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PYODERMAS

Dr. Asih Budiastuti, SpKK
Department of Dermato-venereology
Medical Faculty of Diponegoro University
Semarang

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)

b)
c)
d)

e)
f)
g)

h)
i)
j)

Impetigo
Folliculitis
Furuncles
Carbuncles
Ecthyma
Erythrasma
Erysipelas
Cellulitis
Paronychia
Staphylococcal scalded skin syndrome

Hidradenitis supurativa .Ulcers .Secondary pyoderma Complicating preexisting skin lesions. varicella. eczema.2. such as scabies.Infectious eczematous dermatitis .Intertrigo . thus clinical manifestations are not characteristic. Examples: .

Antibiotics . General treatments: .Immunological factor .PYODERMAS TREATMENT 1. personal & environmental hygiene advices .Medical.

cloxacillin.Systemic Antibiotics: a) Penicillin: ampicillin. b) c) d) e) penicillin resistant strain:  amoxicillin+clavulanate acid (3x125mg. 250-500mg). amoxicillin. Erythromycin 30-40 mg/kg/day  3 doses Cefalexin: 50 mg/kg/day  2 doses Lincomycin: 30 mg/kg/day  3-4 doses Ciprofloxacin 2 x 500-750 mg .

Specific treatments: .Topical Antibiotic Mupirocin Gentamycin Erythromycin Fucidic acid • Tetracycline 3% • Chlorampenicol • Neomycin+basitracin • Secondary pyodermas : treatment of the preexisting diseases •Chronic cases: culture & resistance test 2.

PRIMARY PYODERMAS 4 types of primary pyoderma considered from the etiology: 1.sycosis barbae .impetigo contagiosa bullosa .folliculitis. furuncles & carbuncles .Staphylococcal Scalded Skin Syndrome . Staphylococcus .

Erythrasma . Streptococcus: q Impetigo contagiosa crustosa q Ecthyma q Erysipelas 3.PRIMARY PYODERMAS (etiology) 2. Staphylococcus & Streptococcus: v Cellulitis 4. Corynebacterium minutissimum: .

2 types of impetigo: 1. very infectious.IMPETIGO A bacterial infection that attacks superficial epidermal between stratum corneum and stratum granulosum. Impetigo contagiosa bullosa 2. Impetigo contagiosa crustosa .

mucous membrane. along with constitution manifestations Pre-school children  neck. Impetigo contagiosa bullosa = Impetigo neonatorum Neonatal 10-14 days: on the palm of hand. erosions  scalded-by-fire-like appearance .1. face. arm Flaccid Bullae (hipopion).

extremities Streptococcus group A serotype 2.2. Impetigo contagiosa crustosa Manifestation: erythematous eritema. vesicle and bullae  pustule  thick crust. Predilection: face. Complicationsacute 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. Deep folliculitis Deep microabces + crust  abces collar button . erythematous surrounding 2.

Hordeolum (stye): a deep folliculitis of the cilia of the eyelid margin. ii. Sycosis barbae occuring in the bearded areas of the face and upper lip.Deep folliculitis (Examples): i. 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 .

Seborrheic dermatitis  Th/Specific: if there is abscess  incision .FURUNCLES An infection in hair follicles & surrounding tissue (perifoliculer) Course & clinical manifestations: Acute pain. Predilection: nape. erythema  5 days: central suppuration. nodules with sharply defined margins. buttocks.Diabetes mellitus -Malnutrition . axilla. Predisposition factors: . blind boil.

FURUNCLE .

Carbuncles ulcer . multiple perforations. Superficial carbuncles: Red nodules. Course & clinical manifestations: 1. with coalescence of furuncles and marked inflammation. leaving deep ulcer. there are multiple pustules.CARBUNCLES • the worst form of a furuncle. Deep carbuncles: The nodules appear like carsinoma. 2. multiple perforation : without leaving deep ulcers.

upper nodule : warm compress .abscess : incision .Carbuncle (treatment) Treatment: Systemic: general pyodermas treatment Local: .

CARBUNCLE .

raised and violaceous. There are ulcers if crusts are debrided Course & clinical manifestations: Predilection: legs. characterized by sticky crustae. the margin of the ulcer is indurated.ECTHYMA A pyogenic infection. DD/ Impetigo . buttocks  vesiculopustulae  thick crust  the ulcer has a ‘punch out’ appearance.

ECTHYMA .

Etiology: Corynebacterium minutissimum Symptoms & signs: The body folds. toe web  macula (brownish redness) or plaque. superficial lesions with sharply defined margins.ERYTHRASMA A skin disease caused by gram-positive bacterial infection. . Wood’s lamp: a coral red fluorescence. obesity. genitocrural. Treatment: erythromycin 4 x 250 mg/ day. axilla. Predisposing factors: heat. fine scaly. humidity.

ERYTHRASMA .

diabetes mellitus.ERYSIPELAS (superficial cellulitis) An acute infection disorder caused by Streptococcus betahaemoliticus with cardinal signs of sharply circumscribed erythematous skin. and bad hygiene . fever and chills Predilections: face and head  extremities & genital Predisposition factor: cachexia. systemic diseases.

lower legs and feet. palpation: warm & pain. Quick progress  pain. oedema. oedema can be caused by blockage of the venous and lymphatic vessels  on the lips. wound.ERYSIPELAS (course & clinical manifestation) Beginning from ulcer. weakness Spreading erythema to the periphery. sharply circumscribed. Elephantiasis nostras . fever. pustule. Vesicles & bullae on the erythematous skin. Exacerbation in the same place causes permanent changes: swelling.

ERYSIPELAS Predilections: face and head  extremities & genital Treatments: v Bed rest v General pyoderma treatment: systemic antibiotic Cold 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 .

where the inflammation involves more of soft tissue.CELLULITIS acute infection. extending deeper into the dermis and subcutaneous tissues. Group B Streptococcus  neonatus . primary sign: skin erythematic without sharply defined margins. Etiology: Group A Streptococcus &Staphylococcus aureus.

gangrene gas. red. warm. extended. perianal cellulitis. vCelullitis can occur on the head. small wound. raising vesicles or bullaes  crepitation sign . necrotizing fasciitis if the infections have extended into the fascia and caused blood vessels thrombosis  gangrene. fever and chills. Erythema and severe pain. palpation: pain and heat. ulcers (porte d’entre). vVesicles  local abscess  necrotic. vBecoming march celullitis.Course & clinical manifestations: vBeginning from insect bite. vInitially is edematous.

debridement of necrotic tissues .Cellulitis treatment: Bed rest  better general conditions Systemic: antibiotic general pyoderma treatment: Topically: acute  cold compress Abscess/ gangrene  incision.

. There is latitude line on the nail fold. a drop of pus may sometimes be expressed from them. prolonged immersion in water and simple injuries. Chronic paronychia is favored by ingrown nail. 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.PARONYCHIA an infection of the nail fold surrounding the nail plate.

PARONYCHIA Treatments: 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. .

caused by typical exotoxin of Staphylococcus aureus with a characteristic sign of epidermolysis. v Focal infections are eye. nose. v The exotoxins produce epidermolysis on all over the body into the epidermis. .55 and 71) Staphylococcus aureus. throat & ear infection.STAPHYLOCOCCAL SCALDEDSKIN SYNDROME (SSSS) A skin infection. v There is no bacteria found on the skin. Etiology & pathogenesis: v Group 11 phage (type 52.

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. accompanied by upper respiratory tract infections Erythem on the face. pneumonia.SSSS (Course& clinical manifestations) High fever. axilla. septicemia DD: Toxic epidermal necrolysis. . neck.

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 .

Hidradenitis supurativa .SECONDARY PYODERMA Examples: .Ulcers .Intertrigo .

. perianal & genital. deodorant using. Affecting apocrine sweat gland. Predilection: the axilla.HIDRADENITIS SUPPURATIVA A chronic &recurrent suppurativa infection in apocrine sweat glands. axilla hair cutting. in adult men & women E/:Staphylococcus aureus & Proteus Sp Course & clinical manifestations: Preceded by injuries.

HIDRADENITIS SUPPURATIVA DD/:Scrofuloderma Treatments: • Usually very difficult.recurrence . considering the multiple lesions and the deep location on the profundal layer • Abscess  incision • Chronic and cicatrix  apocrine gland excision PROGNOSIS: poor -.

HIDRADENITIS SUPURATIVA .

under the pendulous breast where the skin meets .INTERTRIGO An inflammation in the redundant skin folds. axillae. the intergluteal cleft. red-colored Predilection: The favorite sites are the groin. erosion. between the toes.

hyperemia. erosions & fissure. maceration.g: diaper rash Influencing factors: Obesity Hot temperature & high moisture. maceration. irritation on the skin. flora decompositions  produces an offensive odor. Bacterial populations  causing inflammation  increased moisture  more macerations DD: Dermatomycosis .INTERTRIGO (Course & clinical manifestations) • • • • Initially the skin is red. sweat retention. e. Bacterial populations.

Milid intertrigo: thorough cleansing & dyring of area 2x/d. 3. systemic: antibiotic orally b topical: mild cases  corticosteroid creams moderate cases  antibiotic creams . 5.INTERTRIGO (Treatment) 1. looser underpants Using electric fans/ ac  a cool environment Medications: a. All soap should be rinsed off Liberal use of baby powder Using uplifting brassieres preventing hanging breasts Using cotton underwear  it can absorb the sweat. 6. 2. 4.

INTERTRIGO .

ULCERS 1. a skin disorder caused by tissue necrotic occurring in the epidermis. dermis and subcutan expanding into bone tissue. 6. 4. 5. 3. Ulcers caused by bacteria: Pyogenicum ulcer Carbuncles ulcers Tuberculosis ulcers Tropicum ulcers Durum ulcers Molle ulcers . 2.

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: .Clean on durum ulcer Surrounding skin: .dirty on carbuncles ulcer .red on carbuncles ulcer .Livide on tuberculosis ulcer .

PYOGENICUM ULCER Round-shaped. .5-1 cm in diameter. often on the foot. 0. red border. E/: Streptococcus/ Staphylococcus. covered by pus.

In diabetes mellitus patient.CARBUNCLES ULCERS Furuncles convalesce. . necrotic. Predilection: on the back and nape.

E/: tuberculosis bacterial toxin . undermined border. B. Orificialis tuberculosis ulcer It is on the oral & anal orifice edge. Livide on the surrounding skin.TUBERCULOSIS ULCERS A. fistula & ulcers. Tuberculosis limphadenitis on the neck and axilla. pale granulation tissue and hemorrhage easily on the base. becomes abscess.

covering serum sometimes dried. E/ Treponema pallidum. .DURUM ULCERS Initially it appears as asmall erosion. inguinal lymph gland enlargement. Palpation feels like cartilage and there is no pain. expanding to the periphery. red. The base is verrucous.

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