pyodermas - fk unissula

PYODERMAS

Definition

Skin infection

Caused by pyogenic bacteria

Easily transmitted

Etiology

•Staphylococcus ( S. aureus, S. albus )

•Streptococcus ß haemoliticus

•Corynebacterium minutissimum

Prediposition factors:

•o Low stamina, malnutrition,

gravis anemia, diabetes mellitus

•o Low hygiene individual

•o Low hygiene area

•o Pre-existing skin diseases

Classification

1. Primary pyodermas

- infection on the normal skin without

other skin diseass

- Caused by: one type microorganisme

Staphylococcus and Streptococcus

- Characteristic skin manifestation

Primary pyodermas (examples)

a) Impetigo

b) Folliculitis

c) Furuncles

d) Carbuncles

e) Ecthyma

f) Erythrasma

g) Erysipelas

h) Cellulitis

i) Paronychia

j) Staphylococcal scalded skin syndrome

2.Secondary pyoderma

Complicating preexisting skin lesions, such

as scabies, eczema, varicella, thus clinical

manifestations are not characteristic.

Examples:

- Hidradenitis supurativa

- Intertrigo

- Ulcers

- Secondary infection

PYODERMAS TREATMENT

1. General treatments:

- Medical; personal & environmental

hygiene advices

- Immunological factor

- Antibiotics

Systemic Antibiotics:

a) Penicillin: ampicillin, amoxicillin,

penicillin resistant strain:

amoxicillin+clavulanate acid (3x125mg,

250-500mg), cloxacillin.

b) Erythromycin 30-40 mg/kg/day 3 doses

c) Cefalexin: 50 mg/kg/day 2 doses

d) Lincomycin: 30 mg/kg/day 3-4 doses

e) Ciprofloxacin 2 x 500-750 mg

Topical Antibiotic

Mupirocin • Tetracycline 3%

Gentamycin • Chlorampenicol

Erythromycin • Neomycin+basitracin

Fucidic acid

• Secondary pyodermas : treatment of the

preexisting diseases

•Chronic cases: culture & resistance test

2.Specific treatments:

PRIMARY PYODERMAS

4 types of primary pyoderma considered from

the etiology:

1. Staphylococcus

- impetigo contagiosa bullosa

- folliculitis, furuncles & carbuncles

- sycosis barbae

- Staphylococcal Scalded Skin Syndrome

PRIMARY PYODERMAS (etiology)

2. Streptococcus:

q Impetigo contagiosa crustosa

q Ecthyma

q Erysipelas

3. Staphylococcus & Streptococcus:

v Cellulitis

4. Corynebacterium minutissimum:

- Erythrasma

IMPETIGO

A bacterial infection that attacks

superficial epidermal between stratum

corneum and stratum granulosum, very

infectious.

2 types of impetigo:

1. Impetigo contagiosa bullosa

2. Impetigo contagiosa crustosa

1. Impetigo contagiosa bullosa

= Impetigo neonatorum

Neonatal 10-14 days: on the palm of

hand, face, mucous membrane, along

with constitution manifestations

Pre-school children neck, arm

Flaccid Bullae (hipopion), erosions

scalded-by-fire-like appearance

2. Impetigo contagiosa

crustosa

Manifestation: erythematous eritema, vesicle

and bullae pustule thick crust.

Predilection: face, extremities

Streptococcus group A serotype 2.

Complicationsacute glomerulonephritis

The most serious complication!

IMPETIGO

Hipopion

Impetigo contagiosa crustosa

Impetigo contagiosa bullosa

FOLLICULITIS

A hair follicle infection.

Course & clinical manifestations:

1. Superficial folliculitis

There are small fragile domeshaped pustules occur at the infundibulum of hair follicles, erythematous surrounding

2. Deep folliculitis

Deep microabces + crust abces collar button

Deep folliculitis (Examples):

i. Sycosis barbae occuring in the bearded areas of the face and upper lip.

ii. Hordeolum (stye): a deep folliculitis of the cilia of the eyelid margin.

Nodule is covered by pustule swelling of perifollicular tissue when dried becomes crust at the edge of palpebra.

Treatment : warm compress

Complication: blepharitis & eye refraction disorder

FOLLICULITIS

SYCOSIS BARBAE

FURUNCLES

An infection in hair follicles & surrounding tissue

(perifoliculer)


Acute pain, nodules with sharply defined

margins, erythema 5 days: central

suppuration, blind boil.

Predilection: nape, axilla, buttocks.

Predisposition factors:

- Diabetes mellitus -Malnutrition

- Seborrheic dermatitis

Th/Specific: if there is abscess incision

FURUNCLE

CARBUNCLES• the worst form of a furuncle, with coalescence of

furuncles and marked inflammation, there are multiple pustules.


1. Superficial carbuncles:

Red nodules, multiple perforation : without leaving deep ulcers.

2. Deep carbuncles:

The nodules appear like carsinoma, multiple perforations, leaving deep ulcer. Carbuncles ulcer

Carbuncle (treatment)

Treatment:

Systemic: general pyodermas treatment

Local: - upper nodule : warm compress

- abscess : incision

CARBUNCLE

ECTHYMA

A pyogenic infection, characterized by stickycrustae. There are ulcers if crusts aredebrided


Predilection: legs, buttocks

vesiculopustulae thick crust the ulcerhas a ‘punch out’ appearance, the margin ofthe ulcer is indurated, raised and violaceous.

DD/ Impetigo

ECTHYMA

ERYTHRASMAA skin disease caused by gram-positive bacterial infection, superficial lesions with sharply defined margins.

Etiology: Corynebacterium minutissimum

Symptoms & signs:

The body folds, axilla, genitocrural, toe web macula (brownish redness) or plaque, fine scaly.

Wood’s lamp: a coral red fluorescence.

Predisposing factors: heat, humidity, obesity.

Treatment: erythromycin 4 x 250 mg/ day.

ERYTHRASMA

ERYSIPELAS

(superficial cellulitis)

An acute infection disorder caused by

Streptococcus betahaemoliticus with cardinal

signs of sharply circumscribed erythematous

skin, fever and chills

Predilections:

face and head extremities & genital

Predisposition factor: cachexia, diabetes

mellitus, systemic diseases, and bad hygiene

ERYSIPELAS (course & clinical

manifestation)

Beginning from ulcer, wound, pustule.

Quick progress pain, fever, weakness

Spreading erythema to the periphery, sharply circumscribed, oedema, palpation: warm & pain. Vesicles & bullae on the erythematous skin.

Exacerbation in the same place causes permanent changes: swelling, oedema can be caused by blockage of the venous and lymphatic vessels on the lips, lower legs and feet. Elephantiasis nostras

ERYSIPELAS

Predilections:

face and head extremities

& genital

Treatments:

v Bed rest

vGeneral pyoderma treatment:

systemic antibioticCold compress

Complication: ELEPHANTIASIS NOSTRAS

ELEPHANTIASIS NOSTRAS

VERUCOSUS

It is caused by recurrent erysipelas

Location: lower legs

Feet: very thick and big (2-3 x normal)

Verrucous lesions are made up of

crowded wart-like growths with

papilomas among them.

Caused by lymphatic vessels blockage

CELLULITISacute infection, where the inflammation

involves more of soft tissue, extending

deeper into the dermis and subcutaneous

tissues,

primary sign: skin erythematic without sharply

defined margins.

Etiology:

Group A Streptococcus &Staphylococcus

aureus; Group B Streptococcus neonatus


vBeginning from insect bite, small wound, ulcers

(porte d’entre). Erythema and severe pain, fever

and chills, palpation: pain and heat.

vVesicles local abscess necrotic.

vCelullitis can occur on the head, perianal

cellulitis,

vBecoming march celullitis, gangrene gas,necrotizing fasciitis if the infections have extendedinto the fascia and caused blood vesselsthrombosis gangrene.

vInitially is edematous, warm, red, extended, raisingvesicles or bullaes crepitation sign

Cellulitis treatment:

Bed rest better general conditions

Systemic: general pyoderma treatment:antibiotic

Topically: acute cold compress

Abscess/ gangrene incision, debridement ofnecrotic tissues

PARONYCHIAan infection of the nail fold surrounding the nail plate.

E/: Staphylococcus or fungal: Candida albicans


Beginning from nail folds – expanding into nail matrix & nail plate : characterized by the swelling of the lateral nail fold adjacent to the side of the nail, a drop of pus may sometimes be expressed from them.

Chronic paronychia is favored by ingrown nail, prolonged immersion in water and simple injuries. There is latitude line on the nail fold.

PARONYCHIATreatments:

o Systemic: acute antibiotic/ penicillin

o Topical:

Acute rivanol 1 %, after drying – antibiotic ointment

Chronic/ recurrence nail extraction

Candida albicans:

Antibiotic+ Anticandida nystatin

Prognosis: generally good.

STAPHYLOCOCCAL SCALDED-

SKIN SYNDROME (SSSS)

A skin infection, caused by typical exotoxin of Staphylococcus aureus with a characteristic sign of epidermolysis.

Etiology & pathogenesis:

vGroup 11 phage (type 52,55 and 71) Staphylococcus aureus.

v The exotoxins produce epidermolysis on all over the body into the epidermis.

v There is no bacteria found on the skin.

v Focal infections are eye, nose, throat & ear infection.

SSSS (Course& clinical manifestations)

High fever, accompanied by upper respiratory tract infections

Erythem on the face, neck, axilla, groin all over the body in 24 hours.

Characteristic tissue-papers like wrinkling of epidermis is followed by appearance of large flaccid bullae (Nicolsky sign +) like combustion

Complication: cellulitis, pneumonia, septicemia

DD: Toxic epidermal necrolysis.

SSSS (Treatments)

• Systemic: cloxacillin – adult 3x250mg/day

Neonatus 3x50mg/day orally

• Topical: wide lesions sofratulle/

antibiotic cream

• Intravenous electrolyte and liquid wide

epidermolysis produces electrolyte and

liquid imbalance

SECONDARY PYODERMA

Examples:

- Hidradenitis supurativa

- Intertrigo

- Ulcers

- Secondary Infection. eg: Scabies

HIDRADENITIS SUPPURATIVA

A chronic &recurrent suppurativa infection in apocrine sweat glands.

Affecting apocrine sweat gland, in adult men & women

E/:Staphylococcus aureus & Proteus Sp


Preceded by injuries, axilla hair cutting, deodorant using.

Predilection: the axilla, perianal & genital.

HIDRADENITIS SUPPURATIVA

DD/:Scrofuloderma

Treatments:

• Usually very difficult, considering the multiple lesions and the deep location on the profundal layer

• Abscess incision

• Chronic and cicatrix apocrine gland excision

PROGNOSIS: poor -- recurrence

HIDRADENITIS SUPURATIVA

INTERTRIGO

An inflammation in the redundant skin

folds, erosion, red-colored

Predilection:

The favorite sites are the groin, axillae,

between the toes, the intergluteal cleft,

under the pendulous breast where the

skin meets

INTERTRIGO (Course & clinical

manifestations)Initially the skin is red, maceration, hyperemia, erosions & fissure. e.g: diaper rash

Influencing factors:

• Obesity

• Hot temperature & high moisture, sweat retention, maceration, irritation on the skin.

• Bacterial populations, flora decompositions produces an offensive odor.

• Bacterial populations causing inflammation increased moisture more macerations

DD: Dermatomycosis

INTERTRIGO (Treatment)

1. Milid intertrigo: thorough cleansing & dyring of area 2x/d. All soap should be rinsed off

2. Liberal use of baby powder

3. Using uplifting brassieres preventing hanging breasts

4. Using cotton underwear it can absorb the sweat; looser underpants

5. Using electric fans/ ac a cool environment

6. Medications:

a. systemic: antibiotic orally

b topical: mild cases corticosteroid creams

moderate cases antibiotic creams

INTERTRIGO

ULCERS

a skin disorder caused by tissue necrotic occurring in the epidermis, dermis and subcutan expanding into bone tissue.

Ulcers caused by bacteria:

1. Pyogenicum ulcer

2. Carbuncles ulcers

3. Tuberculosis ulcers

4. Tropicum ulcers

5. Durum ulcers

6. Molle ulcers

Consider these when describing

an ulcer:

Shape:

- round on the pyogenic ulcer

- oval on the tropicum ulcer

- irregular on the traumatic ulcer

Border:

- raised on mycosis fungoides

- Verrucosa on carcinoma ulcer

- Undermined on tuberculosis ulcer

Consider these when describing

an ulcer

Base:

- dirty on carbuncles ulcer

- Clean on durum ulcer

Surrounding skin:

- red on carbuncles ulcer

- Livide on tuberculosis ulcer

PYOGENICUM ULCER

Round-shaped, 0.5-1 cm in diameter,

red border, covered by pus,

often on the foot,

E/: Streptococcus

staphylococcus.

CARBUNCLES ULCERS

Furuncles convalesce, necrotic,

Predilection: on the back and nape,

In diabetes mellitus patient.

TUBERCULOSIS ULCERS

A. Orificialis tuberculosis ulcer

It is on the oral & anal orifice edge. Livide on the surrounding skin, undermined border, pale granulation tissue and hemorrhage easily on the base.

B. Tuberculosis limphadenitis on the neck and axilla, becomes abscess, fistula & ulcers.

E/: tuberculosis bacterial toxin

DURUM ULCERS

Initially it appears as asmall erosion,

expanding to the periphery. The base is

verrucous, red, covering serum

sometimes dried. Palpation feels like

cartilage and there is no pain, inguinal

lymph gland enlargement.

E/ Treponema pallidum.

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pyodermas - fk unissula

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