Pyodermia.

A.Rodin

Pustular skin diseases

(pyodermia) take the first place
among all dermatoses and
account 15% of all morbidity with
loss of work capability.

Those diseases that usually occur as a

result of exogenous intradermal
introduction of pyogenic cocci refer to
the group of pyoderma diseases. They
can occur as firstly as well as secondly in
complicated forms of other dermatoses.
More often pruritis dermatoses are
accompanied by mechanical injury and
skin disintegrity.

Etiology.

The causative agent of

pyodermia is commonly
Streptococci and Staphylococci,
Escherichia coli, Proteus
vulgaris, pneumococci and other
microorganisms. Streptococci
and Staphylococci are widely
spread in nature, soil and air.

75% of healthy adults and 60% of

infants have Staphylococci on the
skin. 10% of them have Streptococci,
however, there are no pyodermia
manifestations as not all cocci are of
pathogenic etiology; on the other
hand, uninjured and functioning in
norm skin is a perfect barrier for
their penetration.

Therefore for pyodermia

development it essential to have
exogenous and endogenous
factors changing the protective
functions of the skin.

Exogenous factors:
1. Destruction of water-lipid
coverage under the influence of
skin hygiene insufficiency
(cement pollution, gas-oil
materials, coal, etc.).
2. Skin traumas (as well as
microtraumas).

3.

4.

Supercooling causing the

reduction of sweat glands,
vasoconstriction, overheating
Secretory malfunction:
increased sweat secretion,
seborrhea, that in its turn
decreases its sterile
properties.

Endogenous factors:
1. Endocrine system pathology:
diabetes , thyroid gland insufficiency,
hypophysis and epinephros system
insufficiency, and sex gland
insufficiency.
2. Vegetative neuroses accompanied by
vascular tonicity malfunction as well
as sweat gland malfunction.

3.
4.

Topical trophic disorders.

Chronic intoxication (gastrointestinal pathology, TBC, etc.),
hypovitaminoses, hypotrophy,
immunodeficiency.
5. Hereditary inclination.

Classification.

Depending on the etiological

findings the Staphylodermia,
Streptodermia and mixed forms
of infections are ascertained.

Staphylodermia

Staphylococci parasitize on the skin

in the area of hair follicle orifice
and fat ducts and apocrinic sweat
gland. Moreover, a hair follicle is
supplied with blood vessels and
nerves, weaving a net around it
that is why inflammation is easily
appeared and has severe forms.

Children of neonatal period and

up to 1 year old are excluded.
Staphylodermia are manifested
by means of elements, which are
not connected with hair follicles
and fat glands. But
Staphylococci involve accrine
sweat glands in children.

This is due to fact that apocrine

glands dont function, hair
follicles are not perfect and
excretion ducts of accrine glands
are short, straight and wide
stipulating conditions for
microflora penetration.

Vesiculopustulosis.

It occurs on the 3-5 day after

birth and is stipulated by
follicle orifice involvement of
the accrine glands. Pustules
being of the size of needle head
occur on the hair and folders. If
the essential care is taken and
an appropriate therapy is
administered the dermatosis
vanishes in 3-7 days.

Pseudofurunculosis.
(multiple abscesses).

Some children with

vesiculopustulosis the course of
disease is severe, infection is easily
penetrates into depth of the skin
involving orifice as well as the gland
itself. Multiple intradermal nodes in
the size of a pea to a nut, purple-red
with blue shadows in colour appear
on different areas of the skin.

Disintegrity of infiltrate is
accompanied with skin node
thinning than abscesses eruption
takes place discharging yellowgreen pus. Commonly, weak
children suffer this disease
(artificial feeding, delivery
trauma etc.).

As a rule the general condition is

destroyed (the temperature rises
up to 39 C, anorexia, body weight
loss, dyspepsia, intoxication).
Hypochrome anemia, leukocitoses
with left side shift, accelerated
ESR are in the peripheral blood.
There is a protein, leukocytes,
erythrocytes, and cylinders in the
urine.

Some children suffering

pseudofurunculosis show septic
condition with pyemic focuses
such as a suppurative otitis,
paraproctitis, flegmon,
meningitis, pneumonia.

Epidemic pemphigus in
infants (pyococcic
pemphigoid).

On the 3-15 th day after the

birth slight blisters appear at the
size of pea to nuts surrounded by
lightly pink inflammatory crown.
The rash is localized on the skin
of the trunk near natural folders,
on the extremities. Subfebrility is
noticed.

After blisters eruption a moist

erosian remains, however crust
is not formed. In sever cases
septic development can occur.
Pyococcic pemphigoid is a
catching disease that is why it is
essential to isolate children.

Exfoliate Ritters
dermatitis.

It is one of the severe forms

Staphylodermia in infants. During
the exacerbation period of
epidemic pemphigus, exfoliate
Ritters dermatitis premature and
weak children suffer this disease.
Usually the onset starts in
several days after the birth as a
hyperemia and a maceration
around the mouth.

Than slight skin hyperemia,

epidermis exfoliation and blisters
formation occur on different
areas. The epidermis exfoliates
with wide layers. A new-born
looks as if it has a burn, clinical
picture resembles a scald II, even
a slightest touch causes
epidermis exfoliation (Nikolsky
symptom).

General condition is severe,

temperature rises up to 41 C,
many have toxico-septic
condition, and afterwards sepsis
develops. The lethal outcome is
high.

Many scientists identify exfoliate

Ritters dermatitis as a syndrom
of Staphylococcic skin scald (up
to 5 years old it is considered to
a Staphylococcic variety of the
toxic epidermonecrolisis Layel
syndrome).

Ostiofolliculitis.

The inflammatory process is

localized in the hair follicle
orifice as a pustule in the size of
needle head conic in shape. The
localization is frequently noticed
on the skin of the face, neck.

The pustule exists only 2-3 days,

dries up into a crust and
afterwards there is a pigment
spot remnants. Ostiofolliculitis
can occur as a complicated
pruritis form of dermatosis
(scabies, pediculosis, eczema,
atopic dermatitis).

Folliculitis.

This form of the disease develops

when the infection spreads into the
depth of the hair follicules. The
superficial and deep folliculitis are
identified. In superficial form the
inflammation appears on the papilla
dermal layer level therefore the
eruption doesnt leave any traces

. In deep form of folliculitis the

process involve the whole follicle
and necrotic masses is
accompanied with small ulcer
formation. The folliculitis usually
painful thickened but without
fluctuates in palpation. The course
length takes about 5-7 days.

Furuncle.

This disease involves not only the

follicle itself but also surrounding
tissues. It can develop from
folliculitis however, the
inflammation develops in the
deep layers of the follicle having
the size of a pea or a nut. The
process is accompanied with
intensifying painfulness, edema
and hyperemia.

In 3-4 days the infiltrate becomes

necrotic, thinned. The excreted
pus has a green colour. The central
part becomes rejected, and the
inflammatory processes subside.
The annular ulcer is filled by
granulation to form a scar. The
whole circle takes 10-12 days.

Carbuncle.

It the most sever form of

Staphylogenic piodermia. It
presents any furuncles localized in
one place. Sometimes the size can
be of a fist. The localization is
stipulated to the cloth wearing. In
the center of the carbuncle one can
notice some pustules, necrotic
core.

After the rejection a huge scar

forms. As a rule during period of
exacerbation such symptoms as
headache, general weakness,
temperature increase and
intoxication are observed.

Hydradenitis.
Staphyllogenic purulent
inflammation of apocrine sweat
glands and as a result the
localization is in the armpit, in the
area of genitalia, perianus area.
Clinical manifistation are in
hyperemic abscesses (the size of a
pea) and central fluctuation. The
abscess extracts with a significant
pus amount. There are no necrotic
cores. The disease may prolong
turning into a chronic-recurrent
form.

Staphylodermia treatment.

Osteofolliculitis, superficial
folliculitis can be treated
topically pustule opening,
painting the focuses with anilin
paintings, prophylaxis around
the area of focuses 2%
salicylic, boric, camphor acid.

Deep foliculitis , furuncle,

hydradenitis.
Usually the application of topical
forms is quite appropriate, but in
case if the pustules are observed on
the face antibiotics of a systemic
action (polysynthetic penicillin,
macrolides, tetracicline) are
administed . After the eruption of
the focus the use of hypertonic
solution is of great importance,
after the ulcer cleaning the use of
ointments with antibiotics is also
essential. Sometimes surgical
intervention.

Carbuncle.

Systemic antibiotic treatment, a

wide X-like incision if the course
it sever. Generally the
treatment is the same to
furuncle.

Streptodermia.

Impetigo or Streptodermia
characterized by the surface
involvement of the skin, folders.
Follicles and sweat glands are
not involved. Females and
children suffer this disease
commonly.

The 1-st morphologic element is

phlychtena a thin blister of semispheric shape containing serousturbid substance and located under
the horny layer. Phlychtena occurs
on the hyperemic spots. The
development of each blister takes
about 5-7 days. A thin cover erupts
very quickly, the containing mass
becomes dry very quickly.

After the rejection one can

observe the erosion
consequently epithelized with
unstable erythema formation.
There are no scar and atrophy
changes. The place of
localization is the arms, face,
and trunk.

There are the following

varieties of impetigo
1. Blister impetigo. Mostly observed
in females and children. The place of
localization is wrists, planta pedis,
and ankles but rarely. They appear
singly, the size is variable from 1 sm
up to an egg, and blisters are with
serous-turbid contents. After the
eruption the coverage form an
erosive crust.

2. Cleft-like impetigo.
This form is characterized with a
quickly erupted form of
phlyctena localized in the
peripheries of the mouth, at the
base of the nose wings, eye
fissures. Due to the maceration
clef-like fissures form, the crusts
reject very quickly the disease is
accompanied with painful cracks.

3. Intertrigo
streptodermia.
This form is usually developed in
overweighed people, diabetic
persons and pastosis children. The
phlyctena occur on the surface of
large folders, become fused, after
the eruptions there are huge
erosive moist surfaces of pink
bright colour. This kind of
dermatosis has the form of pruritis.

Chronic ulcer pyodermia.

This disease is characterized with

a quiet course, deep skin
involvement, and usually a lower
extremity. In pathogenesis
microorganisms the main role
play. The blood circulation and
innervation also play an important
part. Males suffer this disease
often at the age of 40-50years old.

Usually the disease starts with deep

pustule gradually proliferating and
becoming fused. The periphery has
the inflammatory infiltration, which
become necrotic. Due to this fact the
ulcer enlarges in diameter. There a
lot of abscesses at the base of the
ulcer. The possibility of periostitis
and osteoperiostitis can occur.

The impetigo treatment.

In usual cases the skin is treated

by means of alcohol solution,
massive crusts are removed by
lotions with oil. The focuses are
painted with ointments with
antibiotics.

Chronic pyoderma
treatment

Due to the ecology,

hypovitaminization, disease
pyodermia turns into a chronic
disease. The cause of this is
immune deficiency. There is
specific and non-specific immune
therapy.

Specific immune therapy

Active

immunization.

1. Absorbed staphylococcic
anatoxin
2. Native staphylococcic anatoxine
3. Staphylococcic antiphagin

Passive immunization

is performed when the

patients organism is in no
condition to produce its own
protective properties.
Staphylococcic hyperimmune
plasma
Anti-staphylococci gammaglobulin.

Non specific therapy

Autohemotherapy; blood
transfusion
Pyrotherapy (pyrogenal)
Ultraviolet and laser radiation of
the blood, ozonetherapy
Immune modulators (T-activin,
pentoxil, amixine, thymolin etc).

General therapy. Vitamines (B1,

B6, B12, A, C, E), biogenic
stimulants.
In deep chronic cases antibiotics
as well as corticosteroids are
administered (20-40 mg of
prednizolone) during 3-6 weeks.

In severe cases synthetic analog

of vitamin A is essential aroma
retinoid (Roaccutan).
Physiotherapy. UV, microwave,
ultersonnic and magnitotherapy.
X-ray therapy in deep forms of
pyodermia. Sanatoriums and
resorts at period of remission
(Radon, sulfic, sea, natrium
chloride bathes).

Scabies.
is a parasitary disease,
relating to dermatosoonoses (the
penetration of a live parasite into
a living organism). The causative
agent is a scabby tick, the tick
drills an entrance of 5-10 mm at
length under the horny layer of
epidermis and saves there its
eggs. Contamination usually takes
from 3-14 days to 1.5 months by
means of hand-shaking, coitus ,
articles of the dress, toys, etc as
well as cat.

Clinical characteristics
Scabies tick drills entrances in
the thin layers of the skin
(interfinger spaces, wrists,
genitalia., etc. in distinction
from the adults the infants may
have the involvements of face,
palms, soles).

On the spots of intervention there

are miliary papule, at the top of it
there is a vesicle. The rash is
doubled (the distance between them
consists of 2-3 to 10 mm) the place
of the parasite entrance and a place
of egg-delivery. There is a gray line
between them that denote a scabies
transition.

Skin pruritis is a characteristic

feature for scabies intensifying
in the evening as during this
period parasites drill the
entrances.

Treatment.

1) 20% benzil benzoatis during 4

days (children must be rubbed in
10% benzil benzoatis).
2) effective one-time use
Spregal aerosol.
Personal cloth articles must be
disinfected.

The skin pruritis usually remains

after the treatment for a period
of 5-7 days as the algestic
(painful) receptors of the
epidermis were involved. That is
why the use of antipruritis
medicines with menthol,
anaesthezine, etc.

PEDICULOSIS.

The causative agents are the

louses, i.e. the parasites feeding
with blood and living on the
human body. The sources of
contamination are the coitus, hat,
articles of the dress, bed. There
are head, pubis and underwear
(clothes) parasites.

Head pediculosis.

The parasites live on the hair. At

the spots of bites the pruritis
spots occur. As a result the
second infection can appear. On
examination of the hair one can
notice the parasites themselves
and the nits.

Pubic pediculosis

They in the hair part of pubis,

low part of the abdomen, breast
and beard as well as moustache
is rare.

Underwear pediculosis

The parasites live in the

underwear folders. The appeared
vascular spot, papules elements
are localized on the places of
wear articles and skin contact
(shoulders, upper part of the
back, abdomen).

Treatment of the
pediculosis