a minor scratch.

We must never take the skin infections lightly, and consult the medical practitioner immediately.

Common Questions about Benign Infections of the Skin

Q: What is Staphylococcus Epidermidis?

Staphylococcus Epidermidis is a kind of bacterial infection of the skin. They live on the top layer of the skin and fortunately don’t cause health problems for people.

Q: How are skin infections classified?

Infections of the skin are classified based on the depth at which they can penetrate the underlying skin layers. The deeper they extend, the more problems they create.

Q: Is there any way to manage skin infections?

Infections of the skin can mostly be cured/managed by hot compresses, antibiotic therapies, incision and drainage, as well as topical antibiotics (if the infection is not severe).

Keep Reading
Seemingly Benign Infections of the 1950s in the US
Viral Diseases of the 1950s and 1960s
The Changing Outlook Toward Infectious Diseases