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What Is a Flesh Eating Bacterial Infection

What Is a Flesh Eating Bacterial Infection?

Media reports have popularized the term flesh-eating bacteria to refer to a type of very rare but serious bacterial infection known as necrotizing fasciitis. Necrotizing fasciitis is an infection that starts in the tissues just below the skin and spreads along the flat layers of tissue (fascia) that separate different layers of soft tissue, such as muscle and fat. This dangerous and potentially deadly infection most commonly occurs in the arms, legs, and abdominal wall and is fatal in 30%-40% of cases.

What causes flesh-eating disease?

Although necrotizing fasciitis may be caused by an infection with one or more than one bacterium, in most cases, the term flesh-eating bacteria has been applied to describe infections caused by the bacterium known as Streptococcus pyogenes. The term flesh-eating has been used because the bacterial infection produces toxins that destroy tissues such as muscles, skin, and fat. Streptococcus pyogenes is a member of the group A streptococci, a group of bacteria that are commonly responsible for mild sore throat (pharyngitis) and skin infections. Rarely, this form of strep bacterium causes severe illnesses such as toxic shock syndrome and necrotizing fasciitis. Most infections with group A streptococci result in mild illness and may not even produce symptoms.

Sometimes, other bacteria, including Klebsiella, Clostridium, E. coli, Staphylococcus aureus, or even a combination of different bacteria may produce necrotizing fasciitis. In 2012, a case was reported of a young woman who suffered a zip-lining accident on a river in West Georgia. She contracted an infection with the bacteria Aeromonas hydrophila, which produced a necrotizing infection that resulted in the loss of a leg and part of her abdomen. Vibrio vulnificus is a type of bacteria found in brackish water that has caused necrotizing fasciitis in swimmers who have been in infected water with open wounds.

What are the early symptoms of flesh-eating disease?

The early stage of necrotizing fasciitis is characterized by symptoms of redness, swelling, and pain in the affected area. Blisters may be seen in the involved area of skin. Fever, nausea, vomiting, and other flu-like symptoms are common. Another characteristic of necrotizing fasciitis is that the symptoms develop very rapidly, usually within 24 hours after a wound in the skin has allowed the bacteria to invade the tissues beneath the skin. The pain is described as being more severe than would be expected from the appearance of the wound. Late symptoms can include death (gangrene) of affected areas with scaling, discoloration, or peeling of the skin. Amputation of affected extremities is sometimes necessary.

Many of the people who have developed necrotizing fasciitis have been in good health before developing the condition. People with chronic medical conditions (for example diabetes and cancer) or who have weakened immune systems are at an increased risk of developing necrotizing fasciitis. Recent wounds (including surgical incisions) and recent viral infections that cause a rash (such as chickenpox) may constitute an increased risk. Nevertheless, healthy people with strong immune systems have a very low risk of developing necrotizing fasciitis if they practice proper hygiene and wound care. Necrotizing fasciitis is not highly contagious and is only rarely spread from person to person. Usually, infection occurs by the bacteria entering the body through open areas on the skin.

Necrotizing fasciitis is treated with antibiotics, and early treatment is critical. Hospitalization, usually with treatment in the intensive-care unit (ICU), is required. Surgery to remove infected fluids and tissue is almost always necessary, along with medications to treat shock and other potential complications.

Good hygiene practices are the best way to prevent a bacterial infection of the skin. Prevention of infection includes avoidance of swimming in pools or open water sources, or soaking in hot tubs, with open wounds or sores. Additionally, keeping open wounds covered with dry bandages until healed, washing hands often, and proper care of wounds and injuries, including scrapes, blisters, and cuts, can prevent necrotizing fasciitis.

SLIDESHOW

The Epidermis

The epidermis is the outermost layer of the three layers of skin. Its thickness depends on where it is located on the body. For example, it's thinnest on the eyelids (half a millimeter). It's thickest on the palms of the hands and soles of the feet (1.5 millimeters).

  • Stratum basale: This bottom layer, which is also known as the basal cell layer, has column-shaped basal cells that divide and push older cells toward the surface of the skin. As the cells move up through the skin, they flatten and eventually die and shed.
  • Stratum spinosum: This layer, which is also known as the squamous cell layer, is the thickest layer of the epidermis. It contains newly formed keratinocytes, which are strengthening proteins. It also contains Langerhans cells that help prevent infection.  
  • Stratum granulosum: This layer contains more keratinocytes moving toward the surface.
  • Stratum lucidum: This layer exists only on the palms of the hands and soles of the feet.
  • Stratum corneum: This is the outermost or top layer of the epidermis. It’s made of dead, flat keratinocytes that shed approximately every two weeks.
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The epidermis contains three specialized cells:

    that produce pigment (melanin) that act as the first line of defense in the skin’s immune system
  • Merkel cells that have a function that is not yet fully understood.  

2. Skin Plays an Important Role in Regulating Your Body Temperature

Not only does your skin play a role in your immune function but it also acts as a personal thermostat through a process known as thermoregulation.

“Sweating is a bodily function that helps regulate your body temperature,” says David Bank, MD, director of the Center for Dermatology, Cosmetic, and Laser Surgery in Mount Kisco, New York. “Normal sweating can be as much as a quart of fluid per day.” In fact, your skin likely has anywhere between two and four million sweat glands, according to the International Hyperhidrosis Society. Sweating isn’t your body’s only way of keeping you cool, though. When you’re especially warm, your skin helps cool you down via vasodilation. Per research, vasodilation occurs when blood vessels just below the surface of the skin dilate, allowing for increased blood flow and heat dissipation.

Conversely, your skin can also help keep you warm when it’s cold outside, via the process of vasoconstriction. Think of it as the opposite process to vasodilation: As temperatures drop, blood vessels in the skin narrow to decrease the amount of heat lost from the body through the surface of the skin, per the same research. Dr. Bank also notes that pores tighten and become smaller when exposed to colder temperatures to aid heat retention. When your skin develops goose bumps, it’s an inherited thermoregulatory response from our furry animal ancestors, according to the Cleveland Clinic. Each bump is attached to one tiny hair, which, when standing on end, helps trap a layer of insulation around the body to keep you warm (though the effect is limited to nonexistent, now that humans no longer have thick fur on their bodies).

So the next time you’re feeling a chill or sweating it out, know that your skin is working to keep your body temperature as comfortable as possible.

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How to Tighten Loose Skin After Losing Weight

Losing weight to manage overweight or obesity can significantly reduce disease risk.

However, major weight loss can sometimes result in loose skin. For some people, this may lead to feelings of self-consciousness and discomfort that may be significant enough to interfere with quality of life.

This article takes a look at what causes loose skin after weight loss. It also provides information on natural and medical solutions that can help tighten and get rid of loose skin.

The skin is the largest organ in your body. It forms a protective barrier against the environment.

The innermost layer of your skin consists of proteins, including collagen and elastin. Collagen, which makes up 80% of your skin’s structure, provides firmness and strength. Elastin provides elasticity and helps your skin stay tight.

During weight gain, skin expands to make room for increased growth. Pregnancy is one example of this expansion.

Skin expansion during pregnancy occurs over a few months’ time. The expanded skin typically retracts within several months of delivery.

By contrast, when skin has been significantly stretched and remains that way for a long period of time, collagen and elastin fibers become damaged. As a result, they lose some of their ability to retract ( 1 ).

Consequently, when you lose a lot of weight, excess skin may hang from the body. In general, the greater the weight loss, the more pronounced the effect of loose skin.

What’s more, researchers report that people who have weight loss surgery form less new collagen, and its composition is not as strong as the collagen in young, healthy skin ( 2 , 3 , 4 ).

Summary

Skin stretched during significant weight gain often loses its ability to retract after weight loss due to damage to collagen, elastin, and other components responsible for elasticity.

Several factors contribute to loose skin following weight loss:

  • Length of time. In general, the longer someone has had overweight or obesity, the looser their skin will be after weight loss due to elastin and collagen loss.
  • Amount of weight lost. Weight loss of 100 pounds (46 kg) or more typically results in a greater amount of loose skin than more moderate weight loss.
  • Age. Older skin has less collagen than younger skin and tends to be looser following weight loss ( 5 ).
  • Genetics. Genes may affect how your skin responds to weight gain and loss.
  • Sun exposure. Chronic sun exposure has been shown to reduce skin’s collagen and elastin production, which may contribute to loose skin ( 6 , 7 ).
  • Smoking. Smoking leads to a reduction in collagen production and damage to existing collagen, resulting in loose, sagging skin ( 8 ).

Summary

Several factors affect loss of skin elasticity during weight changes, including age, genetics, and the length of time someone has carried excess weight.

For some people, loose skin from a lot of weight loss may cause physical and emotional challenges:

  • Physical discomfort. Excess skin may be uncomfortable and possibly interfere with normal activity. One longitudinal study found a possible increase in self-consciousness after weight loss ( 9 ).
  • Decreased physical activity. While one study found that weight loss encouraged more people to exercise, excess skin was found to interfere with exercise in some people after bariatric surgery (10).
  • Skin irritation and breakdown. One study found that of 124 people who requested plastic surgery to tighten skin after weight loss surgery, 44% had reported skin pain, ulcers, or infections due to the loose skin ( 11 ).
  • Poor body image. Loose skin from weight loss may pose negative effects on body image and mood ( 12 , 13 ).

Summary

A number of problems may develop due to loose skin, including physical discomfort, limited mobility, skin breakdown, and poor body image.

The following natural remedies may improve skin strength and elasticity to some degree in people who have lost small to moderate amounts of weight.

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Perform resistance training

Engaging in regular strength training is one of the most effective ways to build muscle mass in both young and older adults ( 14 , 15 ).

While research isn’t currently available, it’s possible that an increase in muscle mass may help improve the appearance of loose skin.

Take collagen

Collagen hydrolysate is very similar to gelatin. It’s a processed form of the collagen found in the connective tissue of animals.

Although it hasn’t been tested in people with loose skin related to major weight loss, studies suggest that collagen hydrolysate may have a protective effect on skin’s collagen ( 16 , 17 ).

In a controlled study, skin elasticity, along with texture and hydration, increased significantly after 12 weeks of taking a liquid collagen supplement. The drink also contained vitamins C and E, as well as biotin and zinc ( 18 ).

Collagen hydrolysate is also known as hydrolyzed collagen. It comes in powdered form and can be purchased at natural food stores or online.

Another popular source of collagen is bone broth, which provides other health benefits as well.

Consume certain nutrients and stay hydrated

Certain nutrients are important for the production of collagen and other components of healthy skin:

  • Protein. Adequate protein is vital for healthy skin. The amino acids lysine and proline play a direct role in collagen production.
  • Vitamin C. Vitamin C is needed for collagen synthesis and also helps protect skin from sun damage ( 19 ).
  • Omega-3 fatty acids. The omega-3 fatty acids found in fatty fish may help increase skin elasticity and have anti-aging effects ( 20 ).
  • Water. Staying well hydrated may improve the skin’s appearance. One study found that women who increased their daily water intake had significant improvements in skin hydration and function ( 21 ).

Use firming creams

Many “firming” creams contain collagen and elastin.

Although these creams may temporarily give a slight boost to skin tightness, collagen and elastin molecules are too large to be absorbed through your skin. In general, collagen must be created from the inside out.

Summary

Some natural remedies may help tighten loose skin after pregnancy or small to moderate weight loss.

Medical or surgical treatments are more invasive options to tighten loose skin after major weight loss.

Body-contouring surgery

People who have lost a significant amount of weight via bariatric surgery or other weight loss methods often request surgery to remove excess skin ( 22 ).

In body-contouring surgery, a surgeon makes a large incision and removes excess skin and fat. They then suture the incision with fine stitches to minimize scarring.

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Specific body-contouring surgeries include:

  • abdominoplasty (tummy tuck): removal of skin from the abdomen
  • lower-body lift: removal of skin from the belly, buttocks, hips, and thighs
  • upper-body lift: removal of skin from the breasts and back
  • medial thigh lift: removal of skin from the inner and outer thighs
  • brachioplasty (arm lift): removal of skin from the upper arms

Multiple surgeries are usually performed on different body parts over the span of 1 to 2 years after major weight loss.

Body-contouring surgeries usually require a hospital stay of 1 to 4 days. Recovery time at home is typically 2 to 4 weeks. There may be also some complications from the surgery, such as bleeding and infections.

Body-contouring surgery may improve quality of life after significant weight loss. However, one study reported that some quality of life scores decreased in people who had the procedure ( 23 , 24 , 25 , 26 ).

Alternative medical procedures

Although body-contouring surgery is by far the most common procedure to remove loose skin, less invasive options with a lower risk of complications include:

  • Radiofrequency treatment. Such treatments may use a combination of infrared light, radiofrequency, and massage to reduce loose skin. While this treatment doesn’t induce weight loss, it may help reduce small areas of fat cells ( 27 ).
  • Ultrasound. A controlled study of ultrasound treatment in people who had bariatric surgery found no objective improvement in loose skin. However, people did report relief of pain and other symptoms following treatment ( 28 ).

It appears that although there are fewer risks with these alternative procedures, the results may not be as dramatic as with body-contouring surgery.

Summary

Body-contouring surgery is the most common and effective procedure to remove loose skin that occurs after major weight loss. Some alternative procedures are also available, but not as effective.

Having excess loose skin is common after losing a lot of weight. You may choose to seek treatment if the loose skin is bothersome.

For small to moderate amounts of weight loss, your skin will likely retract on its own. Natural home remedies may help too.

However, more significant weight loss may need body-contouring surgery or other medical procedures to tighten or get rid of loose skin.

Layers of the Skin

The skin has three layers:

Fat layer (also called the subcutaneous layer)

Each layer performs specific tasks.

Getting Under the Skin

The skin has three layers. Beneath the surface of the skin are nerves, nerve endings, glands, hair follicles, and blood vessels. Sweat is produced by glands in the dermis and reaches the surface of the skin through tiny ducts.

Epidermis

The epidermis is the relatively thin, tough, outer layer of the skin. Most of the cells in the epidermis are keratinocytes. They originate from cells in the deepest layer of the epidermis called the basal layer. New keratinocytes slowly migrate up toward the surface of the epidermis. Once the keratinocytes reach the skin surface, they are gradually shed and are replaced by newer cells pushed up from below.

The outermost portion of the epidermis, known as the stratum corneum, is relatively waterproof and, when undamaged, prevents most bacteria, viruses, and other foreign substances from entering the body. The epidermis (along with other layers of the skin) also protects the internal organs, muscles, nerves, and blood vessels from injury. In certain areas of the body that require greater protection, such as the palms of the hands and the soles of the feet, the stratum corneum is much thicker.

Scattered throughout the basal layer of the epidermis are cells called melanocytes, which produce the pigment melanin, one of the main contributors to skin color. Melanin’s primary function, however, is to filter out ultraviolet radiation from sunlight (see Overview of Sunlight and Skin Damage Overview of Sunlight and Skin Damage Sunlight stimulates vitamin D production, helps control some chronic skin diseases (such as psoriasis), and causes a sense of well-being. However, sunlight can cause skin damage. Damage includes. read more Overview of Sunlight and Skin Damage ), which damages DNA, resulting in numerous harmful effects, including skin cancer Overview of Skin Cancer Skin cancer is the most common type of cancer. Skin cancer is most common among people who work or play sports outside and among sunbathers. Fair-skinned people are particularly susceptible. read more .

The epidermis also contains Langerhans cells, which are part of the skin’s immune system. Although these cells help detect foreign substances and defend the body against infection, they also play a role in the development of skin allergies.

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Dermis

The dermis, the skin’s next layer, is a thick layer of fibrous and elastic tissue (made mostly of collagen, with a small but important component of elastin) that gives the skin its flexibility and strength. The dermis contains nerve endings, sweat glands and oil glands (sebaceous glands), hair follicles, and blood vessels.

The nerve endings sense pain, touch, pressure, and temperature. Some areas of the skin contain more nerve endings than others. For example, the fingertips and toes contain many nerves and are extremely sensitive to touch.

The sweat glands produce sweat in response to heat and stress. Sweat is composed of water, salt, and other chemicals. As sweat evaporates off the skin, it helps cool the body. Specialized sweat glands in the armpits and the genital region (apocrine sweat glands) secrete a thick, oily sweat that produces a characteristic body odor when the sweat is digested by the skin bacteria in those areas.

The sebaceous glands secrete sebum into hair follicles. Sebum is an oil that keeps the skin moist and soft and acts as a barrier against foreign substances.

The hair follicles produce the various types of hair found throughout the body. Hair not only contributes to a person’s appearance but has a number of important physical roles, including regulating body temperature, providing protection from injury, and enhancing sensation. A portion of the follicle also contains stem cells capable of regrowing damaged epidermis.

The blood vessels of the dermis provide nutrients to the skin and help regulate body temperature. Heat makes the blood vessels enlarge (dilate), allowing large amounts of blood to circulate near the skin surface, where the heat can be released. Cold makes the blood vessels narrow (constrict), retaining the body’s heat.

Over different parts of the body, the number of nerve endings, sweat glands and sebaceous glands, hair follicles, and blood vessels varies. The top of the head, for example, has many hair follicles, whereas the soles of the feet have none.

Fat layer

Below the dermis lies a layer of fat that helps insulate the body from heat and cold, provides protective padding, and serves as an energy storage area. The fat is contained in living cells, called fat cells, held together by fibrous tissue. The fat layer varies in thickness, from a fraction of an inch on the eyelids to several inches on the abdomen and buttocks in some people.

The dermis

Examine how a subcutaneous fat layer supplies nutrients to dense connective tissue and epithelial cells

The dermis makes up the bulk of the skin and provides physical protection. It is composed of an association of fibres, mainly collagen, with materials known as glycosaminoglycans, which are capable of holding a large amount of water, thus maintaining the turgidity of the skin. A network of extendable elastic fibres keeps the skin taut and restores it after it has been stretched.

The hair follicles and skin glands are derived from the epidermis but are deeply embedded in the dermis. The dermis is richly supplied with blood vessels, although none penetrates the living epidermis. The epidermis receives materials only by diffusion from below. The dermis also contains nerves and sense organs at various levels.

Skin Exposures and Effects

It is estimated that more than 13 million workers in the United States are potentially exposed to chemicals that can be absorbed through the skin. Dermal exposure to hazardous agents can result in a variety of occupational diseases and disorders, including occupational skin diseases (OSD) and systemic toxicity. Historically, efforts to control workplace exposures to hazardous agents have focused on inhalation rather than skin exposures. As a result, assessment strategies and methods are well developed for evaluating inhalation exposures in the workplace; standardized methods are currently lacking for measuring and assessing skin exposures.

NIOSH has developed a strategy for assigning multiple skin notations (SK) capable of delineating between the systemic, direct and immune-mediated effects caused by dermal contact with chemicals.

Silhouette of person showing area of skin diseases

OSD are the second most common type of occupational disease and can occur in several different forms including:

  • Irritant contact dermatitis,
  • Allergic contact dermatitis,
  • Skin cancers,
  • Skin infections,
  • Skin injuries, and
  • Other miscellaneous skin diseases.

Contact dermatitis is one of the most common types of occupational illness, with estimated annual costs exceeding $1 billion.

Occupations at Risk

Workers at risk of potentially harmful exposures of the skin include, but are not limited to, those working in the following industries and sectors:

  • Food service
  • Cosmetology
  • Health care
  • Agriculture
  • Cleaning
  • Painting
  • Mechanics
  • Printing/lithography
  • Construction

Anatomy and Functions of the Skin

The skin is the body’s largest organ, accounting for more than 10 percent of body mass. The skin provides a number of functions including:

  • protection,
  • water preservation,
  • shock absorption,
  • tactile sensation,
  • calorie reservation,
  • vitamin D synthesis,
  • temperature control, and
  • lubrication and waterproofing.
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Skin Hazards

circular diagram showing mixed exposures: biological, mechanical, physical, chemical

Causes of OSD include chemical agents, mechanical trauma, physical agents, and biological agents.

  • Chemical agents are the main cause of occupational skin diseases and disorders. These agents are divided into two types: primary irritants and sensitizers. Primary or direct irritants act directly on the skin though chemical reactions. Sensitizers may not cause immediate skin reactions, but repeated exposure can result in allergic reactions.
    • A worker’s skin may be exposed to hazardous chemicals through:
      • direct contact with contaminated surfaces,
      • deposition of aerosols,
      • immersion, or
      • splashes.

      Dermal Absorption

      Dermal absorption is the transport of a chemical from the outer surface of the skin both into the skin and into the body. Studies show that absorption of chemicals through the skin can occur without being noticed by the worker, and in some cases, may represent the most significant exposure pathway. Many commonly used chemicals in the workplace could potentially result in systemic toxicity if they penetrate through the skin (i.e. pesticides, organic solvents). These chemicals enter the blood stream and cause health problems away from the site of entry.

      The rate of dermal absorption depends largely on the outer layer of the skin called the stratum corneum (SC). The SC serves an important barrier function by keeping molecules from passing into and out of the skin, thus protecting the lower layers of skin. The extent of absorption is dependent on the following factors:

      • Skin integrity (damaged vs. intact)
      • Location of exposure (thickness and water content of stratum corneum; skin temperature)
      • Physical and chemical properties of the hazardous substance
      • Concentration of a chemical on the skin surface
      • Duration of exposure
      • The surface area of skin exposed to a hazardous substance

      Research has revealed that skin absorption occurs via diffusion, the process whereby molecules spread from areas of high concentration to areas of low concentration. Three mechanisms by which chemicals diffuse into the skin have been proposed:

      1. Intercellular lipid pathway (Figure 1)
      2. Transcellular permeation (Figure 2)
      3. Through the appendages (Figure 3)

      diagram of skin showing Intercellular lipid pathway

      Figure 1: Intercellular lipid pathway

      As shown in Figure 1, the stratum corneum consists of cells known as corneocytes. The spaces between the corneocytes are filled with substances such as fats, oils, or waxes known as lipids. Some chemicals can penetrate through these lipid-filled intercellular spaces through diffusion.

      diagram of skin showing Transcellular permeation

      Figure 2: Transcellular permeation

      As shown in Figure 2, another pathway for chemicals to be absorbed into and through the skin is transcellular, or cell-to-cell, permeation whereby molecules diffuse directly through the corneocytes.

      diagram of skin showing pathway for diffusion of chemicals Through the appendages (hair follicles, glands)

      Figure 3: Through the appendages (hair follicles, glands)

      As shown in Figure 3, the third pathway for diffusion of chemicals into and through the skin is skin appendages (i.e., hair follicles and glands). This pathway is usually insignificant because the surface area of the appendages is very small compared to the total skin area. However, very slowly permeating chemicals may employ this pathway during the initial stage of absorption.

      Contact Dermatitis

      Contact dermatitis, also called eczema, is defined as an inflammation of the skin resulting from exposure to a hazardous agent. It is the most common form of reported OSD, and represents an overwhelming burden for workers in developed nations. Epidemiological data indicate that contact dermatitis constitutes approximately 90-95% of all cases of OSD in the United States. Common symptoms of dermatitis include:

      Can The Flash Regenerate?

      Ordinarily The Flash does not visit the hospital, as his body heals faster than a normal human’s. Generally, his white blood cells and regeneration go to work immediately following any injury, allowing him to recover from near-fatal wounds in almost no time at all. Bart Allen even had his knee cap blown off and was in well enough shape to run himself out of the emergency room shortly after.

      There can be a downside to this, as the healing process can happen so fast that bones will grow back improperly. The Flash even broke a bone all over again just to reset it, which is a major inconvenience in the midst of battle. Still, it’s certainly better than the alternative, and The Flash isn’t going to give up a handy healing factor just because it causes some unpleasantness every so often.

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