1.1.1. bacterial infection of skin [compatibility mode]

CommonBacterial Infection of

Skin

DR. Ram Sharan Mehta, MSND, CON, BPKIHS

The SkinSkin is largest organ of body. Maintains homeostasis, protects underlying tissues and organs, underlying tissues and organs, protects body from mechanical injury, damaging substances, and ultraviolet rays of sun.


� Broken skin allows Bacteria to enter


Unbroken skin prevents entrance of bacteria .


Normal Skin Flora�Major bacterial groups�Coryneforms (Gram +ve)

�Staphylococci (Gram +ve cocci, aerobs)

�Minor bacterial groups�Acinetobacter (25%) Gram –ve Bacilli�Micrococcus


Bacterial Infection of Skin: 1. FolliculitisFolliculitis is a localized infection of one hair

follicle.


Bacterial folliculitis

•Local antiseptics•Cloxacilline 500 mg

4x/d for 10 days


folliculitis


Folliculits


Management of folliculitis

�Avoid greasy applications on the skin.

�Antibiotic: topically can be used.�Systemic antibiotics: - Cloxacillin or erythromycin (Cefadox) is choices of treatment.


Folliculitis


Superficial folliculitisDR. Ram Sharan Mehta, MSND, CON, BPKIHS

Deep folliculitis�Chronic�Staph. Aureus�Hair follicles of leg: Common�Hair follicles of leg: Common�Multiple �Atrophic scar

�May become chronic especially in beard area (sycosis barbae)


2. Furuncle/Boils

� A furuncle is an infection deep within the hair follicle.

�A furuncle or boil is an acute round, tender, circumscribed, perifollicular tender, circumscribed, perifollicular staphylococcal inflammation, which generally tends to suppurate.


Boils/ Furuncle Boils (also called furuncles) are a deep infection of hair follicles.


Furuncle (Boil)Acute� Staph. Aureus� Small, follicular nodular -Pustule-necrotic -

discharge pus� Heal with scar formation

Neck, Wrist, Waist, Buttocks, Face� Neck, Wrist, Waist, Buttocks, Face� PainfulComplication� Thrombosis� Septicemia (esp. on malnutrition patients)


Treatment: General measures

Preventive measures are very important especially to prevent recurrence of infection from nasal foci, autoinoculation, from peri-anal areas.

� Avoid squeezing, irritation and trauma to the lesions. � Treatment of the colonized areas and the primary focus

as in nostrils. � Topical antibacterial cream such as Muperacin cream � Topical antibacterial cream such as Muperacin cream

which when applied twice daily in the nostril for one week will eradicate colonized micro-organism for 6 months.

� Using a suitable anti septic soap may have some good effect.


3. Carbuncle� A carbuncle is an infection involving

subcutaneous tissue around several hair follicles.


Carbuncle�Extensive infection of a group of

contagious follicles�Staph. Aureus�Middle or old age�Middle or old age�Predisposing factors

�Diabetes�Malnutuition�Severe generalized dermatoses�During prolonged steroid therapyDR. Ram Sharan Mehta, MSND, CON, BPKIHS

CarbuncleDR. Ram Sharan Mehta, MSND, CON, BPKIHS

Carbuncle�Painful�Suppuration begins after 5-7 days�Pus discharge from multiple follicular

orificiesNecrosis of intervening skin�Necrosis of intervening skin

�Large deep ulcer


.

4. Impetigo: Superficial skin infection


Impetigo is a bacterial skin infection.

It is often called school sores because, it most often affects because, it most often affects children.

It is quite contagious.


Impetigo �Vesiculopustular skin infection.

�Bacterial: staphylococcus or streptococcus

�Spread w/ direct contact w/ lesions

�Thick, yellow crust (commonly on the face)


Impetigo

�S/S- one or more pimple-like lesions surrounded by reddened skinreddened skin- lesions fill w/ pus and later form a thick crust- itching

Inv. : Swab for C/S


Impetigo


Mx:Remove crustLocalized:Topical AntibioticSevere: Systemic antibiotics:

Semisynthetic Penicillin : 7-10 dSemisynthetic Penicillin : 7-10 dErythromycine (sensitive)Augmentin (face)Cephalosporin

Great care with personal hygiene and possible isolation.


Impetigo

•Local antiseptics•Cloxacilline 500 mg

4x/d for 10 days


4.1. Non-bullous impetigo

�Superficial (intraepidermal)� Initially vesicular, then becomes

crustedS. pyogenes (90%); also S. aureus�S. pyogenes (90%); also S. aureus

�Mainly children; highly communicable


Nonbullous impetigo


4.2. Bullous impetigo�Mainly newborn and younger

children�About 10% of all cases of impetigo�Caused by S. aureus of phage �Caused by S. aureus of phage

group II


Bullous impetigo


Predisposing factors� Malnutrition� Diabetes� Immuno-compromise status


Impetigo: Management

�Local management for small lesions: -Wash with betadine solution or saline.

�Potassium permanganate 1 in 1000 solution soaking twice a day until the pus exudates dry up.exudates dry up.

�Gentian violet (GV) paint 0.5% apply BID.�Topical antibiotics can be used, such as

2% mupirocin, Gentamycine, Fucidic acid can be used but costly.


� Oral amoxacyllin or Ampicillin can also be used.

� For Bullous impetigo: - cloxacillin 500 mg po QID for 7 to 10 days. In cases, with an allergy to penicillin, erythromycin can be given.

� The underlining skin conditions such as eczemas, scabies, fungal infection, or eczemas, scabies, fungal infection, or pediculosis should be treated.

� When impetigo is neglected it becomes ecthyma, a superficial infection which involves the upper dermis which may heal forming a scar.


5. Periporitis� Miliary papules and papulovesicles with

staphylococcic infection. � Pustular lesions. � The commonest sites involved are the buttocks,

upper part of the trunk and the scalp. � The lesion affects mainly malnourished infants and

young children. � Skin lesions may progress to sweat gland

abscesses.


Rx� Treatment is directed towards improving the

nutrition and general condition. � Preventing sweat retention by aeration. � Appropriate topical antibiotic may be enough � Appropriate topical antibiotic may be enough

to control periporitis.� Oral antibiotics may be needed, especially

when there are multiple abscesses.


6. Ecthyma� Formation of adherent dry crusts,

beneath which ulcer present� Strptococcal & staph� Common in children� Common in children� Small bullae or pustules� Butocks, thighs and legs, commonly

affected� Heals with scar and pigementation


EcthymaDR. Ram Sharan Mehta, MSND, CON, BPKIHS

7. Sycosis Barbae�Pustules surrounded by erythema in Beard region

�Common in Males�After puberty�After traumas�Upper lip and chin�Staph. auraus common


Sycosis barbaeDR. Ram Sharan Mehta, MSND, CON, BPKIHS

8. Cellulitis

�Acute / Sub-acute / Chronic inflammation of loose connective tissue

�Streptococcal (Group A), Staphylococci �Streptococcal (Group A), Staphylococci and rarely clostridia.

�Erythematous & oedematous swelling�Pain/tenderness


CellulitisDR. Ram Sharan Mehta, MSND, CON, BPKIHS

Cellulitis

�An acute spreading infection involving the dermis

�Spread: tissue damage, lowered body defenses, or virulence of invading organism.


Cellulitis � Red, painful, hot, swollen skin area with ill-

defined borders.� Deeper involvement of the Subcutaneous� Raised, hot, tender, erythematous� Raised, hot, tender, erythematous� Source: Cut , abrasion or ulcer� Palpable, tender LN� Fever, leucocytosis

�Differential Diagnosis: DVTDR. Ram Sharan Mehta, MSND, CON, BPKIHS

Mx� Cold application: to relief local discomfort� Analgesic to relief pain� Treat the fever and pain and elevate the

affected part.� Crystalline penicillin or procaine penicillin is � Crystalline penicillin or procaine penicillin is

the first line therapy and oral Ampicillin or Amoxicillin may be used for mild infection and after the acute phase resolves.

� Appropriate Antibiotic, according to culture: Erythromycin, Augmentin.


9. ERYSIPELAS� Superficial Cellulitis caused by group A β-hemolytic

streptococcus. � Usually begins on the face or a lower extremity� Having pain, superficial erythema, and plaque-like

edema with a sharply defined margin to normal edema with a sharply defined margin to normal tissue

� Fever may precede local signs� Boarder easily palpable� Early Stage of Cellulitis?


�Erysipelas is a type of cellulites involving mainly the dermis; other forms of cellulites extend to the cellulites extend to the subcutaneous tissues.


ErysipelasDR. Ram Sharan Mehta, MSND, CON, BPKIHS

10. Pyonychia�Acute Erythmatous swelling of proximal and lateral nail fold

�Painful�Rx: Drain Pus,

Antibiotic, Analgesic


PyonychiaDR. Ram Sharan Mehta, MSND, CON, BPKIHS

11. Staphylococcal scalded skin syndrome(Ritter’s disease)

�A severe reaction to S. aureus strains producing toxins

�Large, flaccid bullae rupture, causing same effect as a third-degree burnsame effect as a third-degree burn

�Scald – tender red skin�Denuded skin (necked skin)�Heals 7-14 day


Staphylococcal scalded-skin syndrome


�Complication 2%�Cellulitis�Pneumonia


12. Erysipeloid� It is bacterial infection seen in people who handle

raw meat (especially pork) and Fish. � Organism get entry through breaks in the skin.� Common on fingers, hand or forearms.� Common on fingers, hand or forearms.� No systemic symptoms� The main symptom is warmth, tenderness, and

redness on the skin.� Rx: Penicilline-V or Oxytetracycline 500 mg QID

7-10 days


13. Principles of therapy of pyoderma

� Good personla hygiene� Local therapy�Cleaning with soap-water and weak

KMN04 solutionRemoval of crusts with KMN04 solution�Removal of crusts with KMN04 solution

�Application of antibacterial cream� Systemic therapy�Antibiotics


Management of predisposing factors�Local�Attend to traumas, pressure�Treat pre-existing dermatosis�Investigate carrier sites

�Systemic�Treatment of disease like DM, Nutritional deficiency and immunodeficiencyDR. Ram Sharan Mehta, MSND, CON, BPKIHS

14. Common Diagnostic Tests for Integumentary Disorders� Biopsy.� Patch Testing: Allergy test

� Tzanck smear: detect type of cells in Chicken Pox, H. simplex, H. Zoster, Bullous diseases

� Skin scrapings.� Culture and sensitivity.� Diascopy: visualization by special microscope

� Wood’s light examination: Use of U.V. rays


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16. Prevention and control of Bacterial skin diseases

Personal hygiene is the most effective methods for prevention and control of bacterial infections. The following points illustrate the possible The following points illustrate the possible preventive methods for bacterial skin infections:

� Washing of hands with warm water and soap before touching broken skin.

� Washing the body with warm water and soap preferably everyday to remove dust and dirt.


Prevention and control of Bacterial skin diseases…………………

� Wearing the right size and type of clothes to suit local weather conditions.

� After washing clothes, if possible, iron it before wearing

� Regular exposure of the skin to air and � Regular exposure of the skin to air and sunlight is beneficial.

� It is also important to clear the bacteria colonizing the nostrils and under the fingernails with either antibiotic ointment or petroleum jelly several times daily for one week of each month.DR. Ram Sharan Mehta, MSND, CON, BPKIHS

Methods of Preventing Long Term Skin Damage

�Avoid sun�Avoid midday sun�Use photo-protective clothing, hats etc

�Use sunblocks


17. Practice in BPKIHS: Derma OPD

COMMON BACTERIAL INFECTIONS ARE:

�Periporitis� Impetigo (Non-bullous common)� Impetigo (Non-bullous common)�Absces�Cellulitis�Folliculitis�STIsDR. Ram Sharan Mehta, MSND, CON, BPKIHS

Rx Prescribe: 1. Antibiotics:

a. Topical: Mupirocin, Fucidic acidb. Oral: Cefadox, Cloxacyline

2. Personal hygiene teaching 2. Personal hygiene teaching 3. Symptomatic management


Summary: Common Bacterial Infections

1. Folliculitis: Localized infection of one hair follicles.2. Furnicle/Boil: Deep hair follicle infection. 3. Carbuncle: Several hair follicle infection.4. Impetigo: superficial skin infection.5. Periporitis: Millary and papulovesicles infection.5. Periporitis: Millary and papulovesicles infection.6. Ecthyma: Formation of adherent dry crusts.7. Sycosis Barbae: Pustules in beard region.8. Cellulitis: Loose connective tissue infection.9. Erysipelas: Superficial cutaneous cellulitis.10. Pyonochia: Swelling of nail fold.


11. Staphylococcal Scalded Skin Syndrome: RT exfoliative toxins.

12. Erysipeloid : Bacterial infection among meat handlers.

13. Principles of therapy of pyoderma.14. Common diagnostic tests for derma 14. Common diagnostic tests for derma

disorders.15. Common antibiotic used in skin disorders16.Prevention and control of Bacterial skin

infection.17. Practices in BPKIHS derma OPD


Thank you


MACROSCOPIC TERMSMacule : Circumscribed lesion of up to 5 mm in diameter characterized by flatness and usually discolored (often red) Patch : Circumscribed lesion of more than 5 mm in diameter characterized by flatness and usually discolored (often red) Papule : Elevated dome-shaped or flat-topped lesion 5 mm or less across. Nodule : Elevated lesion with spherical contour greater than 5 mm across. Plaque : Elevated flat-topped lesion, usually greater than 5 mm across (may be caused by coalescent papules). Vesicle : Fluid-filled raised lesion 5 mm or less across. Bulla : Fluid-filled raised lesion greater than 5 mm across. Bulla : Fluid-filled raised lesion greater than 5 mm across. Blister : Common term used for vesicle or bulla. Pustule : Discrete, pus-filled, raised lesion. Wheal : Itchy, transient, elevated lesion with variable blanching and erythema formed as the result of dermal edema. Scale: Dry, horny, platelike excrescence; usually the result of imperfect cornification (i.e., keratinization). Lichenification : Thickened and rough skin characterized by prominent skin markings; usually the result of repeated rubbing in susceptible persons. Excoriation : Traumatic lesion characterized by breakage of the epidermis, causing a raw linear area (i.e., a deep scratch) Onycholysis : Separation of nail plate from nail bed.


MICROSCOPIC TERMS (histologic) Hyperkeratosis : Thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin. Parakeratosis : Modes of keratinization characterized by the retention of the nuclei in the stratum corneum. On mucous membranes, parakeratosis is normal. Hypergranulosis : Hyperplasia of the stratum granulosum, often due to intense rubbing. Acanthosis : Diffuse epidermal hyperplasia. Papillomatosis : Surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae. Dyskeratosis : Abnormal keratinization occurring prematurely within individual cells or groups of cells below the stratum granulosum. Generally the same as DYSPLASIA.Acantholysis : Loss of intercellular connections resulting in loss of cohesion between keratinocytes. keratinocytes. Spongiosis : Intercellular edema of the epidermis. Hydropic swelling (ballooning) : Intracellular edema of keratinocytes.Exocytosis : Infiltration of the epidermis by inflammatory or circulating blood cells. Erosion : Discontinuity of the skin exhibiting incomplete loss of the epidermis. Ulceration : Discontinuity of the skin exhibiting complete loss of the epidermis and often of portions of the dermis and even subcutaneous fat. Vacuolization : Formation of vacuoles within or adjacent to cells; often refers to basal cell-basement membrane zone area. Lentiginous : Referring to a linear pattern of melanocyte proliferation within the epidermal basal cell layer. Lentiginous melanocytic hyperplasia can occur as a reactive change or as part of a neoplasm of melanocytes.DR. Ram Sharan Mehta, MSND, CON, BPKIHS

1.1.1. bacterial infection of skin [compatibility mode]

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