A.R. Shipman; G.W.M. Millington

Disclosures

The British Journal of Dermatology. 2011;165(4):743-750. 

In This Article

Cutaneous Infections in the Obese

Cutaneous infections, including methicillin-resistant Staphylococcus aureus, are more common in those with an elevated BMI.[83] This may relate to the physical effects of larger skin folds[7] but may equally relate to the immunological alterations seen in the skin in the obese.[5,29,59,62,63] Friction and increased moisture in the deep skin creases lead to maceration and inflammation, so that intertrigo is a common association with obesity.[73,84] Poor mobility and inability to maintain adequate levels of hygiene may exacerbate this problem. For example, urinary incontinence may be more common in obese than nonobese women, exacerbating any tendency to infection and ulceration in the groins and genital area.[73]

Cellulitis occurs particularly in legs with coexisting lymphoedema.[85] This cellulitis can be particularly difficult to clear, as it may require higher initial doses of antibiotics than used normally (partly because of the higher BMI) and may also need prophylactic antibiotics to prevent recurrence.[85] Recurrent soft tissue bacterial infections in the damaged lymphatics lead to a condition called elephantiasis nostras verrucosa, which is particularly common in the obese.[86]

Folliculitis, furunculosis and paronychia are problems encountered by many and increased incidence of Candida albicans is also associated with obesity.[22] Erythrasma (an infection caused by Corynebacterium minutissimum) occurs in the obese and superficial fungal infections including onychomycoses are also a problem, particularly if patients also have diabetes.[87] Less common infections include necrotizing fasciitis and gas gangrene.[7,22,88,89]

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