What is the progression of necrotizing fasciitis?

Updated: Sep 02, 2020
  • Author: Steven A Schulz, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Physical findings may not be commensurate with the degree of patient discomfort. Early in the disease course, the patient may look deceptively well; unfortunately, this may interfere with early detection, which is key to a favorable outcome. Soon, however, the patient will usually begin to appear moderately to severely toxic.

Typically, the infection begins with an area of erythema that quickly spreads over a course of hours to days. The redness quickly spreads, and its margins move out into normal skin without being raised or sharply demarcated. As the infection progresses, the skin near the site of insult develops a dusky or purplish discoloration. Multiple identical patches expand to produce a large area of gangrenous skin, as the erythema continues to spread.

Iwata et al reported that 2 of 3 patients who lacked inflammatory signs such as redness and heat experienced fulminant progression of necrotizing fasciitis and death. [59]

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