What are the causes of recurrent skin infections?

From the Guidelines

Recurrent skin infections are most commonly caused by bacteria such as Staphylococcus aureus and Streptococcus, and prevention of recurrence involves maintaining good hygiene, promptly treating skin injuries, managing underlying conditions, and completing full courses of prescribed antibiotics. The causes of recurrent skin infections can be multifactorial, including breaks in the skin barrier from conditions like eczema, psoriasis, or minor trauma, as well as poor hygiene, compromised immune function, and close contact in settings like gyms or dormitories 1, 2. Fungal organisms like dermatophytes and Candida can also cause persistent infections, particularly in warm, moist areas of the body. Underlying medical conditions that impair circulation or immune response, such as diabetes or immunosuppressive medications, make individuals more susceptible to repeated infections.

Some key factors to consider in the management of recurrent skin infections include:

• Local causes such as pilonidal cyst, hidradenitis suppurativa, or foreign material, which should be addressed to prevent further recurrences 1
• The importance of incision and drainage for recurrent abscesses, as well as the potential benefits of adjunctive antimicrobial therapy in preventing recurrences 1, 3
• The use of decolonization regimens, such as intranasal mupirocin and daily chlorhexidine washes, to reduce the rate of further infections, although the efficacy of these regimens in the current era of community-acquired MRSA is unclear 1, 4
• The potential role of genetic factors, such as natural deficiencies in antimicrobial peptides, in contributing to recurrent skin infections 2

In terms of specific management strategies, the use of a 5- to 10-day course of an antibiotic active against the pathogen isolated, as well as consideration of a 5-day decolonization regimen, may be effective in preventing recurrences. Additionally, maintaining good hygiene, promptly treating skin injuries, and managing underlying conditions are essential strategies for preventing recurrence 1, 3, 4.

It is also important to note that:

• Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood 1
• The use of systemic corticosteroids as an optional adjunct for treatment of uncomplicated cellulitis and erysipelas in selected adult patients may be considered, although further studies are warranted 5
• Elevation of the affected area and appropriate therapy for any underlying condition that may have predisposed to the infection are also important aspects of treatment 5

From the FDA Drug Label

Skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes Serious skin and soft tissue infections; Skin and soft tissue infections.

The causes of recurrent skin infections include:

• Staphylococcus aureus
• Streptococcus pyogenes These bacteria can cause skin and skin structure infections and serious skin and soft tissue infections 6, 7.

From the Research

Causes of Recurrent Skin Infections

Recurrent skin infections can be caused by various factors, including:

• Local and systemic conditions that favor the growth of bacteria, such as obesity, diabetes, cancer, and immunosuppressive disease 8
• Bacterial pathogens, including:
  • Streptococcus spp. and Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus, MRSA) 8, 9, 10, 11
  • Gram-negative bacteria and polymicrobial infections 8, 9
• Underlying predisposing factors, such as:
  • Comorbidities that increase the risk of skin infections 8
  • Poor wound care and inadequate antibiotic therapy 8, 12, 10
• Failure to prevent recurrences, including:
  • Inadequate treatment of underlying conditions 8
  • Incomplete source control and inadequate antibiotic prophylaxis 8

Risk Factors for Recurrent Skin Infections

Several risk factors can increase the likelihood of developing recurrent skin infections, including:

• History of previous skin infections 9
• Presence of comorbidities, such as diabetes, obesity, and immunosuppressive disease 8
• Poor wound care and inadequate antibiotic therapy 12, 10
• Exposure to bacterial pathogens, such as Staphylococcus aureus and Streptococcus pyogenes 9, 11

Prevention and Management of Recurrent Skin Infections

Prevention and management of recurrent skin infections require a comprehensive approach, including:

• Treatment of underlying predisposing factors 8
• Complete source control and appropriate antibiotic therapy 8
• Antibiotic prophylaxis for recurrent erysipelas and decolonization for MRSA carriers 8
• Use of topical antibiotics to avoid systemic allergic reactions and provide high antibiotic concentrations at the site of infection 12
• Patient-tailored approach to management, including risk stratification and targeted prophylaxis and decolonization strategies 8