Kuliah Pioderma Dr Asih Budiastuti
Transcript of Kuliah Pioderma Dr Asih Budiastuti
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PYO ERM S
Dr. Asih Budiastuti, SpKK
Department of Dermato-venereology
Medical Faculty of Diponegoro UniversitySemarang
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Definition
Skin infectionCaused by pyogenic bacteria
Easily transmitted
Etiology
•Staphylococcus ( S. aureus, S. albus )
•Streptococcus ß haemoliticus
•Corynebacterium minutissimum
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Prediposition factors:
•o Low stamina, malnutrition,
gravis anemia, diabetes mellitus
•o Low hygiene individual
•o Low hygiene area
•o Pre-existing skin diseases
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Classification
1. Primary pyodermas
-infection on the normal skin withoutother skin diseass
- Caused by: one type microorganisme
Staphylococcus and Streptococcus- Characteristic skin manifestation
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Primary pyodermas (examples)
a) Impetigo
b) Folliculitis
c) Furuncles
d) Carbunclese) Ecthyma
f) Erythrasma
g) Erysipelash) Cellulitis
i) Paronychia
j) Staphylococcal scalded skin syndrome
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2.Secondary pyoderma
Complicating preexisting skin lesions, such
as scabies, eczema, varicella, thus clinical
manifestations are not characteristic.
Examples:- Hidradenitis supurativa
- Intertrigo
- Ulcers- Infectious eczematous dermatitis
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PYODERMAS TREATMENT
1. General treatments:
- Medical; personal & environmental
hygiene advices
- Immunological factor
- Antibiotics
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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 dosese) Ciprofloxacin 2 x 500-750 mg
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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:
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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
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PRIMARY PYODERMAS (etiology)
2. Streptococcus:
q Impetigo contagiosa crustosa
q Ecthyma
q Erysipelas
3. Staphylococcus & Streptococcus:
v Cellulitis4. Corynebacterium minutissimum:
- Erythrasma
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IMPETIGO
A bacterial infection that attacks
superficial epidermal between stratum
corneum and stratum granulosum, veryinfectious.
2 types of impetigo:
1. Impetigo contagiosa bullosa
2. Impetigo contagiosa crustosa
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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
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2. Impetigo contagiosa
crustosa
Manifestation: erythematous eritema, vesicle
and bullae pustule thick crust.
Predilection: face, extremitiesStreptococcus group A serotype 2.
Complicationsacute glomerulonephritis
The most serious complication!
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IMPETIGO
Hipopion
Impetigo contagiosa crustosa
Impetigo contagiosa bullosa
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FOLLICULITIS
A hair follicle infection.
Course & clinical manifestations:
1. Superficial folliculitis
There are small fragile domeshapedpustules occur at the infundibulum of hairfollicles, erythematous surrounding
2. Deep folliculitis
Deep microabces + crust abces collarbutton
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Deep folliculitis (Examples):
i. Sycosis barbae occuring in the beardedareas of the face and upper lip.
ii. Hordeolum (stye): a deep folliculitis of thecilia of the eyelid margin.
Nodule is covered by pustule swelling ofperifollicular tissue when dried becomescrust at the edge of palpebra.
Treatment : warm compress
Complication: blepharitis & eye refractiondisorder
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FOLLICULITIS
SYCOSIS BARBAE
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FURUNCLES
An infection in hair follicles & surrounding tissue
(perifoliculer)
Course & clinical manifestations:
Acute pain, nodules with sharply defined
margins, erythema 5 days: centralsuppuration, blind boil.
Predilection: nape, axilla, buttocks.
Predisposition factors:- Diabetes mellitus -Malnutrition
- Seborrheic dermatitis
Th/Specific: if there is abscess
incision
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FURUNCLE
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CARBUNCLES
• the worst form of a furuncle, with coalescence offuruncles and marked inflammation, there aremultiple pustules.
Course & clinical manifestations:
1. Superficial carbuncles:Red nodules, multiple perforation : withoutleaving deep ulcers.
2. Deep carbuncles:
The nodules appear like carsinoma, multipleperforations, leaving deep ulcer . Carbunclesulcer
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Carbuncle (treatment)
Treatment:
Systemic: general pyodermas treatment
Local: - upper nodule : warm compress
- abscess : incision
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CARBUNCLE
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ECTHYMA
A pyogenic infection, characterized by stickycrustae. There are ulcers if crusts aredebrided
Course & clinical manifestations:
Predilection: legs, buttocks vesiculopustulae thick crust the ulcer
has a ‘punch out’ appearance, the margin ofthe ulcer is indurated, raised and violaceous.
DD/ Impetigo
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ECTHYMA
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ERYTHRASMA
A skin disease caused by gram-positivebacterial infection, superficial lesions withsharply defined margins.
Etiology: Corynebacterium minutissimum
Symptoms & signs:The body folds, axilla, genitocrural, toe web macula (brownish redness) or plaque, finescaly.
Wood’s lamp: a coral red fluorescence.
Predisposing factors: heat, humidity, obesity.
Treatment: erythromycin 4 x 250 mg/ day.
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ERYTHRASMA
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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, diabetesmellitus, systemic diseases, and bad hygiene
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ERYSIPELAS (course & clinicalmanifestation)
Beginning from ulcer, wound, pustule.
Quick progress pain, fever, weakness
Spreading erythema to the periphery,
sharply circumscribed, oedema, palpation:warm & pain. Vesicles & bullae on theerythematous skin.
Exacerbation in the same place causespermanent changes: swelling, oedema canbe caused by blockage of the venous andlymphatic vessels on the lips, lower legs
and feet. Elephantiasis nostras
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ERYSIPELAS
Predilections:
face and head extremities
& genital
Treatments:
v Bed rest
vGeneral pyoderma treatment:
systemic antibioticCold compress
Complication: ELEPHANTIASIS NOSTRAS
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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
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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
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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, perianalcellulitis,
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, raising
vesicles or bullaes crepitation sign
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Cellulitis treatment:
Bed rest better general conditions
Systemic: general pyoderma treatment:antibiotic
Topically: acute cold compress
Abscess/ gangrene incision, debridement ofnecrotic tissues
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PARONYCHIA an infection of the nail fold surrounding the nailplate.
E/: Staphylococcus or fungal: Candida albicans
Course & clinical manifestations:
Beginning from nail folds – expanding into nailmatrix & nail plate : characterized by theswelling of the lateral nail fold adjacent to theside 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 simpleinjuries. There is latitude line on the nail fold.
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PARONYCHIATreatments:
o Systemic: acute antibiotic/ penicillino Topical:
Acute rivanol 1 %, after drying – antibioticointment
Chronic/ recurrence nail extraction
Candida albicans:
Antibiotic+ Anticandida nystatin
Prognosis: generally good.
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STAPHYLOCOCCAL SCALDED-
SKIN SYNDROME SSSS)
A skin infection, caused by typical exotoxin ofStaphylococcus aureus with a characteristic signof epidermolysis.
Etiology & pathogenesis:
vGroup 11 phage (type 52,55 and 71)Staphylococcus aureus.
v
The exotoxins produce epidermolysis on all overthe body into the epidermis.
v There is no bacteria found on the skin.
v Focal infections are eye, nose, throat & ear
infection.
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SSSS (Course& clinical manifestations)
High fever, accompanied by upper respiratorytract infections
Erythem on the face, neck, axilla, groin allover the body in 24 hours.
Characteristic tissue-papers like wrinkling ofepidermis is followed by appearance of largeflaccid bullae (Nicolsky sign +) like combustion
Complication: cellulitis, pneumonia, septicemia
DD: Toxic epidermal necrolysis.
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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
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SSSS
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SECONDARY PYODERMA
Examples:
- Hidradenitis supurativa
- Intertrigo- Ulcers
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HIDRADENITIS SUPPURATIVA
A chronic &recurrent suppurativa infection inapocrine sweat glands.
Affecting apocrine sweat gland, in adult men
& womenE/:Staphylococcus aureus & Proteus Sp
Course & clinical manifestations:
Preceded by injuries, axilla hair cutting,deodorant using.
Predilection: the axilla, perianal & genital.
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HIDRADENITIS SUPPURATIVA
DD/:Scrofuloderma
Treatments:
• Usually very difficult, considering the multiple
lesions and the deep location on theprofundal layer
• Abscess incision
• Chronic and cicatrix apocrine glandexcision
PROGNOSIS: poor -- recurrence
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HIDRADENITIS SUPURATIVA
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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 theskin meets
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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
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INTERTRIGO
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ULCERS
a skin disorder caused by tissue necroticoccurring in the epidermis, dermis andsubcutan expanding into bone tissue.
Ulcers caused by bacteria:
1. Pyogenicum ulcer
2. Carbuncles ulcers
3. Tuberculosis ulcers
4. Tropicum ulcers5. Durum ulcers
6. Molle ulcers
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Consider these when describing
an ulcerBase:
- dirty on carbuncles ulcer
- Clean on durum ulcer
Surrounding skin:
- red on carbuncles ulcer
- Livide on tuberculosis ulcer
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PYOGENICUM ULCER
Round-shaped, 0.5-1 cm in diameter,
red border, covered by pus,
often on the foot,E/: Streptococcus/ Staphylococcus.
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CARBUNCLES ULCERS
Furuncles convalesce, necrotic,
Predilection: on the back and nape,
In diabetes mellitus patient.
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THANK YOU
AK®