DEPARTEMENT OF DERMATOVENEROLOGY REFERAT 2021

FACULTY OF MEDICINE
HASANUDDIN UNIVERSITY

THE DIAGNOSIS AND

TREATMENT OF PYODERMA
Arnaldi Rai Patanduk Karangan C014202266
Yaumil Dewi Purnama C014202291
Andika Sulastriani C014202264
Aminullah C014202260
Febi Ananda Ramadhan C014202271

Resident
dr. Clinton

Supervisor
dr. St. Nur Rahmah, Sp.KK,
 DEFINITION

Pyoderma is a skin disease caused by Streptococcus B

haemolyticus, while Staphylococcus epidermidis is a normal
inhabitant of the skin and rarely causes infection.

Impetigo Ecthyma Foliculitis Furuncles

Erysipelas Cellulitis Flegmon Carbuncles

Djuanda A, Hamzah M, Aisah S. Ilmu Penyakit Kulit dan Kelamin. Edisi 6. Jakarta: Badan Penerbit FKUI; 2010
 EPIDEMIOLOGY

>> Higher in the pediatric population

>> Higher in the tropics.
>> A study published in 2015 showed that the prevalence of impetigo
in children was 12.3%.
>> Meanwhile, the prevalence of cellulitis in America was reported to
increase to 37.3% of all patients with skin and soft tissue infection.
>> Pyoderma epidemiological data are still unclear.

Bowen, A.C., et al. The Global Epidemiology of Impetigo and pyoderma. Plos One, 2015. 10(8) : 1-15.
https://dx.doi.org/10.1371%2Fjournal.pone.0136789 
 ETIOLOGY
• In general, the main causative pathogens of pyoderma are Staphylococcus
and Group-ß-hemolytic streptococci (GBHS).
DISEASE STREPTOCOCCUS STAPHYLOCOCCUS AUREUS
PYOGENES
IMPETIGO YES YES (ESPECIALLY)
ECHTYMA YES -
FOLLICULITIS - YES
FURUNCLES YES (ESPECIALLY) -
CARBUNCLES YES YES

ERYSPELAS YES -
CELLULITIS YES YES
FLEGMAN - YES
HIDRADENITIS
ABSES MULTIPLE YES
 PATOGHENESIS

The main causes are Staphylococcus aureus and Streptococcus B

haemolyticus, while Staphylococcus epidermidis is a normal inhabitant of the skin
and rarely causes infection. The intact stratum corneum is one of the skin's
defenses against pathogenic bacteria that cause pyoderma. Some of the factors that
play a role in the development of pyoderma are insect bites, local trauma, skin
disorders (especially atopic dermatitis), poor hygiene, high temperature and
humidity, patient age, history of antibiotic use, and dense settlements.
Transmission occurs through direct contact with infected individuals.

Djuanda A, Hamzah M, Aisah S. Ilmu Penyakit Kulit dan Kelamin. Edisi 6. Jakarta: Badan Penerbit FKUI; 2010
Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia: Saunders;
2014
 CLINICAL MANIFESTATION
Usually patients come complaining of scabs or skin sores. Initially shaped like
a small, itchy rash, may be filled with fluid or pus with a reddish base and
surrounding rim. This complaint can extend to swelling accompanied by pain. The
nodule then breaks off and becomes a dry, hard and very sticky scab / scab.

Djuanda Adhi. 2016. Ilmu Penyakit Kulit dan Kelamin. 7 th edition. Jakarta : Fakultas Kedokteran Universitas Indonesia.
 CLINICAL FEATURE
Superficial pyoderma
Impetigo
Impetigo bulosa Impetigo nonbulosa

Clinical Feature • General symptoms (-) • General symptoms (-)

• Erythema, bullae, bulla • Erythematous macules or papules 
hypopion vesicles or pustules  honey yellow
• The bulla  ruptures  annular crust (honey color).
scale with an erythematous • Itching and discomfort
center and dries quicklycrust.
• Rapid progression of vesicles
into sagging bullae.

Predilection intertriginous areas (axillary, Face (perioral area)

inguinal, gluteal), chest, and back.

Picture
 CLINICAL FEATURE

Ecthyma
Clinical feature Erythema -> vesicle -> rupture -> thick yellowish crust is
difficult to remove and there is a shallow ulcer underneath
Predilection lower extremities, usually sites of relatively high trauma
Picture
 CLINICAL FEATURE
Folliculitis, Furunkel, Karbunkel
Folliculitis Furunkel Karbunkel
Clinical • Inflammation of • Inflammation of hair follicles & • Bundles of furuncles ->
Feature the hair follicles surrounding tissues. If >1 -> form large nodes filled
• Erythematous furunculosis with necrotic tissue.
macules with • Erythema macula -> cone node • Fever and malaise
papules and there is a pustule in the
• Pustules have middle -> abscess -> if it ruptures
hair in the -> fistula.
middle • pain

Predilection hairy areas -> scalp where there is hair  neck, face, axilla, and buttocks.
(children), chin,
axillae, lower
extremities, upper
lip, buttocks
(adults).

Picture
 CLINICAL FEATURE
Profunda Pyoderma
Erysipelas Cellulitis Phlegmon
Clinical • Acute inflammation that is • Acute inflammation • if cellulitis is
future more superficial than cellulitis mainly affects the suppuration ->
(epidermis & dermis) dermis and phlegmon
• fever, malaise, chills subcutaneous tissue.
• The erythema is bright red,
with firm borders and raised
margins.
• Pain in the lesion
• edema, vesicles, and bullae

• General symptoms (+)

• - Lesions are erythematous, warm, swollen & there
is tenderness.
• - Not well-defined with signs of acute
inflammation

Predilection lower extremities (lower limbs), but erysipelas can also affect the face.

Picture
 CLINICAL FEATURE
Sweat gland abscess
Clinical Feature • Found in children
• Decreased body resistance
• Lots of sweat
• Nodes erythema, multiple,
dome shape painless ->
break up
Predilection sweaty areas
Picture
Hydradenitis
• infection of the apocrine
glands
• General symptoms (+)
• Inflamed node -> abscess
-> fistula -> multiple
sinuses
sweaty areas (axillary,
perineum)
 DIAGNOSIS

• The diagnosis of pyoderma is made through physical examination and

supporting examination, germ culture, and antibiotic resistance test.
• Culture and antibiotic resistance test taken form the lesion or aspirate
preparation if the lesion is not responsive to empirical treatment.
• Histopathological examination can be performed if the lesion is not
specific.
• Biopsy may be appropriate in doubtful or refractory cases of pyoderma

Harlim, A. 2019. BUKU AJAR ILMU KESEHATAN KULIT DAN KELAMIN FK UKI.
 DIFFERENTIAL DIAGNOSIS
Lesions that mimic varicella and herpes.
Lesions that lead to impertigo- crusted
color and no prodromal symptoms.
If the vesicles ruptured, impetigo needs to
Impetigo NonBullosa be differentiated from ectomy Varicella

Colaret bullae that similar to fungal

infections such as tinea corporis.
In fungal infections, the lesions do
Impetigo Bullosa not start with a ruptured of bullae
Tinea korporis
Folliculitis on the chin sometimes
difficult to differentiated from tinea
barbae.
KOH test positive in tinea barbae
Folliculitis Tinea Barbae
Djuanda A, Hamzah M, Aisah S. Ilmu Penyakit Kulit dan Kelamin. Edisi 6. Jakarta: Badan Penerbit FKUI; 2010
Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia: Saunders;
2014.
 DIFFERENTIAL DIAGNOSIS
Ecthyma lesions is similar to crustous
impetigo but different in the location of
the lesions
The basis of ecthyma lesions is ulcers, not
Ecthyma erosions as in impetigo Impetigo Krustosa
The differential diagnosis is dermatitis
and urticaria. In both diseases, there are
no systemic symptoms such as in
erysipelas.
Erysipelas Dermatitis
This disease is similar to scrofuloderma
In scrofuloderma, there may also have
nodes, abscesses, and fistulas.
However, scrofuloderma was absent from
leucocystosis and other acute systemic
Hidradenitis Scrofuloderma
symptoms.
Atanaskova N, Tomecki K. Innovative Management of recurrent Furunculosis
Hall JC. Seborrheic Dermatitis, Acne, and Rosacea. Hall BJ, Hall JC. Sauer’s Manual of Skin Disease. 10th Ed. Canada. Wolters Kluwer. 2010. 152.
 DIFFERENTIAL DIAGNOSIS
The differential diagnosis depends
on the location of the lesion.
Disorders that can mimic cellulitis
include insect bites, deep vein
thrombosis and dermatitis.
Deep vein thrombosis should be
watched out if you find symptoms
of cellulitis in the legs, because it
can cause fatal complications that
can lead to misdiagnosis.
To differentiates this disease from
cellulitis is via the Virchow triad
Cellulitis
(stasis, endothelial dysfunction, Deep vein
hypercoagulability). thrombosis

Atanaskova N, Tomecki K. Innovative Management of recurrent Furunculosis

Hall JC. Seborrheic Dermatitis, Acne, and Rosacea. Hall BJ, Hall JC. Sauer’s Manual of Skin Disease. 10th Ed. Canada. Wolters Kluwer. 2010. 152.
 DIFFERENTIAL DIAGNOSIS

Suppurative hydradenitis, initially only

an abscess in a certain area, then
develops into a sinus tract with scar
tissue connecting to a lesion, and then
combines into a lesion, sinus tract,
inflammation, and chronic processes. Hidradenitis
Furuncles

This disease is painful, has a conical

shape with a pustule in the middle and
breaks down relatively quickly.
Multiple Sweat Gland Furunculosis
Abscess

Atanaskova N, Tomecki K. Innovative Management of recurrent Furunculosis

Hall JC. Seborrheic Dermatitis, Acne, and Rosacea. Hall BJ, Hall JC. Sauer’s Manual of Skin Disease. 10th Ed. Canada. Wolters Kluwer. 2010. 152.
 DIFFERENTIAL DIAGNOSIS

An inflamed epidermal cyst can

suddenly become red, tender and
increase in size within a day.
This can be ruled out based on the
presence of a history of previous
cysts at the same site.
The compression of the lesion will Inflamed Epidermal
Carbuncles Cyst
produce a cheese-like mass that
smells unpleasant while the
carbuncle releases purulent material.

Atanaskova N, Tomecki K. Innovative Management of recurrent Furunculosis

Hall JC. Seborrheic Dermatitis, Acne, and Rosacea. Hall BJ, Hall JC. Sauer’s Manual of Skin Disease. 10th Ed. Canada. Wolters Kluwer. 2010. 152.
TREATMENT
 Non medicamentosa

o Maintaining hygiene
o High calories and protein nutrition
o Immunity

Pengurus besar IDI. 2017. Panduan Praktis Klinis Bagi Dokter Di Fasilitas Pelayanan Kesehatan Primer 1 st edition.
 Medicamentosa
A. Topical

* There is a lot of pus /crusting, do an open compress with 1/5.000calliculus

permanganas (PK) or 7.5% povideom iodine diluted 10x

* If not covered with pus or crusting, given ointment or cream of fusidic acid

2% or muporisin 2%, applied 2-3 times a day for 7-10 days.

Pengurus besar IDI. 2017. Panduan Praktis Klinis Bagi Dokter Di Fasilitas Pelayanan Kesehatan Primer 1 st edition.
 Medicamentosa
B. Oral antibiotics can be givem from one of the following groups :
Penicillins that are resistant to penicillinase, such as:

Pengurus besar IDI. 2017. Panduan Praktis Klinis Bagi Dokter Di Fasilitas Pelayanan Kesehatan Primer 1 st edition.
 PROGNOSIS

If the disease is not accompanied by complications, the prognosis is

generally bonam, if with complications, the prognosis is generally dubia et
bonam

Pengurus besar IDI. 2017. Panduan Praktis Klinis Bagi Dokter Di Fasilitas Pelayanan Kesehatan Primer 1 st edition.
THANK YOU