pyodermas - fk unissula
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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)
Course & clinical manifestations:
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.
Course & clinical manifestations:
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
Course & clinical manifestations:
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
Course & clinical manifestations:
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
Course & clinical manifestations:
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
SSSS
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
Course & clinical manifestations:
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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