Necrotizing fasciitis: New insights with a focus on dermatological aspects

Abstract

Necrotizing fasciitis is a destructive and quickly progressing bacterial infection of the subcutaneous layer and superficial fascia. It is associated with high levels of unhealthiness and mortality if not treated early. Recently, countless published cases demonstrated an increasing frequency and severity of these infections, especially those caused by Group A Streptococcus (GAS), which afflicts even young and healthy persons. It is classified as type I when caused by a mixed anaerobic flora and other bacteria, and type II when caused by GAS alone or in association with Staphylococcus aureus. Predisposing factors include: chronic and malignant diseases, alcohol abuse, intravenous drug use, skin lesions such as chicken pox, chronic ulcers, psoriasis, surgery, and opened or closed traumas, among others. Clinical features are intense pain, severe edema, fast progress and poor antibiotic therapy feedback. A high level of suspicion is necessary to achieve a clinical diagnosis for this disease. Moreover, it is confirmed primarily when surgery takes place and reveals the superficial fascia necrosis. Radiological examinations are useful and the differential diagnosis must be done mainly with cellulitis at its initial stage. Treatment must be done early and with broad spectrum antibiotics, aggressive surgical debridement and clinical and nutritional support measures.