Pathophysiology
- Bacterial: S. aureus (local pustules/boils) or S. pyogenes (fast-spreading cellulitis)
- Fungal: Dermatophytes digesting keratin (tinea/ringworm) or yeasts like C. albicans in moist environments
- Viral: HSV (herpes) or HPV (warts) invading host cells. May remain latent in nerve ganglia
- Parasitic: Ectoparasites (scabies mites, lice) burrowing under or living on skin
- Inflammatory response produces cardinal signs: pain, heat, redness, swelling
- Uncontrolled local infection can progress to sepsis or toxic shock syndrome
Signs and Symptoms
Hallmark Indicators
- Bacterial: Pustules, honey-colored crusts (impetigo), hot spreading red plaques (cellulitis)
- Fungal: Red scaly rings with central clearing (tinea), white flaky patches (candidiasis)
- Viral: Clustered blisters on red base (herpes), hard rough-surfaced nodules (warts)
- Parasitic: Burrow tracks (reddish/grayish lines), tiny white nits on hair shafts
- Systemic signs: Red streaks (lymphangitis), swollen regional lymph nodes, fever
Red Flags and Rule-Outs
- Red streaks (lymphangitis): Infection has entered the lymphatic system — systemic red flag, immediate referral
- Fever with local skin infection: Systemic involvement requiring medical referral
- Rapidly spreading erythema: Cellulitis — absolute contraindication, urgent referral
- Distinguish pathogen types by morphology: pustules/crusts (bacterial), rings (fungal), vesicles (viral), burrows (parasitic)
MT Considerations
- Cardinal rule: If skin is not entirely intact, hands-on massage is inappropriate for that area
- Local contraindication: Acute local infections (boil, wart) — avoid the site to prevent cross-contamination
- Systemic contraindication: Widespread infection, airborne pathogens, or systemic distress (fever, red streaks, malaise) — reschedule
- IPAC: Wash hands/arms to above elbow before and after every client. Cover own open wounds with finger cots or gloves
- Fomite precaution: Environmental sanitation between clients is vital
- Post-infection: Massage may help remodel scar tissue and restore mobility
- Comorbid caution: Clients with diabetes or HIV are at higher risk for aggressive, slow-resolving infections
CMTO Exam Relevance
- Cardinal rule: if skin is not entirely intact, hands-on massage is inappropriate for that area
- Each pathogen type produces characteristic lesions: bacterial (pustules, honey crusts), fungal (scaly rings), viral (blisters, warts), parasitic (burrows, nits)
- Red streaks (lymphangitis) indicate systemic spread — major red flag
- Fever with a local infection suggests systemic involvement requiring referral
- KOH prep and Wood light fluorescence are diagnostic standards
Key Takeaways
- Skin infections are caused by bacteria, viruses, fungi, or parasites entering through portals in the skin barrier
- The cardinal rule: if skin is not entirely intact, hands-on massage is inappropriate for that area
- Each pathogen type has characteristic lesions enabling recognition
- Red streaks (lymphangitis) indicate systemic spread and are a major red flag
- IPAC protocols (hand washing, covering wounds, linen sanitation) are the primary defense