Superficial pyodermas by aseem
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SUPERFICIAL BACTERIAL INFECTIONS
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STAPHYLOCOCCAL
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STREPTOCOCCAL
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Impetigo
Non-bullousBullous
1. Cause
Streptococcal (Group A) Staph. aureus
Staph. aureus (Phage Groups II)
2. Pre-school / Children All ages
3. Very thin walled vesicle
on an erythematous base Bullae of 1-2cm
4. TransientPersist for 2-3 day
5. Thick yellowish crusts Thin, flat, brownish crust
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6. Irregular peripheral extension Central extension with healing
Without healing
7. Regional LAN Rare
8. Constitutional symptoms present Absent
9. Face (around the nose, mouth & limbs) occur anywhere
10. Palms & sole spared May be involved
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Non-bullous impetigo is a superficial skin infection that manifests as clusters of vesicles or pustules that rupture and develop a honey-colored crust.
Bullous impetigo is a superficial skin infection that manifests as clusters of vesicles or pustules that enlarge rapidly to form bullae. The bullae burst and expose larger bases, which become covered with honey-colored varnish or crust.
Impetigo (Bullous)Impetigo (Non-Bullous)
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Ecthyma• Strep / Staph
• Common in children
• Small bullae or pustules on erythematous base
• Formation of adherent dry crusts
• Ulcer present beneath
• Indurated base • Heals with scar and pigmentation
• Buttocks, thighs and legs commonly affected
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Ecthyma gangrenosum is a bacterial skin infection (caused by Pseudomonas aeruginosa) that usually occurs in people with a compromised immune system.
Ecthyma is a skin infection similar to impetigo, but more deeply invasive. Usually caused by a streptococcus infection, ecthyma goes through the outer layer (epidermis) to the deeper layer (dermis) of skin, possibly causing scars.
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Folliculitis
• Superficial folliculitis (= Bockhardt’s Impetigo)
• Dome-shaped pustule at Follicular Ostium at
Infundibulum
• Commonly caused by Staph. Aureus
• Children
• Scalp & limbs
• Rarely painful
• Heals in a week
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Furuncle
• Friction / Occlusion / Perspiration
• Staph. aureus
• Small, hard, tender, folliculocentric nodule
Fluctuant Ruptures
• Painful
• Constitutional symptoms
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• Heals with scar
• Site: Neck, Wrist, Waist, Buttocks, Face
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Carbuncle
• Extensive infection of a group of contagious follicles
that develop subcutaneous connections
• Staph. aureus
• Middle or old age
• Nape of Neck / Buttocks
• Painful, hard lump
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• Suppuration begins after 5-7 days
• Pus discharge from multiple follicular orificies
• Necrosis of intervening skin
• Large deep ulcer with yellowish granulation tissue
• Constitutional symptoms
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Erysipelas
• Erysipelas is a type of superficial cellulitis with dermal lymphatic involvement.
• Erysipelas is characterized clinically by shiny, raised, indurated, and tender plaque-like lesions with distinct margins.
• Erysipelas is most often caused by GAS and occurs most frequently on the legs and face. Also by S aureus.
• It is commonly accompanied by high fever, chills, and malaise. Erysipelas may be recurrent and may result in chronic lymphedema.
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Erysipelas is characterized by shiny, raised, indurated, and tender plaque-like lesions with distinct margins. It is most often caused by β-hemolytic streptococci and occurs most frequently on the legs and face.
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Principles of therapy of pyoderma
• Good personal hygiene• Management of predisposing factors
– Local • Attend to traumas, Pressure, Sweating, Bites• Treat pre-existing dermatosis• Investigate carrier sites: Nose, Umblical, Perineum
Systemic• Treatment of disease like DM • Nutritional deficiency • Immunodeficiency
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Principles of therapy of pyoderma
• Local therapy
– Cleaning with soap-water and weak KMN04
solution to remove crusts
– Application of antibacterial cream
• Systemic therapy
– Antibiotics
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Staphylococcal Pyoderma : Specific Treatment
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Specific Treatment : Streptococcal Pyoderma
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Staphylococcal Carrier Elimination
• Nasal / Umblical / Perianal Care (4-point)
• Rifampicin 600 mg/d x 7-10 days
• Clindamycin 150 mg/d x 3 months
• Topical mupirocin 2% for nasal
decolonization
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