PYODERMAS Definition Caused by pyogenic Easily transmitted Etiology •Staphylococcus ( S. aureus, S. albus ) • ß haemoliticus • minutissimum Prediposition factors:

•o Low stamina, ,

gravis anemia, mellitus

•o Low hygiene individual

•o Low hygiene area

•o Pre-existing skin diseases Classification

1. Primary - 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) Furuncles d) e) f) g) h) i) j) Staphylococcal scalded skin syndrome 2.Secondary

Complicating preexisting skin , such as , eczema, varicella, thus clinical manifestations are not characteristic. Examples: - supurativa - - Ulcers - Secondary infection PYODERMAS TREATMENT

1. General treatments: - Medical; personal & environmental hygiene advices - Immunological factor - Systemic Antibiotics:

a) Penicillin: ampicillin, , penicillin resistant strain:  amoxicillin+clavulanate acid (3x125mg, 250-500mg), . b) 30-40 mg/kg/day  3 doses c) : 50 mg/kg/day  2 doses d) Lincomycin: 30 mg/kg/day  3-4 doses e) Ciprofloxacin 2 x 500-750 mg Topical • 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. Complicationsacute glomerulonephritis The most serious ! 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: & eye refraction disorder FOLLICULITIS

SYCOSIS BARBAE FURUNCLES An infection in hair follicles & surrounding tissue (perifoliculer) Course & clinical manifestations: Acute , nodules with sharply defined margins,  5 days: central suppuration, blind . Predilection: nape, , buttocks. Predisposition factors: - Diabetes mellitus -Malnutrition - Seborrheic  Th/Specific: if there is  incision FURUNCLE CARBUNCLES • the worst form of a furuncle, with coalescence of furuncles and marked , 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 . Carbuncles ulcer (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, web  macula (brownish redness) or plaque, fine scaly. Wood’s lamp: a coral red fluorescence. Predisposing factors: heat, humidity, . 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, and 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. 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 -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 and subcutaneous tissues, primary sign: skin erythematic without sharply

defined margins. Etiology: Group A Streptococcus &; 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, , vBecoming march celullitis, gas, if the 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 fold surrounding the nail plate. E/: Staphylococcus or fungal: 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 may sometimes be expressed from them. Chronic paronychia is favored by , 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 , 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 . 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

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/: 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 , 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 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: 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. : 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. 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 fungoides - Verrucosa on 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. THANK YOU

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