Skin infections in palliative care

Patients with palliative care needs may be immunocompromised because of their life-limiting illness, concomitant conditions or drugs (eg corticosteroids, chemotherapy). Patients who are immunocompromised are at increased risk of developing skin infections, including bacterial infections (eg cellulitis), viral infections (eg herpes) and fungal infections (eg candida).

Management of skin infections in patients with palliative care needs is guided by the potential benefits and burdens of treatment, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. Common infections are listed below; for information on management of a broader range of skin infections, see the Dermatology guidelines.

Mucocutaneous herpes infections (herpes simplex and herpes zoster) are common in patients who are immunocompromised and can have various presentations. For information on the presentation and management of herpes simplex infection, see Oral mucocutaneous herpes in the Dermatology guidelines and Genital ulcer disease in the Antibiotic guidelines.

Herpes zoster infection (shingles) is also common in patients with palliative care needs who are immunocompromised. For information on the presentation and management of herpes zoster infection, see the Antibiotic guidelines. Manage acute pain associated with herpes zoster with analgesic therapy; see the Pain and Analgesia guidelines for advice. For the management of postherpetic neuralgia; see the Pain and Analgesia guidelines.

Candidiasis of the skin and mucosal cavities is common in patients with palliative care needs who are immunocompromised. For management of candidiasis of the skin, see the Dermatology guidelines. For management of candidiasis of the mucosal cavities, see Oropharyngeal candidiasis in palliative care and Swallowing difficulties and oesophagitis in palliative care.