Necrotizing Fasciitis

Jennifer T. Trent, MD, Robert S. Kirsner, MD


Wounds. 2002;14(8) 

In This Article

Risk Factors

While NF is rare, there are many underlying conditions that can predispose patients to develop NF ( Table 1 ).[1,2,3,6,7,9,10,11,12,13,14,15,16,17,18,19] Importantly, immunosuppression caused by a variety of conditions, such as diabetes mellitus, C4 deficiency, AIDS, and malignancy, are predisposing factors. Additionally, certain medications that can induce immunosuppression have been implicated in the development of NF. Newer medications have been added to the growing list of known immunosuppressive medications. Infliximab, an inhibitor of tumor necrosis factor-alpha (TNF ), has been linked to an increase in infections due to its effects on lymphocytes and cytokines and has also been associated with one case of NF.[19] FK506, a macrolide immunosuppressant used primarily in post transplantation, has also been linked to an increase in infections due to its immunosuppressive qualities, as well as a case of NF.[17]

The portal of entry for bacteria causing NF is varied. Simply put, the entrance of bacteria can occur from any break in the skin, even in patients with pre-existing skin conditions, such as psoriasis, pressure ulcers, or perirectal abscesses.[1] Any condition in which the integrity of the integument is compromised can permit the entrance of bacteria and subsequent development of NF.

Often, NF may occur as a result of trauma (including burns and lacerations), post-surgical wounds, or needle sticks often from intravenous drug abusers (IVDA).[18] NF arising in IVDA often presents with an abscess of the arm, while commonly other portals of entry more often present on the lower extremities and buttocks.

Children, who possess similar risk factors for NF as adults, such as diabetes mellitus, post-surgical wounds, trauma, and minor lacerations, are at increased risk.[3] However, children more often have other common risk factors, such as malnutrition, history of varicella, and immunosuppression.