Lightning Learning: Necrotising Fasciitis

Lightning Learning: Necrotising Fasciitis

“This rare condition requires a high index of suspicion. Clinical features are progressive, but mortality can double after only 24 hours of presentation!”
— advice is based on local guidelines & procedures


Suspect with “any soft tissue infection unresponsive to treatment with rapid deterioration.” This rare condition requires a high index of suspicion as it has devastating consequences...

Risk factors include: immunosuppression, diabetes, malnutrition, alcoholism, IV drug misuse

Trigger factors include: trauma, surgery, chickenpox (varicella), any local skin damage, omphalitis (in babies)

Important clues: it can take up to a week from the trigger to early signs (see below), after which progression is rapid


Clinical features are progressive… mortality doubles after 24 hours of presentation!

Stage 1: erythema, swelling, warmth, TENDERNESS beyond area of affected skin

Stage 2: blisters, bullae formation, serous fluid, fluctuance and induration of the skin

Stage 3: numb, crepitus, bleeding, discolouration, necrosis progressing to gangrene


The Top Bacterial Cause? Polymicrobial

Others? Group A haemolytic streptococci, Strep pyogenes, enterococci, E. Coli, Pseudomonas aeruginosa,  Clostridium sp. & more.


  1. FBC, CRP, U&Es, LFTs, Clotting and blood cultures

  2. XR/USS imaging may help

Immediate Management?

  1. CALL THE SURGEONS for urgent consult +/- surgical debridement (definitive treatment)

  2. IV Antibiotics Broad beta-lactam or Carbapenem + clindamycin + vancomycin, NB: check local policy

  3. Treat shock and deranged electrolytes as necessary

For more on Necrotising Fasciitis…
Lightning Learning: Bilious Vomiting

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