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PYODERMAS Definition Skin Infection Caused by Pyogenic Bacteria Easily Transmitted Etiology •Staphylococcus ( S

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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 sticky crustae. There are ulcers if crusts are debrided Course & clinical manifestations: Predilection: legs, buttocks vesiculopustulae thick crust the ulcer has a ‘punch out’ appearance, the margin of the ulcer is indurated, raised and violaceous. DD/ Impetigo ECTHYMA ERYTHRASMA A 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 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 CELLULITIS acute 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 extended into the fascia and caused blood vessels thrombosis gangrene. vInitially is edematous, warm, red, extended, raising vesicles or bullaes crepitation sign Cellulitis treatment: Bed rest better general conditions Systemic: general pyoderma treatment: antibiotic Topically: acute cold compress Abscess/ gangrene incision, debridement of necrotic tissues PARONYCHIA an 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. 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. STAPHYLOCOCCAL SCALDED- SKIN SYNDROME (SSSS) A skin infection, caused by typical exotoxin of Staphylococcus aureus with a characteristic sign of epidermolysis. Etiology & pathogenesis: v Group 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.
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  • Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G

    Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G

    Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G. Bellew, DO, PGY3; Chad Taylor, DO; Jaldeep Daulat, DO; Vernon T. Mackey, DO Advanced Desert Dermatology & Mohave Centers for Dermatology and Plastic Surgery, Peoria, AZ & Las Vegas, NV Abstract Management & Clinical Course Discussion Conclusion Pyogenic granulomas are vascular hyperplasias presenting At the time of the periungal eruption on the distal fingernails, Excess granulation tissue and pyogenic granulomas have It has been reported that the resolution of excess as red papules, polyps, or nodules on the gingiva, fingers, the patient was undergoing isotretinoin therapy for severe been described in both previous acne scars and periungal granulation tissue secondary to systemic retinoid therapy lips, face and tongue of children and young adults. Most nodulocystic acne with significant scarring. He was in his locations.4 Literature review illustrates rare reports of this occurs on withdrawal of isotretinoin.7 Unfortunately for our commonly they are associated with trauma, but systemic fifth month of isotretinoin therapy with a cumulative dose of adverse event. In addition, the mechanism by which patient, discontinuation of isotretinoin and prevention of retinoids have rarely been implicated as a causative factor 140 mg/kg. He began isotretinoin therapy at a dose of 40 retinoids cause excess granulation tissue of the skin is not secondary infection in areas of excess granulation tissue in their appearance. mg daily (0.52 mg/kg/day) for the first month and his dose well known. According to the available literature, a course was insufficient in resolving these lesions. To date, there is We present a case of eruptive pyogenic granulomas of the later increased to 80 mg daily (1.04 mg/kg/day).