SUPERFICIAL BACTERIAL INFECTIONS

STAPHYLOCOCCAL

STREPTOCOCCAL

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

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

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)

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

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.

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

Furuncle

• Friction / Occlusion / Perspiration

• Staph. aureus

• Small, hard, tender, folliculocentric nodule

Fluctuant Ruptures

• Painful

• Constitutional symptoms

• Heals with scar

• Site: Neck, Wrist, Waist, Buttocks, Face

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

• 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

Carbuncles

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.

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.

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

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

Staphylococcal Pyoderma : Specific Treatment

Specific Treatment : Streptococcal Pyoderma

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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