Skin Infection Treatment in Ankara, Turkey

Skin infection treatment is planned according to the type of infection, the causative microorganism, and the patient’s general health condition. The aim is to control the infection, prevent its spread, and restore skin integrity. Treatment is supported with topical or systemic medications.

In bacterial skin infections, antibiotic treatment is applied according to the sensitivity of the causative agent. While topical mupirocin or fusidic acid is sufficient in mild cases, systemic antibiotics are preferred in widespread infections. The treatment duration is determined according to the clinical response.

Antifungal agents are used in fungal skin infections. Medications such as terbinafine, clotrimazole, or fluconazole provide effective results in both topical and oral forms. During treatment, avoiding humid environments and maintaining hygiene are important in terms of infection control.

Viral skin infections tend to heal with the support of the immune system; however, antiviral drugs are used in conditions such as herpes simplex. Vaccinations, protective measures, and early diagnosis play a key role in preventing recurrence of the infection.

Things You Should Know	Information
Treatment Area	Dermatology – Skin infection treatment
Targeted Problem	Bacterial, viral, fungal, or parasitic skin infections
Common Infection Types	Impetigo, cellulitis, furuncle (abscess), cold sore (herpes), wart (HPV), athlete’s foot, jock itch, scabies
Diagnostic Methods	Clinical examination, skin scraping, culture tests, dermatoscopy
Methods Used	Topical and systemic drug treatment, antiseptic applications, hygiene measures, supportive care
Bacterial Infections	Usually treated with antibiotic cream or oral antibiotics
Viral Infections	Controlled with antiviral creams and medications (for example cold sore and wart treatments)
Fungal Infections	Antifungal creams and oral antifungal medications are used
Parasitic Infections	In conditions such as scabies, special topical medications and, if necessary, systemic treatment are applied
Antiseptic Applications	Cleaning and disinfecting the infected area helps prevent the spread of the infection
Hygiene Measures	Personal hygiene, avoiding sharing towels and clothing, covering the infected area
Treatment Duration	Varies according to the type and severity of the infection; it may last from a few days to a few weeks
Suitable Patient Profile	It can be seen in all age groups; more careful treatment is required in individuals with weakened immunity
Complications	If left untreated, there is a risk of spread, inflammation, scarring, or progression to systemic infection
Follow-up and Control	Regular follow-up is recommended during treatment; it should be ensured that the infection has completely healed

What Is a Skin Infection?

A skin infection is a group of diseases in which microorganisms (bacteria, viruses, fungi, or parasites) settle on the skin surface or in the lower layers and cause inflammation. Symptoms such as redness, swelling, pain, itching, and discharge may be seen in the infected area. Treatment is planned with antibiotics, antifungal, or antiviral medications according to the type of infection. Paying attention to hygiene rules is effective in reducing the risk of transmission and spread.

What causes skin infections and why are they so common?

Skin and soft tissue infections are a condition we frequently encounter in dermatology practice. While planning treatment, we decide by looking at what caused the infection, the patient’s general health condition, and most importantly, the bacterial resistance in the region where you live.

The organisms that cause these infections are very diverse. Bacteria lead the way; especially Staphylococcus aureus (including a resistant type called MRSA) and Streptococcus pyogenes (Streptococcus) are the ones we see most often.

Fungal infections are also quite common. They like hot and humid environments. Tinea (foot, groin, body fungus) and Candidiasis (yeast infection) fall into this group. Viruses also target the skin. The best known are Herpes Simplex (Cold Sore), Varicella-Zoster (Chickenpox and Shingles), Condyloma (Genital Wart), and Molluscum Contagiosum.

In recent years, we have seen an increase in the frequency of these infections. There are several main reasons for this. The population is aging, more patients are being treated in intensive care units, and most importantly, the number of patients with suppressed immune systems (for example due to HIV, cancer treatment, or organ transplantation) is increasing. In addition, the fact that some bacteria no longer respond to standard antibiotics (multidrug resistance) is another important factor that makes our work more difficult.

How can it be understood whether a skin infection is serious?

We divide skin infections into simple (uncomplicated) or complex (complicated). However, what is really important is to rapidly evaluate how far and how deeply the infection has spread.

Infections causing tissue death, such as Necrotizing Fasciitis (NF), are the most serious conditions requiring urgent and rapid intervention. This condition, also known among the public as “flesh-eating bacteria,” is generally a surgical emergency.

There are different types of this serious condition:

• Type I (The most common one, generally caused by mixed bacterial types after surgeries or injuries)
• Type III (Generally develops after contact with seawater or seafood)
• Type IV (Occurs after trauma and is caused by fungi)

If you have rapidly spreading redness on your skin and severe, disproportionate pain, especially if you have cut or injured yourself in the sea, this condition should be suspected. This picture requires rapid diagnosis and immediate surgical intervention.

What technologies do dermatologists use to see the depth of a skin infection?

In skin infections, diagnosis usually begins with a clinical examination. Sometimes a biopsy (taking a small tissue sample) may be necessary to be sure. However, today, we can obtain very detailed information with non-invasive methods, that is, without making any incision in the skin.

One of our most valuable tools in this field is High-Frequency Ultrasound (HFUS). You can think of this method as a “skin sonar.” It clearly shows us just beneath the skin surface, the depths of the epidermis and dermis.

With this method, we can clearly see:

• How deeply the infection has gone.
• Whether the condition is “cellulitis” (a widespread inflammation) or an “abscess” (a sac filled with pus).
• If there is an abscess, whether emptying this sac with a needle (aspiration) will be sufficient.
• Whether a more extensive surgical incision is necessary.

Obtaining this information without cutting the skin directly shapes our treatment plan and prevents you from unnecessarily going under the knife.

How is the microbe causing a skin infection definitively diagnosed?

Sometimes it can be difficult to understand what is causing an infection, or the microbe may not grow in culture. In such cases, molecular techniques come into play.

The PCR (Polymerase Chain Reaction) test is one of the leading methods. You can think of this test as a very sensitive detector that searches for the microbe’s DNA or RNA. It is used to detect the tuberculosis bacillus or some viruses (such as Epstein-Barr) in skin infections.

These methods are especially very valuable in mycology. For example, in cases of ringworm (tinea capitis), knowing the exact type of fungus helps us determine which medicine will be the most effective. These modern methods are much faster and more definite than old-style microscope or culture methods.

If I cannot immediately reach a specialist dermatologist, can I still get a diagnosis of a skin infection?

Yes, at this point Teledermatology (Remote Dermatology) comes into play. This system allows you to send your medical information related to skin problems to a specialist through telecommunication technologies.

The most commonly used method is the “Store-and-Forward” system. In this method, high-resolution photographs of the problem on your skin (for example, taken with a dermoscope) and your medical history are sent digitally to a specialist. The specialist reviews this information at a convenient time and returns to you with a diagnosis or advice. You do not need to be online at the same time.

Alternatively, the “Live Interactive” method allows you to speak with the doctor live through a video conference.

Teledermatology is a technology that greatly facilitates access to specialist opinion, especially for patients living in areas where specialist dermatologists are scarce or who cannot come to an appointment because of work.

How is impetigo (contagious skin infection) treated?

The treatment of superficial and small bacterial skin infections such as impetigo is generally local and short.

Antibiotic creams such as Mupirocin 2% ointment or Retapamulin are generally used by applying them twice a day for 5 days. This is sufficient for most simple cases.

However, in some cases oral (systemic) antibiotics may be required:

• If the lesions have spread over a very large area.
• If it has turned into a deeper form called “ecthyma.”
• If there is an outbreak (for example in schools) and we suspect that this outbreak is caused by a bacterium affecting the kidneys (a nephritogenic strain).

If oral treatment is required, a 7-day course of an antibiotic effective against “Staph” (S. aureus) bacteria (for example Cephalexin) is generally preferred.

What is the most effective treatment for abscesses and boils?

The treatment applied for purulent skin infections, that is, abscesses, carbuncles (the merging of several boils), and large boils, is drainage and antibiotic therapy. In some cases, intralesional injection may also be applied.

Think of an abscess as a water balloon filled with dirty water. No matter how much medication you give from the outside (whether cream or pill), it will not heal unless you burst that balloon and completely empty it. The source (the pus) must be controlled.

How is treatment planned if the skin infection is widespread (Cellulitis) or if MRSA is suspected?

Unlike an abscess, cellulitis is generally a widespread inflammation of the skin and subcutaneous tissue without pus accumulation inside. The skin is red, warm, swollen, and painful.

Treatment depends on the severity of the condition. Mild cases can be treated as an outpatient, that is, with pills to be used at home.

However, in the following situations, inpatient hospital treatment (and intravenous IV treatment) may be required:

• If there is a high fever, chills, or a feeling of being very ill.
• If mental clouding or confusion has begun.
• If there is suspicion that the infection is turning into the “flesh-eating bacteria” type (Necrotizing Fasciitis).
• If the patient’s immune system is very weak (for example, if they are receiving chemotherapy).
• If outpatient oral treatment has failed.

MRSA Treatment:

If cellulitis develops after a penetrating injury (especially with a history of intravenous substance use) or if there is purulent discharge from the area, we suspect MRSA. MRSA is a “Staph” bacterium resistant to most standard antibiotics.

Interestingly, normal cellulitis is usually caused by ‘Strep’ (Streptococcus), but if there is also MRSA risk, we need to target both at once. In this case, one medication for MRSA (for example Doxycycline or SMX-TMP) AND another medication for Strep (for example Amoxicillin or Cephalexin) may be given at the same time.

What is the most common mistake in the treatment of foot, groin, and body fungus?

The most common and most serious mistake we encounter in the treatment of superficial fungal infections (athlete’s foot, jock itch, etc.) is the use of combination creams.

These creams contain both an antifungal (fungus medicine) and a topical steroid (cortisone):

Why is this a mistake? The steroid (cortisone) is a very powerful inflammation suppressor and quickly stops the itching. Since the itching goes away, the patient thinks they are “healed.” However, cortisone also suppresses the local immune response in the area. This causes the fungus to hide from the immune system and spread even more strongly. The itching goes away temporarily, but the fungal infection becomes chronic and deepens in the background (“the condition we call Tinea Incognito”).

Moreover, this misuse is one of the main reasons for the emergence of new treatment-resistant fungal species worldwide (for example Trichophyton indotineae).

So what is the correct approach?

To treat the infection, only a cream containing an antifungal (fungus medicine) should be used.

If the itching is unbearable, a low-potency steroid cream in a separate tube may be prescribed. This cortisone cream is used only for a few days (until the itching decreases) and is stopped immediately.

The antifungal cream, however, should be continued for some more time (generally a total of 4 weeks) even after all symptoms have disappeared.

Why can oral medications for nail fungus be dangerous?

In conditions such as nail fungus (Onychomycosis) or very widespread body fungus, creams are insufficient and oral (systemic) antifungal medications must be used.

However, these medications can place a serious burden on the liver and may enter into dangerous drug-drug interactions (DDI) with other medications.

Think of these medications as a “highway” and your liver as a “traffic control center.” If you are also using other medications on this highway at the same time (for example cholesterol medications, blood thinners, or some blood pressure drugs), traffic in the liver may become blocked. This may cause the blood levels of some drugs to rise to dangerous levels or become ineffective.

Especially when drugs in the Itraconazole group are used together with some heart rhythm medications or the blood thinner Warfarin, life-threatening consequences may occur.

Therefore, before starting these treatments, the following are mandatory:

• Current liver function tests (blood test).
• A detailed list and review of all other medications the patient uses (and even herbal supplements).
• In some cases, an electrocardiogram (ECG).

Which methods are used in the treatment of scabies and lice?

Scabies and lice, which are parasitic skin infestations, are generally treated with topical agents.

• Scabies Treatment:

Permethrin 5% Cream: This is the most commonly used and most effective method. The cream is applied to the entire body (from below the chin), including between the fingers and under the nails. It is left on for 8-12 hours (generally applied at night) and then washed off. This process is repeated 7-14 days later.

• Benzyl Benzoate (10–25 Lotion): This is an alternative lotion.

Ivermectin (Oral Pill): Used in severe, crusted (Norwegian scabies) or resistant cases that do not respond to cream treatments. Two doses are taken 7 days apart.

• Lice (Pediculosis) Treatment:

Permethrin 1% Lotion/Shampoo: This is the first choice. It is applied and repeated 7-10 days later (for new lice that will hatch from eggs).

How are cold sore and shingles (Herpes) infections treated?

Our main treatment for both cold sores/genital herpes (Herpes Simplex – HSV) and the viruses that cause shingles and chickenpox (Varicella-Zoster – VZV) is Acyclovir and its newer derivatives (Valacyclovir, Famciclovir).

Treatment varies according to the condition:

Shingles (Herpes Zoster): Starting treatment within the first 72 hours is critical in order to prevent the spread of the rash and, most importantly, “post-shingles pain” (PHN). High-dose oral Acyclovir (for example 800 mg 5 times a day) or Valacyclovir/Famciclovir is used.

Chickenpox (Varicella): Since it is more severe in adolescents and adults, Acyclovir treatment is recommended.

Complicated Cases: If the patient’s immune system is very weak (for example HIV, chemotherapy) or if the infection involves the eye or internal organs, treatment is started in the hospital with intravenous (IV) Acyclovir. When the condition is brought under control, treatment is completed by switching to oral pills.

An important warning: The live chickenpox vaccine (Varivax™) should not be administered to people whose immune systems are severely suppressed (especially HIV patients with a CD4 count < 200).

If Acyclovir (cold sore/shingles medication) does not work, which treatment is applied?

Failure of Acyclovir treatment means that the virus has developed resistance to Acyclovir. This is especially seen in patients whose immunity has long been suppressed (for example organ transplant or HIV patients).

In this case, the recommended treatment is intravenous (IV) Foscarnet.

Why is Foscarnet effective?

For Acyclovir to work, it needs an “ignition key” inside the virus (the thymidine kinase enzyme). Resistant viruses break this ignition key. Foscarnet, however, does not need the “ignition key”; by directly blocking the virus’s replication mechanism (DNA polymerase), it stops the engine, so to speak, with a “direct start.”

However, Foscarnet has serious risks:

This drug can be very toxic to the kidneys and may cause seizures by leading to mineral imbalances in the blood (especially calcium and magnesium). Therefore, Foscarnet treatment is applied only in the hospital setting, with close kidney function monitoring, intensive fluid support, and consultation from infectious disease specialists.

What can be done for persistent nerve pain (PHN) after shingles?

Burning, stabbing, and severe nerve pain that continues even weeks or months after the shingles (Herpes Zoster) rash has healed is called Post-Herpetic Neuralgia (PHN). This is the most feared complication of shingles.

Prevention Comes First: Getting the shingles vaccine (RZV) and starting antiviral treatment (Acyclovir, etc.) within the first 72 hours when shingles occurs reduces the risk of PHN.

If the pain has already become established, treatment is no longer with antiviral medications but with medications aimed at calming the damaged nerves.

If the pain is established, the goal is to calm the nerves:

• Lidocaine (pain-relieving) patches: Applied directly to the painful area.
• Capsaicin (obtained from hot pepper) creams: Desensitize the nerve endings (may burn a lot at first).
• Tricyclic antidepressants: Drugs such as Amitriptyline or Desipramine are used in this condition not for their antidepressant effects, but for their ability to treat chronic nerve pain at very low doses.
• Anticonvulsants: Medications such as Gabapentin, Pregabalin, or Phenytoin (generally known as “epilepsy/seizure medications”) are very effective in blocking abnormal nerve signals and are among the cornerstones of PHN treatment.

How does freezing (Cryosurgery) treatment work for viral skin infections such as warts and molluscum?

One of the procedures we most frequently resort to for benign viral lesions such as warts and molluscum is Cryosurgery, that is, freezing treatment.

In this procedure, liquid nitrogen (-196°C) is generally used with the help of a spray or cotton swab. This extreme cold freezes the target tissue (the wart) within seconds.

Liquid nitrogen damages the tissue in two ways:

• By freezing the small blood vessels feeding the lesion (ischemia or cutting off the blood supply).
• By forming ice crystals inside the cells and breaking apart the cell membranes during thawing (direct cellular damage).
• After the procedure, the area first blisters (bulla), then crusts, and falls off together with the wart tissue within 1-2 weeks.

This method is a treatment option that is rapid, effective, does not require anesthesia, leaves minimal scarring, and can be used safely in a very wide patient group, including pregnant women, breastfeeding women, and children.

Why is cleaning dead tissue (debridement) in infected wounds important?

In complex or deep skin infections, especially in wound beds, the accumulation of dead (necrotic) or non-viable tissues prevents healing. Dead tissue serves as a perfect “food source” for bacteria and prevents the formation of new healthy tissue.

This process of cleaning dead tissue is called Debridement. This is the cornerstone of wound management.

There are different methods to clean the wound bed:

• Surgical Debridement: This is the fastest method. It is the rapid cleaning of dead tissue with sharp tools such as a scalpel or scissors.
• Enzymatic Debridement: This is the use of medical creams containing special enzymes (for example collagenase) that selectively “dissolve” dead tissue.
• Biological Debridement (Larval Therapy): This is the placement of sterile maggots (larvae) produced for medical purposes on the wound. These larvae eat only dead and infected tissue, do not touch healthy tissue, and secrete chemicals that accelerate healing.
• Autolytic Debridement: This is the slowest method. It involves covering the wound with special occlusive dressings and waiting for the body’s own enzymes to dissolve the dead tissue.

Why might it be necessary to use antibiotics during a dermatological procedure (mole removal, etc.)?

Infection rates after dermatological surgery (mole removal, cyst excision, Mohs surgery) are generally very low. We do not routinely use antibiotics.

However, in specific high-risk systemic conditions, it is mandatory to use protective (prophylactic) antibiotics before or during the procedure.

The aim here is not to protect the wound on the skin, but to protect a sensitive area elsewhere in the body. It is inevitable that a small amount of bacteria enters the blood during the procedure (transient bacteremia).

The entry of bacteria into the blood during a skin procedure is dangerous for some patients. In the following situations, protective antibiotics are mandatory:

Those with heart valve disease or a prosthetic heart valve (risk of infective endocarditis).

Those with a prosthetic joint in the body (hip, knee prosthesis) (risk of prosthetic joint infection).

In other words, we give the antibiotic not to prevent infection in the skin, but to protect your heart or your joint.

What should be considered at home during skin infection treatment and when should a doctor be consulted again?

The success of the treatment depends as much on the care you provide at home as on the procedures.

Basic instructions for home care:

• The infected area (if it is on the arm or leg) should be kept above heart level as much as possible to reduce swelling (edema).
• The area should be kept clean and dry as recommended by your doctor.

It is also very important that you know the alarm signs that we call “red flags.”

You should contact your doctor immediately in the following situations:

• If there is no sign of improvement despite 72 hours (3 days) having passed after starting treatment (antibiotic or drainage).
• If the redness, swelling, or pain is increasing or spreading instead of decreasing.
• If fever or chills begin.
• If bruising or blackening begins in the area (this may be a sign of tissue death).

In addition, patients who use strong biological medications that regulate the immune system for conditions such as psoriasis or atopic dermatitis (eczema) need to be extra careful regarding infections. Before starting these treatments, it is mandatory to screen for latent tuberculosis and to be cautious about the risk of shingles (VZV).