Necrotising fasciitis is a serious condition, normally caused by a bacterial infection, that affects the soft tissue under the skin (also know as the fascia). It can be a life-threatening condition if not treated properly and promptly. Unfortunately, many people have misconceptions about the disease that can lead to confusion and fear. In this blog post, we will debunk the top 5 myths about necrotising fasciitis to help you understand the condition better.
Myth 1: Healthy people don’t get necrotising fasciitis
FACT: Although some risk factors do exist, necrotising fasciitis can affect anyone, including the fit and healthy.
In fact, in younger, fit people their body’s coping mechanisms are very good and some of the tell tale signs and symptoms won’t show up until very late in the infection, making it difficult to diagnose early – which is essential to stop the spread.
As Doctor Marina Morgan states in our educational video:
“…particularly for the younger people, their coping mechanisms are quite good. And so they don’t drop their blood pressure and they don’t look that sick until very late on in the infection.Dr Marina Morgan
In this case, Emma Doherty, 37, a young and fit cross country runner sadly lost her leg following contracting necrotising fasciitis in 2021 and given a 1% chance of survival.
Emma’s case has been in the news recently as she tries to raise money for essential medical equipment to help her: a lightweight wheelchair, a hoist and ramp for the car, an anti-stumble electronic prosthetic leg, hydrotherapy and private physio.
Myth 2: You can only get necrotising fasciitis from an open wound
FACT: Although necrotising fasciitis normally occurs when bacteria enter the body through a break in the skin, it can also happen if you have a trauma that doesn’t break the skin.
Take the recent example of young wrestler, Robb from Nebraska, who contracted necrotising fasciitis after noticing a bruise on his leg.
Although Robb almost lost his leg, early diagnosis by medical teams are what saved his leg when his condition began to worsen following the initial diagnosis of a ‘common infection’.
Medical teams suspect Robb may have had a very slight graze in the area, although none was apparent at the time, demonstrating the fact that clear breaks in the skin are not always evident.
Myth 3: Necrotising fasciitis is a “flesh eating bug”
FACT: Bugs are microorganism, such as bacteria or viruses. Necrotising fasciitis is a condition that occurs due to an infection by a microorganism. It can be caused by many different ‘bugs’.
Equally, Necrotising fasciitis is not a flesh eating bacteria, which is another common term used to refer to the condition.
The term ‘flesh eating bug’ is actually a misnomer – necrotising fasciitis is actually a flesh eating disease.
Although there is a subtle difference it is essential that we understands how necrotising fasciitis can be caused in the first instance to be able to successfully diagnose it and although the majority of cases of necrotising fasciitis are caused by Strep A bacteria there are various other causes.
According to Dermnet the main types of necrotising fasciitis are:
- Type I (polymicrobial ie, more than one bacteria involved – this normally only affects immunocompromised people)
- Type II (monomicrobial ie, only one bacteria involved eg. due to haemolytic group A streptococcus, and/or staphylococci including methicillin-resistant strains/MRSA)
- Type III (gas gangrene e.g. due to clostridium bacterium)
- Type IV (caused by fungal infections (e.g. candida and zygomycetes)
- Other: very rare reports of necrotising fasciitis from marine organisms (vibrio species, Aeromonas hydrophila, considered Type III in some reports)
You can find out more about microbial causes of necrotising fasciitis on our website under the ‘About necrotising fasciitis’ section of the website.
Myth 4: Necrotising fasciitis eats your flesh
FACT: The bacteria causing the condition produce toxins in the body, which cause the blood supply to the fascia to be restricted and the tissue to die. They also produce enzymes which can ‘digest or dissolve’ the tissue.
So let’s get this straight – there are no tiny critters chomping away with little nashers at your body when you have necrotising fasciitis.
Group A Strep does however produce tissue digesting or dissolving toxins- which is why clindamycin & linezollid work in the treatment of necrotising fasciitis caused by bacterial infections – they switch off production of the exotocins, which allow the Group A Strep to spread through the tissue.
Once the blood supply to the area is damaged by the toxins it prevents intravenous antibiotics reaching the area to stop the progress of the infection. For this reason, fascia is often cut away to in order to stop the progress of the infection through the body.
Most of the early symptoms of infection are actually caused by these toxins, which can wreak havoc on the body. These symptoms include vomiting and diarrhoea, and some toxins can induce a rash. Some of these toxins can also encourage the spread of bacteria through the bloodstream and tissues as the bacteria multiply.
Myth 5: You can’t protect yourself from Necrotising Fasciitis
Fact: There are plenty of simple precautions you can take to protect yourself!
Practice cleanliness to avoid the spread of infections such as Strep A. Treat and dress wounds to avoid infections, and seek medical attention early if you suspect an aggressive infection.
Certain condition, such as diabetes, put people at increased risk of bacterial infections that may lead to necrotising fasciitis. But there are plenty of things to help reduce the risk in such conditions.
Diabetes and necrotising fasciitis
Diabetes can affect immunity in some, but it can also affect the skin by reducing blood flow to the outer layers, which reduces the skins ability to look after itself and makes some sufferers more susceptible breaks in the skin. Having diabetes means your at much greater risk of developing foot problems, a condition called diabetic foot. If left untreated, these problems can lead to serious complications, including (but not limited to) necrotising fasciitis.
Keep skin clean and moisturised to avoid cracks and breaks in the skin in general. Wear well fitting shoes and avoid walking bear foot to help prevent any foot injuries which may struggle to heal. Anyone with concerns about their foot health, such as pain/aches/tingling, blisters that won’t heal or swelling should consult a local Health Care Professions Council (HCPC) Registered Podiatrist.
Necrotising fasciitis is a serious condition that should not be taken lightly. By understanding the facts and debunking the myths, we can better protect ourselves and our loved ones from this potentially life-threatening condition. Remember to seek medical attention immediately if you suspect you may have necrotising fasciitis, and practice good hygiene to prevent infection and the spread of infections.