THE CLINICAL FACTORS OF EVOLUTION AND PROGNOSIS IN CUTANEOUS SEPSIS: DERMATOLOGIST’S PERSPECTIVE IN SEVEN BASIC STEPS
Abstract
Disturbances of the skin microbiome characterize a variety of infectious and inflammatory dermatoses with important impact on the quality of life. Most of these have presents a skin manifestation one or more lesions with loss of tissue, which are infected with microorganism. Increased mortality because of sepsis and increased incidence of organ dysfunction are a global health problem. Pathophysiological mechanism from skin infection to sepsis evolves rapidly, by triggering a complex cascade involving inflammatory and coagulation processes. Materials and methods: Clinical factors of evolution and prognosis, together with skin changes, are essential elements in the management of cutaneous sepsis. This retrospective observational study aims to assess clinical risk factors in cutaneous sepsis and their involvement in the evolution and prognosis of this disease. A total of 441 medical documents of patients with skin lesions with loss of tissue, in various stages of evolution, admitted to dermatology over a period of 3 years were analyzed. Out of the 441 infectious dermatoses, 363 had a favorable evolution, without septic complications and 78 presented sepsis. The most frequent skin infections were: venous ulcers, microbial eczema, cellulitis, superinfected bullous dermatoses (pemphigus, bullous pemphigoid, dermatitis herpetiformis), erysipelas, erythroderma. Results: Skin semiology was correlated with risk factors such as smoking, obesity, using invasive devices and with comorbidities - cardiovascular, metabolic and neuropsychiatric. This way it was described the correlation between skin-sepsis in seven basic steps. Conclusions: The study illustrates the importance of skin manifestations, which although they are initially not important, should not be neglected, as they can become bacterially infected and progress to severe infections, even sepsis, with a fatal prognosis. At the same time, this study encourages further research for a prompt and appropriate approach of cutaneous sepsis.
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