Bacterial Skin Infections: Acne, Rosacea, Impetigo & More

Rocky Mountain Spotted Fever (Legs)

Rocky Mountain spotted fever is caused by tick bites, and is potentially fatal.

Have you noticed a bump, rash, or outbreak on your skin? Skin conditions can be mild and disappear quickly, or they can cause lasting disfigurement and even death. Learn about many of the bacterial skin conditions that impact humans, from mostly harmless conditions like acne to serious and potentially fatal disorders like Rocky Mountain spotted fever.

Rocky mountain spotted fever (RMSF) is a tick-borne illness caused by the Rickettsia rickettsii bacteria. Symptoms develop 2 to 14 days after a tick bite and may include fever, rash, headache, muscle aches, nausea, vomiting, and more. The infection is potentially fatal because it causes inflammation of blood vessels (vasculitis) and increases the risk of blood clots. Prompt treatment with antibiotics is warranted in cases of RMSF.

Rocky Mountain Spotted Fever (Hand)

The rash from a Rocky Mountain spotted fever infection is characterized by red and purple papules.

Rocky Mountain Spotted Fever (RMSF) is a tick-borne bacterial illness that results in a characteristic rash. The picture shows the spotted, red and purplish macules and papules on the left wrist of a young child with RMSF.

Rocky Mountain Spotted Fever (Ankles and Feet)

Early treatment is crucial to avoid potentially the deadly consequences of Rocky Mountain spotted fever.

Rocky Mountain spotted fever (RMSF) is a disease carried by ticks and caused by the bacterium Rickettsia rickettsii. It can be transmitted to humans through tick bites and is potentially fatal if not diagnosed and treated early. Symptoms of the illness include headache, fever, muscle pain, abdominal pain, and vomiting. Sometimes a red rash containing hemorrhagic macules and papules may develop several days into the infection. Doxycycline is considered the first-line treatment for the infection. Treatment is most effective when it is initiated within the first 5 days of the occurrence of symptoms.

Acne Vulgaris Nodulocystic

Oral isotretinoin can be used to treat acne vulgaris nodulocystic.

This photo depicts pustules, cysts, and inflammatory nodules characteristic of acne vulgaris nodulocystic. The 23-year-old patient failed both oral and topical treatment. She has scars from the severe acne lesions. The photo on the right shows the same patient after undergoing a 4-month long course of oral isotretinoin, 1 mg/kg. Treatment was successful and led to a remission.

Acne

Acne is caused by dead skin cells clogging hair follicles with the help of sebum, the oil on the skin.

Acne appears when oil and dead skin cells clog up hair follicles, leading to whiteheads, blackheads, and other blemishes.

Acne medications can help clear up the unwanted skin condition. Over-the-counter treatments containing benzoyl peroxide or salicylic acid may be effective. Stronger treatments containing higher concentrations of active ingredients are available by prescription. Some doctors prescribe antibiotics to treat acne. Acne treatments may take 4 to 8 weeks to work.

Baby Acne

Maternal hormones typically cause baby acne, which is not a dangerous condition.

Baby acne, or neonatal acne, is typically caused by exposure to maternal hormones in the womb. Hormones stimulate the baby's sebaceous (oil) glands and produce pink pimples. The condition is not dangerous and resolves without treatment in weeks to months. Rashes in infants accompanied by malaise, fever, cough, and lack of appetite may indicate a more serious condition that warrants prompt medical evaluation.

Cystic Acne

Cystic acne usually appears on the face, and is typically found in teens experiencing changes in hormones.

Cystic acne is a severe type of acne that forms when oil glands become blocked and oil, dead skin cells, and other debris are trapped under the skin. Cystic acne can be disfiguring and cause deep pits and scars on the skin. Unfortunately, cystic acne most commonly occurs on the face. Teens experiencing changing hormone levels often suffer from the condition.

Erythematous Deep Acne Scars

Sometimes severe acne can leave deep acne scars, which can either be mild or severely disfiguring.

Acne scars may occur after severe cases of inflammatory or cystic acne. Acne scars may range from mild and barely noticeable to severe and disfiguring. There are many treatments available to reduce the appearance of acne scars. This picture shows a young woman with deep, red (erythematous) acne scars.

Ice Pick Scars

One of the most difficult forms of acne to treat are ice-pick stars, which take the form of deep, pitted lesions.

Ice-pick scars are deep, pitted lesions that occur as a result of severe acne. They are not easily treated with laser therapy due to their depth. Other types of surgical and resurfacing treatments may help reduce the appearance of ice-pick scars.

Ice Pick Scars Treatment

Nonablative skin resurfacing is one effective treatment for ice pick acne scars.

Many forms of surgical treatment have been found effective for the deep acne scars known as ice pick scars. The photo depicts ice pick scars 1 week after surgical treatment. The area was further treated with nonablative resurfacing.

Hidradenitis Suppurativa

Underarms, the groin and the anus are common locations for hidradentis suppurativa, a chronic skin disease.

Hidradentis suppurativa is a chronic skin disease that causes painful boil-like lumps (nodules) to form under the skin, usually under the armpits or near the groin or anus. Hidradentis suppurativa is not contagious, but it can recur. The disease is sometimes mistaken for acne, folliculitis, or boils.

Those most likely to be affected by hidradentis suppurativa are women, African Americans, and people with a history of acne. The disease usually occurs in a person's teens or 20s. Genetic factors are thought to play a part in determining who is more likely to develop hidradentis suppurativa.

Hidradentis suppurativa treatment may include the use of antibiotics, anti-inflammatory medicines, and surgery. Skin irritation may be relieved by wearing loosely fitting clothes and losing weight.

Furuncle (S. Aureus)

A furuncle is an infection caused by the bacteria Staphylococcus aureus.

This photo depicts the forehead of a man with furuncle caused by Staphylococcus aureus infection. The lesion has a central abscess, is very swollen, and about to rupture.

Rosacea

Rosacea causes deep red noses and cheeks, and may be set of by stress, sunlight, certain foods, and other causes.

Rosacea is a skin condition that causes redness and flushing on the nose and cheeks. It may be associated with spider veins, acne-like lesions, sensitivity, and scaling. People who are prone to rosacea may be more sun sensitive and tend to flush easily. Rosacea triggers may include stress, sunlight, certain foods and drinks, and others. Some people with rosacea have eye involvement as well. Rosacea runs in families. The condition is treatable with topical medication, laser or light treatments, and antibiotics. Sunscreen is recommended to protect sun-sensitive skin. Treatment is recommended to help prevent rosacea from getting worse.

Rosacea

There is no cure for rosacea, but fortunately the condition is not dangerous.

Rosacea is a chronic, inflammatory skin condition that causes redness, papules, and pustules to form on the skin. Typically rosacea only affects the face, and may cause a swollen nose, itchy eyes, small, broken blood vessels under the skin, and sometimes vision problems along with the characteristic redness of the face. There is no cure for rosacea. The condition is not dangerous. Treatment for rosacea may include topical medications, creams, sunscreen, laser treatments, and antibiotics (topical and oral). Doctors may also use dermabrasion and electrocautery to treat the condition.

Folliculitis

Infected hair follicles cause the condition folliculitis, which includes razor bumps and barber's itch.

Folliculitis is a condition that results when hair follicles become infected and inflamed. Razor bumps, hot tub rash, and barber's itch are all examples of folliculitis. The condition can appear anywhere on the skin. Symptoms of folliculitis commonly include a rash, itching, and pimples near hairs in the neck, groin, or genital area.

Bacteria are typically to blame for folliculitis. Sometimes viruses or fungi may be responsible for the infection. Hair follicles are usually damaged by something prior to becoming infected. Exposure to heat, sweat, and skin dressings containing adhesive tape may all irritate hair follicles. Friction from shaving, wearing tight clothes, skin injury (scrapes), and skin conditions like acne and dermatitis can also predispose one to folliculitis.

Folliculitis treatment may include the use of a hot, moist compress to help drain the infected hair follicles. Oral or topical antibiotics may be prescribed as well as antifungal medicine. Treatments tend to work well at stopping folliculitis, but the condition may return.

Bartonellosis

Bartonellosis (cat scratch disease) can cause enlarged lymph nodes after being scratched by a feline.

The photo depicts a child with Bartonella infection (cat scratch disease). The child has enlarged lymph nodes (adenopathy) in the armpit (axilla) that developed on the same side of the body after being scratched by a cat on the back of the hand.

Impetigo

Staph and Strep bacteria can cause impetigo, a contagious skin condition.

Impetigo is a common skin infection that may be caused by either Staphylococcus or Streptococcus bacteria. Children are more likely to be affected by the condition than adults. Impetigo starts as red blisters that later erupt and form yellow, crusty sores. Topical antibiotics may be used to treat the condition. Impetigo is contagious. Uninfected individuals should avoid contact with the lesions.

Transient Neonatal Pustular Melanosis

African American infants are most prone to transient neonatal pustular melanosis, which causes brown freckles. It is not dangerous.

Transient neonatal pustular melanosis (TNPM) is a harmless skin lesion that heals into a brown blemish. The condition is most common in African-American infants. It is the likely cause of brown freckles called lentigines neonatorum found in 15 percent of African-American newborns. The condition is not dangerous; it will lead to unusual pigmentation that persists for about 3 months. The lesions of transient neonatal pustular melanosis are almost always present at birth. They are 1 to 3 millimeters long and usually appear on the chin, neck, forehead, back, and buttocks, as well as the palms of the hands and soles of the feet. The cause of the condition is unknown and it does not require treatment.

Transient Neonatal Pustular Melanosis

Transient neonatal pustular melanosis is a harmless skin condition most often affecting African American newborns.

Transient neonatal pustular melanosis is a self-limiting benign skin condition that is most common in African-American newborns. The condition causes vesiculopustules on the skin that rupture and produce a characteristic scaly rash. The lesions most often appear on the neck, behind the ears, on the forehead, chin, and back. The cause of the condition is unknown. It is not dangerous and usually resolves on its own within about 10 days.

Eosinophilic Pustular Folliculitis

Eosinophilic pustular folliculitis affects children with itchy red, yellow, and white sores on the scalp, forearms, and lower legs.

Eosinophilic pustular folliculitis is a rare condition that occurs in children. Itchy, red papules and yellow or white pustules occur on the scalp, forearms, and lower legs of affected individuals. The lesions are approximately 1 to 3 millimeters in diameter. Examination of scrapings from a lesion on a Tzanck smear may reveal large numbers of eosinophils. Peripheral eosinophilia may occur during disease flares. The condition does not cause systemic symptoms. Spontaneous resolution often occurs. Topical steroids may be somewhat helpful for this condition.

Infantile Acropustulosis

Infantile acropustulosis usually affects babies less than a year old, causing itchy outbreaks on the feet and hands.

Infantile acropustulosis is a skin condition that most commonly first affects babies between 2 and 10 months of age. The condition causes recurrent outbreaks of intensely itchy papulovesicle and pustules. The lesions occur on the soles of the feet and the palms of the hands. The backsides (dorsal surfaces) of hands and feet may also be affected. Forearms and ankles may be affected. More rarely, the skin on the upper trunk, face, and scalp will be affected.

Miliaria Crystallina

Miliaria crystallina refers to clear, thin vesicles that form on sweat glands, especially on the face, scalp, trunk, armpit, groin, and between fingers.

Miliaria crystallina is a skin condition that develops after sweat glands in the stratum corneum become obstructed. Clear, thin vesicles form on the skin. Different factors may trigger the rash including sunburn, fever, or profuse sweating in an excessively hot and humid environment. Miliaria crystallina most commonly forms on the face, scalp, trunk, armpit, groin, and between the fingers. The vesicles resolve after the underlying cause of the condition goes away.

Miliaria Rubra (Prickly Heat)

Prickly heat causes a rash when the sweat glands are plugged, sending sweat into surrounding skin.

Miliaria rubra, known as prickly heat, is a condition in which the sweat glands become plugged and sweat is released into the surrounding skin. The miliaria rubra rash looks like reddish papules and vesicles. The lesions most commonly appear on the upper trunk, forehead, and areas where skin comes into contact with other areas of skin like the armpits, neck, and groin. Taking measures to cool off and dry off resolves this type of rash.

Scarlet Fever

Those affected by scarlet fever are typically children 5-15. The condition is caused by a Strep infection.

Scarlet fever is a bacterial infection that most commonly affects children between the ages of 5 and 15. The bacteria group A Streptococcus causes the condition. This is the same bacteria that causes strep throat. Scarlet fever is treatable with antibiotics. Early diagnosis and treatment reduce the risk of potential complications associated with the condition. Fever, sore throat, chills, and vomiting may be early symptoms of scarlet fever. A rash may appear on the neck and chest at first and then spread across the body. After the red rash, the skin may blister and peel, especially on the extremities.

Pitted Keratolysis

Pitted keratolysis appears on the bottoms of feet, causing a pitted appearance.

Pitted keratolysis is a bacterial infection on the soles of the feet. Affected skin has a pitted appearance. Symptoms range from none to itching, erosion of the skin, and tenderness. There may be excess sweating and foul odor. Some of the bacteria associated with pitted keratolysis are Kytococcus (formerly Micrococcus), Corynebacterium and Actinomyces. Topical antibiotics such as erythromycin, mupirocin, and clindamycin may be used to treat the condition.

Lepromatous Leprosy

Lepromatous leprosy allows large communities of organisms to develop in the skin, causing skin lesions.

Leprosy (Hansen's disease) is a chronic infectious disease caused by the bacteria Mycobacterium leprae. Nearly 215,000 new cases of leprosy were reported worldwide in 2014. Leprosy is curable with multidrug therapy (MDT).

Leprosy manifests itself in many ways depending on how strong an infected person's T-cell immunity to leprosy may be. Lepromatous leprosy (LL leprosy), as shown in this photo, affects people with the lowest T-cell immunity. LL leprosy allows large numbers of organisms to develop in the skin. Those who suffer from LL leprosy have many skin lesions that are slightly lighter than the surrounding skin.

Leishmaniasis

Leishmaniais comes from a parasite transmitted by sandflies. Bites cause red macules to form on the skin.

Leishmaniais is a parasitic infection caused by the protozoan Leishmania tropica. The infection is transmitted by phlebotamine sandflies. There are several forms of leishmaniasis. The cutaneous form is shown in the picture. The disease is endemic in the Middle East, Africa, China, the former Soviet Union, and India. After a bite, a reddish macule forms which then turns into a papule.

Periorbital Dermatitis

A rash around the eye may be periobital dermatitis, which can be set off from allergic reactions.

Periobital dermatitis is a rash that occurs around the eyes. The photo depicts a case of the condition in a young woman. Reddish micropapules and small papulovesicles are apparent on the skin around the eyes. Allergic contact dermatitis, atopic eczema, airborne contact dermatitis, and irritant contact dermatitis may cause the condition. Less frequently, rosacea, allergic conjunctivitis, or psoriasis vulgaris may cause periorbital dermatitis.

Sebaceous Hyperplasia

Though this skin condition is mostly harmless, sebaceous hyperplasia may be confused for certain forms of skin cancer.

Sebaceous hyperplasia is a benign yellowish growth that ranges from 2 to 5 millimeters in diameter. The growths may be associated with spider veins (telangiectasias). Sebaceous hyperplasia arises from enlarged sebaceous glands. The lesions may resemble basal cell carcinomas. A biopsy can help differentiate the two skin conditions.

Sources:

IMAGES PROVIDED BY:

  1. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  2. Fitzpatrick's Color Atlas & Synopsis of Clinical DermatologyKlaus Wolff, Richard Allen Johnson, Dick SuurmondCopyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.
  3. Fitzpatrick's Color Atlas & Synopsis of Clinical DermatologyKlaus Wolff, Richard Allen Johnson, Dick SuurmondCopyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.
  4. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  5. eMedicineHealth
  6. Copyright 2007 Interactive Medical Media LLC
  7. Color Atlas & Synopsis of Pediatric Dermatology; Kay Shou-Mei Kane, Jen Bissonette Ryder, Richard Allen Johnson, Howard P. Baden, Alexander Stratigos; Copyright 2002 by The McGraw-Hill Companies. All rights reserved.
  8. Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
  9. Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
  10. Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
  11. Image reprinted courtesy of eMedicine, 2008
  12. Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology Klaus Wolff, Richard Allen Johnson, Dick Suurmond Copyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.
  13. Interactive Medical Media LLC
  14. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  15. Color Atlas & Synopsis of Pediatric DermatologyKay Shou-Mei Kane, Jen Bissonette Ryder, Richard Allen Johnson, Howard P. Baden, Alexander StratigosCopyright 2002 by The McGraw-Hill Companies. All rights reserved.
  16. Color Atlas & Synopsis of Pediatric Dermatology Kay Shou-Mei Kane, Jen Bissonette Ryder, Richard Allen Johnson, Howard P. Baden, Alexander Stratigos Copyright 2002 by The McGraw-Hill Companies. All rights reserved.
  17. Fitzpatrick's Color Atlas & Synopsis of Clinical DermatologyKlaus Wolff, Richard Allen Johnson, Dick SuurmondCopyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.
  18. Color Atlas of Pediatric DermatologySamuel Weinberg, Neil S. Prose, Leonard KristalCopyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  19. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  20. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  21. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  22. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  23. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  24. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  25. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  26. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  27. Color Atlas of Pediatric DermatologySamuel Weinberg, Neil S. Prose, Leonard KristalCopyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  28. Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology Klaus Wolff, Richard Allen Johnson, Dick Suurmond Copyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.
  29. Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2011 by The McGraw-Hill Companies, Inc. All rights reserved.

REFERENCES:

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  • American Academy of Dermatology: "Rosacea."
  • Primary Care Dermatology Society: “Folliculitis and Boils (Furuncles/Carbuncles)."
  • Centers for Disease Control and Prevention: "Bartonella Infection (Cat Scratch Disease, Trench Fever, and Carrion's Disease) Symptoms."
  • American Osteopathic College of Dermatology: "Impetigo."
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  • Dermatology, 1st edition: "Miliaria."
  • FamilyDoctor.org: "Heat Rash."
  • Centers for Disease Control and Prevention: "Scarlet Fever: A Group A Streptococcal Infection."
  • American Osteopathic College of Dermatology: "Pitted Keratolysis."
  • National Institute of Allergy and Infectious Diseases: "Leprosy (Hansen’s Disease)."
  • World Health Organization: "Leprosy."
  • Kuby Immunology, 6th edition: "Immune Effector Mechanisms."
  • Centers for Disease Control and Prevention: "Parasites – Leishmaniasis."
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  • American Osteopathic College of Dermatology: "Sebaceous Hyperplasia."
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