dr. Uun Khusnul Khotimah, SpKK

Skin infection Caused by pyogenic bacteria Easily transmitted

Etiology•Staphylococcus ( S. aureus, S. albus ) •Streptococcus ß haemoliticus •Corynebacterium minutissimum

•o    Low stamina, malnutrition,

gravis anemia, diabetes mellitus

•o    Low hygiene individual

•o    Low hygiene area

•o    Pre-existing skin diseases

1. Primary pyodermas- infection on the normal skin without

other skin diseass- Caused by: one type microorganisme

Staphylococcus and Streptococcus- Characteristic skin manifestation

a) Impetigob) Folliculitisc) Furunclesd) Carbunclese) Ecthymaf) Erythrasmag) Erysipelash) Cellulitisi) Paronychiaj) Staphylococcal scalded skin syndrome

Complicating preexisting skin lesions, such as scabies, eczema, varicella, thus clinical manifestations are not characteristic.

Examples:- Hidradenitis supurativa

- Intertrigo- Ulcers- Secondary infection

1. General treatments:-  Medical; personal & environmental hygiene

advices-  Immunological factor -  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 dosesd) Lincomycin: 30 mg/kg/day 3-4 dosese) Ciprofloxacin 2 x 500-750 mg

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:

4 types of primary pyoderma considered from the etiology:

1. Staphylococcus- impetigo contagiosa bullosa- folliculitis, furuncles & carbuncles- sycosis barbae- Staphylococcal Scalded Skin Syndrome

2.  Streptococcus: Impetigo contagiosa crustosa Ecthyma Erysipelas3. Staphylococcus & Streptococcus: Cellulitis4.  Corynebacterium minutissimum: -   Erythrasma

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

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

Manifestation: erythematous eritema, vesicle and bullae pustule thick crust.

Predilection: face, extremities Streptococcus group A serotype 2. Complicationsacute glomerulonephritis The most serious complication!

HipopionImpetigo contagiosa crustosa

Impetigo contagiosa bullosa

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 folliculitisDeep 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 compressComplication: blepharitis & eye refraction disorder

SYCOSIS BARBAE

An infection in hair follicles & surrounding tissue (perifoliculer) 

Course & clinical manifestations: Acute pain, nodules with sharply defined

margins, erythema 5 days: central suppuration, blind boil.

Predilection: nape, axilla, buttocks.  Predisposition factors:

- Diabetes mellitus -Malnutrition- Seborrheic dermatitis

Th/Specific: if there is abscess incision

• the worst form of a furuncle, with coalescence of furuncles and marked inflammation, 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 ulcer. Carbuncles ulcer

Treatment: Systemic: general pyodermas treatment Local: - upper nodule : warm compress - abscess : incision

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

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, toe web macula (brownish redness) or plaque, fine scaly.Wood’s lamp: a coral red fluorescence.

Predisposing factors: heat, humidity, obesity. 

Treatment: erythromycin 4 x 250 mg/ day.

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, diabetes

mellitus, systemic diseases, and bad hygiene

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. Elephantiasis nostras

Predilections:face and head extremities & genital Treatments: Bed rest General pyoderma treatment: systemic antibiotic Cold compress Complication: ELEPHANTIASIS NOSTRAS

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

Course & clinical manifestations:Beginning from insect bite, small wound, ulcers (porte d’entre). Erythema and severe pain, fever and chills, palpation: pain and heat.

Vesicles local abscess necrotic.

Celullitis can occur on the head, perianal cellulitis,

Becoming march celullitis, gangrene gas, necrotizing fasciitis if the infections have extended into the fascia and caused blood vessels thrombosis gangrene.Initially 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

an infection of the nail fold surrounding the nail plate.

E/: Staphylococcus or fungal: Candida albicans 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 pus may sometimes be expressed from them.

Chronic paronychia is favored by ingrown nail, prolonged immersion in water and simple injuries. There is latitude line on the nail fold.

Treatments:o   Systemic: acute antibiotic/ penicillino   Topical:  Acute rivanol 1 %, after drying –

antibiotic ointment  Chronic/ recurrence nail extraction    Candida albicans: Antibiotic+ Anticandida nystatin Prognosis: generally good. 

A skin infection, caused by typical exotoxin of Staphylococcus aureus with a characteristic sign of epidermolysis.

 Etiology & pathogenesis: Group 11 phage (type 52,55 and 71)

Staphylococcus aureus. The exotoxins produce epidermolysis on all

over the body into the epidermis. There is no bacteria found on the skin. Focal infections are eye, nose, throat & ear

infection.

High fever, accompanied by upper respiratory tract infectionsErythem 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 combustionComplication: cellulitis, pneumonia, septicemiaDD: Toxic epidermal necrolysis.

• 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

AK®

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