PENYAKIT KULIT YANG DISEBABKAN OLEH BAKTERIYunita Hapsari Bagian Ilmu Kesehatan Kulit dan KelaminFakultas Kedokteran Universitas Mataram

PYODERMAInfeksi pada kulit, yang disebabkan oleh bakteri yg membentuk nanah atau piogenik dan mudah menularEtiologi :Staphylococcus S.aureusStreptococcus Streptococcus grup AKedua-duanya

Faktor predisposisi :Daya tahan tubuh rendahHigiene individu kurangHigiene lingkungan kurangTelah ada penyakit kulit sebelumnya

Klasifikasi pyoderma :PRIMERSEKUNDERImpetigo FolikulitisFurunkelKarbunkelParonikia Ektima ImpetigenisataHidradenitis supurativaIntertrigoUlkus

IMPETIGOPyoderma superfisialEtiology : Streptococcus grup A S.aureus2 bentuk :BulosaNon-bulosa / krustosa

Impetigo vesiko-bulosa, cacar monyetEtiology : phage group II S.aureus (strain 77 & 55) exfoliatin toxin type A and BClinical : newborn and older infantsVesicle flaccid bullae (rapid progression)Nikolsky sign (-)Bullae : clear yellow fluid dark yellow & turbidMargin : sharply demarcated w/o erythematous halow/i a day or two bullae rupture & collapseIMPETIGO BULOSA

IMPETIGO BULOSA

Lab : Pengecatan GramKultur histoPADD/ :Dermatitis kontakInsect biteErupsi obat tipe bulosaIMPETIGO BULOSA

Complication :CellulitisLymphangitisBacteremiaOsteomyelitisSeptic arthritisPneumonitisSepticemiaSSSSIMPETIGO BULOSA

IMPETIGO NON BULOSA/KRUSTOSAImpetigo kontagiosa, impetigo vulgaris, impetigo Tillbury Fox70% of cases of this form of pyodermaEtiology :Streptococcus group A pre-school aged children (

Clinical finding:Pruritus; soreness; burning ; painlessCommonly on the skin of the face (around the nares) or extremities after traumaTransient pustule or vesicle honey-colored crusted plaque (2cm) w/i surrounding erythemaNo constitutional symptomsRegional lymphadenopathy (90%)

IMPETIGO NON BULOSA/KRUSTOSA

IMPETIGO NON BULOSA/KRUSTOSA

Lab : Gram stainCulture DD/ :Atopic dermatitisAllergic contact dermatitisVaricella Dermatophyte infectionIMPETIGO NON BULOSA/KRUSTOSA

Complication :Untreated process may persist and new lesions over the course and for several weeksResolve spontaneusly except there is some underlying cutaneous diseaseErysipelasCellulitisBacteremiaMajor serious sequela acute post-streptococcal glomerulonephritisIMPETIGO NON BULOSA/KRUSTOSA

MANAGEMENT OF IMPETIGOWashing (removal of dirt, crusts and debris by soaking with soap & water)Good hygienePharmacology: topical and systemicTopical & Systemic Antibiotic

FOLIKULITISDef : a pyoderma that begins within the hair folliclesClassified : Depth of invasion : superficial and deepMicrobial etiology : bacterial, fungal, viral and parasite infestation

FOLIKULITIS SUPERFISIALImpetigo Bockhart; follicular impetigoEtiology : S.aureusClinical finding:Location : scalp (children); beard area, axillae, extremities, buttocks (adults)A small, fragile, dome-shaped pustule infudibulum of a hair follicleDD/ : - gram-negative folliculitisPityrosporum folliculitisHerpes simplexDeep folliculitis sycosis barbae

FURUNKELBoil / bisulDeep-seated inflammatory nodule that develops around a hair follicle, usually from a preceding, more superficial folliculitis and often evolving into an abcessEtiology: S.aureusClinical finding :Pain surrounding the lesionNodule (hard, tender, red folliculocentric) enlarge fluctuant abcess formation ruptureSingle/multiple

Furunkel / Furunkulosis ?

FURUNKELLab:LeukocytosisGram stain of pusCulture

ComplicationNot commonRecurrent furunculosis

KARBUNKELLarger, more serious inflammatory lesion with a deeper baseExtremely painfulFever, malaiseLocation : nape of the neck, the back or thighsEfl : red, indurated, multiple pustules confluent

MANAGEMENT OF FURUNCLE & CARBUNCLEWashing and hygieneLocalized local application of moist heatSystemic systemic antibiotic Incision and draining the lesions

EKTIMAA cutaneous pyoderma characterized by thick crusted erosions or ulcerationEtiology: S.aureus &/ group A StreptococcusClinical finding:Poor hygiene & neglectLocation : lower extremities (children, DM, elderly)Efl: ulcer punched-out, indurated, raised, violaceous, granulating base slow to heal need several weeks of antibiotic treatments

ERISIPELAS Soft tissue infection erysipelas & cellulitisUsually present at an antecedent lesion or siteLocal pain, variable degrees of erythema, systemic symptoms

ERISIPELAS Distinct type of superficial cutaneous cellulitis with marked dermal lymphatic vessel involvementEtiology : group A -hemolytic Streptococcus (>>) ; S.aureus (

SELULITISExtends deeper into the dermis and subcutaneous tissueEtiology : S.aureus and group A Streptococcus (>>)Clinical finding :Erythema, tenderness, painLack of distinctive margins between affected and normal skinDeeper, firmer form of tender indurationCrepitus on palpationBulla and necrosisRegional lymphadenopathy

SELULITIS

PENATALAKSANAANIstirahat tirah baring & elevasi tungkaiSistemik antibioticTopikal : kompres dingin dengan normal saline sterilIntervensi bedah