The presence and growth of microorganisms that produce tissue damage to the epidermis, dermis, or both of these divisions of the skin. In these cases, the invading organisms may be bacterial, fungal, viral, treponemal, or parasitic.

Any disruption to the basic protective function of the skin can leave the structure vulnerable to invasion by pathogens. Sources of disruption include: injury; trauma, such as burns; disease processes; surgical procedures; and exposure to environmental elements, chemicals, contaminants, and medications. When there is interference with this protective barrier, organisms such as bacteria, fungi, and viruses can become the starting point for the development of secondary infections. For example, viruses can enhance bacterial invasion by damaging the respiratory tract mucosa.

• The most common bacterias causing skin infection are Staphylococcus and Streptococcus. Boils, carbuncles, abscesses, folliculitis (see Analogous Diagnostic Code: 7899-7806 Folliculitis), cellulitis, erythrasma, gangrene of the skin, and staphylococcus scalded skin syndrome are some infectious conditions resulting from bacteria.

• Fungal infections include yeasts, molds, and mushrooms. Fungi generally affect the topmost layer of the skin, and skin surfaces that come together, such as the toes, groin, and under the breasts. The feet, nails, scalp, beard (see Diagnostic Code: 7813 dermatophytosis), and body trunk are other common areas affected by fungi. Fungi can cause allergic reactions on other uninfected parts of the body. In a person with a compromised immune system, such as in AIDS or immunosuppressive drug therapy, fungi are a source of opportunistic infections that can cause death. Ringworm (see Diagnostic Code: 7813 dermatophytosis), sporotrichosis, and tinea versicolor are examples of fungi.

• Many types of viruses can cause infections. The most prevalent viruses of concern include papillomavirus, cold sores caused by the herpes simplex and herpes zoster virus, and poxviruses, such as smallpox, chickenpox, and molluscum contagiosum.

• Infections of the skin by parasites, either temporary or permanent are caused by tiny insects or worms burrowing into the skin through the soles of the feet or from infected water while a person is swimming. Scabies, lice infestation, and hookworm are such parasitic conditions.

• Treponema is one of four main strains of spirochetes, a corkscrew-shaped bacteria. This spirochete bacteria causes nonvenereal infections such as endemic syphilis, yaws, and pinta. It is indistinguishable from the bacteria responsible for syphilis (Treponema pallidum).

Signs and symptoms of skin infections may vary depending on the causative organisms.

• Bacterial skin manifestations may include swelling, redness, tenderness, shininess, fluid-filled blisters, sloughing, scar formation, separation of the epidermal layer from the rest of the skin, and enlarged tender lymph nodes.

• Fungus infections may cause no symptoms or mild symptoms. When symptoms occur they may manifest on the skin as a red irritated rash, and scaling that can be severe. Other symptoms include itching, swelling, and blisters.

• Viral skin manifestations may present as tingling, itching, wart-like, small, painful, fluid-filled blisters; smooth waxy bumps; inflammatory signs; sensitivity to touch; and pain caused by affected nerve roots.

• Parasitic symptoms may manifest with an itchy, flat, raised rash, or swelling of upper eyelids depending on the particular parasitic organism.

• Treponemal skin manifestations include blisters, slimy patches on the inside cheek of the mouth, gummy lumps on the nose and soft palate, raised sores followed by granulomas, and pain.

Determining the organism causing infection may require laboratory studies to include blood, urine, and stool samples; biopsy of fluid from infected areas; and culture and microscopic examination.

Treatments may be directed toward eliminating the specific organism causing infection and toward relieving overt symptoms.

• Bacterial skin infections may be treated with antibiotic therapy, warm soaks, draining of abscesses, skin debridement, surgery, and hyperbaric oxygen therapy (HBO) in cases of extensive gangrene.

• Fungus of the skin may require antifungal creams or oral antifungal medications.

• Treatment of viruses can include immunoglobulin, antiviral drugs and creams, topical antibiotic ointment for prevention of secondary bacterial infection, meticulous cleansing and drying of infected areas, and pain medications.

• Treponemal infections warrant administration of penicillin.

Immunosuppressed individuals and those who have poor circulation are most at risk for developing skin infections. Gangrene can progress rapidly and destroy large amounts of skin and muscle. Some bacterial infections can lead to kidney failure, toxic shock syndrome, or spread to the brain. Recurring bacterial infections may require long-term antibiotic therapy. Virus and treponemal lesions can cause extensive disfiguring scars.

If the Veteran has a diagnosis of pinta, consider service connection on a presumptive basis as a tropical disease (38 CFR §3.307; §3.308; §3.309(b)). 

• 38 CFR 4.118 (a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.  

• 38 CFR 4.118 (b) Two or more skin conditions may be combined in accordance with 38 CFR 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.