Staging of necrotizing fasciitis based on the evolving cutaneous features

Int J Dermatol. 2007 Oct;46(10):1036-41. doi: 10.1111/j.1365-4632.2007.03201.x.


Background: Necrotizing fasciitis is a severe soft-tissue infection characterized by a fulminant course and high mortality. Early recognition is difficult as the disease is often clinically indistinguishable from cellulitis and other soft-tissue infections early in its evolution. Our aim was to study the manifestations of the cutaneous signs of necrotizing fasciitis as the disease evolves.

Methods: This was a retrospective study on patients with necrotizing fasciitis at a single institution. Their charts were reviewed to document the daily cutaneous changes from the time of presentation (day 0) through to day 4 from presentation.

Results: Twenty-two patients were identified. At initial assessment (day 0), almost all patients presented with erythema, tenderness, warm skin, and swelling. Blistering occurred in 41% of patients at presentation whereas late signs such as skin crepitus, necrosis, and anesthesia were infrequently seen (0-5%). As time elapsed, more patients had blistering (77% had blisters at day 4) and eventually the late signs of necrotizing fasciitis characterized by skin crepitus, necrosis, and anesthesia (9-36%) were seen. A clinical staging system was developed based on our observations. Stage migration from early to late stage necrotizing fasciitis was evident with majority of patients in stage 1 at day 0 (59%), whereas by day 4, majority had developed into stage 3 (68%).

Conclusion: This study has demonstrated the continuum of cutaneous manifestations as necrotizing fasciitis evolves. This will help in the early recognition and intervention of this devastating condition.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blister / etiology
  • Comorbidity
  • Disease Progression
  • Fasciitis, Necrotizing / complications
  • Fasciitis, Necrotizing / pathology*
  • Female
  • Humans
  • Hypesthesia / etiology
  • Male
  • Middle Aged
  • Necrosis / etiology
  • Retrospective Studies
  • Skin / pathology*
  • Soft Tissue Infections / complications
  • Soft Tissue Infections / pathology*