Strategies to reduce the risk of surgical site infections of the skin

Surgical site infection represents the most common complication in dermatologic surgery and with an estimated incidence ranging from 0.5% to 3%.The majority of surgical site infection can be prevented by implementing evidence-based strategies supported by high quality studies.Some of these interventions include avoiding razor for hair removal (vs use of clippers), decolonization with antistaphylococcal agents, and antiseptic skin agents (eg, chlorhexidine gluconate and alcohol-based skin preparations), and optimizing patients' comorbidities such as preoperative tight glycemic control and smoking cessation.Despite the increased trend in overprescribing antibiotics in dermatologic surgery, antibiotic prophylaxis is not recommended in otherwise healthy patients.For high-risk patients (eg, patients with cardiac conditions, and those with prosthetic material at risk for hematogenous total joint infections), prophylactic antibiotics are recommended when procedures breach the mucosal membranes (eg, nasal/oral mucosa) or when there is evidence of cutaneous infection (either at the surgical or at a distant site).Antibiotic prophylaxis may also be recommended for procedures involving complex surgical repairs (eg, flaps and grafts on the face), procedures on the lower extremities or groin, and for wedge excisions of the lip and ear.Knowledge regarding strategies to reduce surgical site infection and antibiotic use may help improve adherence to evidence-based guidelines while improving patient outcomes.( JAAD Reviews 2025;5