Skin Infections

A skin infection is a condition in which germs enter through the skin. The infection can cause pain, swelling and skin discolouration. If neglected there can be serious health consequences including septicaemia.

Skin issues are one of the leading causes of health problems in travellers, particularly long-term expatriates residing in tropical climates. Those with weakened immune systems or those who suffer from co-morbidities such as diabetes, are at a higher risk of a skin infection if a wound or skin injury occurs. Water exposure can be a higher risk exposure in countries where public health infrastructure is lacking.

There are many different types of skin infections. Treatment and management differ depending on the condition.

1. Bacterial
   A bacterial skin infection starts when bacteria penetrate the body via a break in the skin (e.g. cut or scratch). These types of infections are the most common in both travellers and returned travellers. Signs of a bacterial skin infection are: redness, swelling and throbbing, The affected area feels warm to touch, There can be itchiness/soreness, etc. Most bacterial infections are mild and can be easily treated with either topical or oral antibiotics. Some bacterial infections are resistant to antibiotics, treating these can be difficult. If seeking treatment or advice from a doctor, it is important to advise them of your travel history, as some regions are more prone to antibiotic-resistant bacteria. The most common bacterial skin infections are boils, cellulitis, impetigo and folliculitis.
2. Viral
   Viral skin infections result from a viral illness, the rash itself will often dissipate once the virus has run its course. Notable viral infections that present with rashes can include: hand, foot and mouth disease (common in young children, particularly day-care/kindergarten age), chickenpox, measles, shingles and warts. Many of these viral illnesses can be prevented by vaccination. Arboviral (mosquito transmitted) infections can often cause rashes during the course of the illness, particularly dengue and chikungunya viruses, and zika virus, albeit to a lesser extent.
   
   
3. Fungal
   These skin infections are caused by fungi, and typically thrive in warm, moist conditions (in areas such as the feet or armpit). These infections are usually confined to one area of the body. When treating a fungal infection, it is important to keep the area dry and cool, and dry well after showering. Antifungal creams, such as Clotrimazole (Clonea/Canesten) are readily available without a prescription and is effective in treating fungal infections. Ensure that treatment is continued to be used for two weeks after the infection seems to have disappeared, otherwise relapse is likely. Types of fungal infections include: athlete’s foot, ringworm, yeast infection, thrush (oral or vaginal) or nail fungus.
   
   
4. Parasitic
   Skin infections can sometimes be caused by a parasite, these infections can spread beyond the skin and infect the bloodstream and organs. A parasitic infection generally isn’t life-threatening, however, types of Malaria (rarely presents with a rash) can become fatal quickly.

Common parasitic infections include: headlice, bedbugs and cutaneous larva migrans (larvae of members in the hookworm family). Hookworm-related cutaneous lava migrans is the most frequent travel-associated skin disease of tropical origin.

Heat rash (prickly heat)

Heat rash commonly occurs when a traveller transitions from a dry climate to a hot and humid climate, caused predominantly by excessive perspiration (sweating). Visually, it appears as tiny, red bumps surrounded by a red zone of skin, usually in the armpits, groin, back and/or chest (often in areas that are covered by clothing). As its name suggests, the rash often stings or feels ‘prickly’.

Treatment is aimed at cooling the body with frequent cold showers and switching to loose, cotton clothing. Avoid soaps, perfumes or other irritants. If the heat rash doesn’t dissipate within a few days under recommended management, a mild steroid cream can be considered.

Cuts, scratches and grazes

Cuts, scratches and grazes are common in travellers. Where possible, it is advised to treat any minor wounds such as these with good hygiene practices (i.e. cleaning with clean, warm water or sterile saline solution) and covering the area with a clean bandage, preferably non-waterproof.

Most cases do not require further treatment such as antiseptics or antibiotics.

Boils and abscesses

Boils and abscesses are caused by an infection of a hair follicle and the surrounding skin. As a result of the infection, white blood cells rush to the area and form pus under the skin, which becomes a red and inflamed lump (size ranges from pea-sized to golf ball-sized).

Medical advice is likely required, especially if the boil/abscess needs to be incised and drained.

Cellulitis

Cellulitis is a serious bacterial infection, that presents as swollen and red areas of the skin (typically the lower limbs but can occur in other areas) which is very painful and warm to touch. Cellulitis can occur when the skin is broken and the infection spreads to under the skin. It is important to seek medical advice early to prevent the infection from spreading.

Ringworm

Despite its name and common misconception, the ringworm is not a worm, but a contagious fungal infection in the Tinea family, that typically occurs on the trunk of the body, as well as arms, legs, feet, groin or scalp. Ringworm presents as an itchy, scaly spot, with a raised red border that spreads out into a circular shape. Treatment is simple and effective with an anti-fungal cream.

Tinea

Tinea is also a common fungal infection for travelers. Tinea typically affects the feet (between the toes) (also known as ‘athlete’s foot’), and around the groin area (also known as ‘jock itch’). The appearance is usually a red, scaly rash, often can be itchy. Antifungal creams are effective means of treatment.

Skin infections and irritations are common, particularly for those travelling in tropical climates. Skin disease is often rated in the ‘top-five’ causes of non-fatal morbidity worldwide.

Research your area of travel and be vigilant of common skin conditions for that region.  Consider taking a targeted medical and first aid kit, particularly if you intend to stay in a remote location.