Kuliah Pioderma Dr Asih Budiastuti

8/10/2019 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



Definition

Skin infectionCaused 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 withoutother skin diseass

- Caused by: one type microorganisme

Staphylococcus and Streptococcus- Characteristic skin manifestation



Primary pyodermas (examples)

a) Impetigo

b) Folliculitis

c) Furuncles

d) Carbunclese) Ecthyma

f) Erythrasma

g) Erysipelash) 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- Infectious eczematous dermatitis



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 dosese) 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 Cellulitis4. Corynebacterium minutissimum:

- Erythrasma



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



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, extremitiesStreptococcus 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 domeshapedpustules occur at the infundibulum of hairfollicles, erythematous surrounding

2. Deep folliculitis

Deep microabces + crust abces collarbutton



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



FOLLICULITIS

SYCOSIS BARBAE



FURUNCLES

An infection in hair follicles & surrounding tissue

(perifoliculer)


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



FURUNCLE



CARBUNCLES

• the worst form of a furuncle, with coalescence offuruncles and marked inflammation, there aremultiple pustules.


1. Superficial carbuncles:Red nodules, multiple perforation : withoutleaving deep ulcers.

2. Deep carbuncles:

The nodules appear like carsinoma, multipleperforations, leaving deep ulcer . Carbunclesulcer



Carbuncle (treatment)

Treatment:

Systemic: general pyodermas treatment

Local: - upper nodule : warm compress

- abscess : incision



CARBUNCLE



ECTHYMA

A pyogenic infection, characterized by stickycrustae. There are ulcers if crusts aredebrided


Predilection: legs, buttocks vesiculopustulae thick crust the ulcer

has a ‘punch out’ appearance, the margin ofthe ulcer is indurated, raised and violaceous.

DD/ Impetigo



ECTHYMA



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.



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, diabetesmellitus, systemic diseases, and bad hygiene



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



ERYSIPELAS

Predilections:

face and head extremities

& genital

Treatments:

v Bed rest

vGeneral pyoderma treatment:

systemic antibioticCold 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




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



Cellulitis treatment:

Bed rest better general conditions

Systemic: general pyoderma treatment:antibiotic

Topically: acute cold compress

Abscess/ gangrene incision, debridement ofnecrotic tissues



PARONYCHIA an infection of the nail fold surrounding the nailplate.

E/: Staphylococcus or fungal: Candida albicans


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.



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.



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.



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.



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



HIDRADENITIS SUPPURATIVA

A chronic &recurrent suppurativa infection inapocrine sweat glands.

Affecting apocrine sweat gland, in adult men

& womenE/:Staphylococcus aureus & Proteus Sp


Preceded by injuries, axilla hair cutting,deodorant using.

Predilection: the axilla, perianal & genital.



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



HIDRADENITIS SUPURATIVA



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



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





INTERTRIGO



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





Consider these when describing

an ulcerBase:

- 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.







THANK YOU

AK®

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Kuliah Pioderma Dr Asih Budiastuti