Laube Simone, Farrell Anne M
Department of Dermatology, University Hospital of Wales, Cardiff, Wales, UK.
Drugs Aging. 2002;19(5):331-42. doi: 10.2165/00002512-200219050-00002.
Skin and soft tissue infections are quite common in elderly people. A number of special conditions and circumstances need to be considered in the diagnosis and therapy. It is important to try to establish the causative organism, exclude other cutaneous disorders and identify precipitating factors. Treatment modalities include antiseptics, topical and systemic antibacterials, dressings and biotherapy. Skin infections presenting with erythema, blisters, pustules, and ulcerations or in body folds are described in detail. Cellulitis and infected ulcers are the most commonly encountered cutaneous infections in the elderly. Accurate and quick diagnosis and treatment are imperative to prevent significant morbidity and mortality. Appropriate antibacterials, antiseptics and dressings are necessary depending on the severity of the clinical presentation and resistance patterns. Laboratory tests, such as skin swabs, to establish the exact pathogen take time and the results might represent colonisation rather than infection of the skin. Cellulitis should be clinically distinguished from erysipelas and necrotising fasciitis. The latter is a life-threatening condition, which in the majority of cases requires surgical debridement of the infected tissue. Blisters and honey-coloured crusts are typical features of impetigo. It is very contagious and close contacts should be examined. Folliculitis is a commonly seen skin infection, which often responds to the use of antiseptics and topical antibacterials. More severe pustular skin eruptions, such as furunculosis and carbunculosis, usually require treatment with systemic antibacterials. Intertrigo and erythrasma have a predilection for the body folds, especially the axillae and groin, and topical therapy is usually sufficient. Secondary skin infections are often the result of persistent pruritus associated with increasing dryness of the aging skin. Emollients and antihistamines are useful measures. Primary cutaneous disorders and systemic diseases should be excluded with the aid of appropriate investigations, such as blood tests and skin biopsy. Staphylococcus aureus and beta-haemolytic streptococci are the most common causative organisms of cutaneous infections.
皮肤和软组织感染在老年人中相当常见。在诊断和治疗时需要考虑许多特殊情况和情形。努力确定致病微生物、排除其他皮肤疾病并识别诱发因素很重要。治疗方式包括防腐剂、局部和全身用抗菌药物、敷料及生物疗法。详细描述了出现红斑、水疱、脓疱、溃疡或发生于身体褶皱处的皮肤感染。蜂窝织炎和感染性溃疡是老年人最常遇到的皮肤感染。准确、快速的诊断和治疗对于预防严重的发病率和死亡率至关重要。根据临床表现的严重程度和耐药模式，需要使用合适的抗菌药物、防腐剂和敷料。诸如皮肤拭子等实验室检查来确定确切病原体需要时间，而且结果可能代表皮肤定植而非感染。蜂窝织炎应在临床上与丹毒和坏死性筋膜炎相区分。后者是一种危及生命的疾病，在大多数情况下需要对感染组织进行手术清创。水疱和蜜黄色痂皮是脓疱疮的典型特征。它具有很强的传染性，应对密切接触者进行检查。毛囊炎是一种常见的皮肤感染，通常使用防腐剂和局部抗菌药物治疗有效。更严重的脓疱性皮肤疹，如疖病和痈病，通常需要全身用抗菌药物治疗。擦烂和红癣好发于身体褶皱处，尤其是腋窝和腹股沟，局部治疗通常就足够了。继发性皮肤感染往往是与老年皮肤日益干燥相关的持续性瘙痒的结果。润肤剂和抗组胺药是有用的措施。应借助适当的检查，如血液检查和皮肤活检，排除原发性皮肤疾病和全身性疾病。金黄色葡萄球菌和β溶血性链球菌是皮肤感染最常见的致病微生物。
