bacterial skin infection- dermatology
TRANSCRIPT
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BACTERIAL SKIN INFECTION
KUSHAL KUMAR
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BACTERIAL INFECTION OF SKINThe SkinDefinition
Skin is largest organ of body. It protects underlying tissues and organs, protects body from mechanical injury, and ultraviolet rays of sun.
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SKIN INFECTIONS
• The skin always has some amount of bacteria, fungus and viruses living on it.
• Occur when there are breaks in the skin and the organisms have uncontrolled growth
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Staph. Aureus Infection
1. Direct infection of skin : impetigo, ecthyma, folliculitis,
furunculosis, carbuncle, sycosis.
2. Secondary infection: eczema, infestations, ulcers, …etc.
3. Effect of bacterial toxin: staph.-associated scalded skin
syndrome (SSSS), toxic shock syndrome.
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Strepto. Infection(gp A streptococci)
Direct inf. of skin or subcut. tissue: Impetigo, ecthyma, cellulitis, vulvovaginitis, perianal inf., ulcers, blistering, necrotizing fasciitis.
2ry inf.: eczema, infestations, ulcers, …etc.
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Tissue damage from circulating toxin: scarlet fever, toxic shock-like syndrome.
Skin lesions attributed to allergic hyper-sensitivity to strepto. antigens: erythema nodosum, vasculitis.
Skin dis. provoked or influenced by strepto. inf.: psoriasis
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IMPETIGO
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•Acute contagious skin infection caused mostly by staph. Aureus and strept.
•Affects children mainly, esp. in summer times.
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CLINICAL TYPES
•1- Non-bullous impetigo: • Caused by staph., strept. or both organisms.
•2- Bullous impetigo:• Caused by staph aureus.
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NON-BULLOUS IMPETIGO
• Staph. aureus or gp A stretp. or both “mixed infections”.
• May arise as 1ry inf. or as 2ry inf. of pre-existing dermatoses, e.g.
pediculosis, scabies & eczemas.
• An intact st. corneum is probably the most important defense against
invasion of pathogenic bacteria.
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• A thin-walled vesicle on
erythematous base, that soon
ruptures & the exuding serum
dries to form yellowish-brown
(honey-color) crusts that dry &
separate leaving erythema
which fades without scarring.
• Regional adenitis with fever
may occur in severe cases.
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Sites: Exposed parts eg. face & extremities. Scalp .Any part could be affected except palms & soles.
Complications: Post-streptococcal acute glomerulo-nephritis “AGN” especially in cases due to strepto. pyogenes
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VARITIES:
• Circinate impetigo: with
peripheral extension of
lesion & healing in the
center.
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•Crusted impetigo: • on the scalp complicating
pediculosis. Occipital & cervical Lymph nodes are usually enlarged & tender.
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• Ecthyma (ulcerative
impetigo): adherent crusts,
beneath which purulent
irregular ulcers occur. Healing
occurs after few weeks, with
scarring.
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• Site: more on distal extremities (thighs & legs).
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BULLOUS IMPETIGO
• Age: all ages, but commoner in childhood & newborn (impetigo neonatorum).
• Site: face is often affected, but the lesions may occur anywhere, including palms & soles.
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• The bullae are less rapidly ruptured (persist for 2-3 days) & become much larger. The contents are at first clear, later cloudy. After rupture, thin, brownish crusts are formed.
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BULLOUS IMPETIGO
•
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BULLOUS IMPETIGO
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BULLOUS IMPETIGO
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TREATMENT OF IMPETIGO:
Treatment of predisposing causes: e.g. pediculosis & scabies.
Remove the crusts: by olive oil or hydrogen peroxide.
Topical antibiotic: e.g. tetracycline, gentamycin,
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FOLLICULITIS
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• inflammatory disease of the hair follicles, which may be
infectious or non-infectious.
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SUPERFICIAL FOLLICULITIS (BOCKHART’S IMPETIGO)
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• a dome-shaped pustule at the orifice of a hair follicle that heals within 7-10 days.
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• Caused by staph aureus and affects mainly extremities and scalp.
• Topical steroids are a common predisposing factor.
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SYCHOSIS VULGARIS
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• Recurrent red follicular papules
or pustules centered on a hair,
usually remain discrete over the
beard or upper lip, but may
coalesce to produce raised
plaques studded with pustules.
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PSEUDOFOLLICULITIS
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• from penetration into the skin of sharp tips of shaved hairs.
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FRUNCULOSIS (BOILS)
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• It is a staphylococcal infection , but
deeper than folliculitis & invades
the deep parts of the hair folliculitis.
• Occasionally several closely
grouped boils will combine to form
a carbuncle. The carbuncle usually
occurs in diabetic cases. The site of
election is the back of the neck.
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FURUNCLE
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FURUNCLE / CARBUNCLE
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CELLULITIS & ERYSIPELAS
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•Cellulitis is an infection of subcutaneous tissues.
• Ersipelas: It’s due to infection of the dermis & upper subcutaneous tissue by gp A streptococci. The organism reaches the dermis through a wound or small abrasion. It is regarded as a superficial “dermal” form of cellulitis.
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Erythema, heat, swelling and pain or tenderness.
Fever and malaise which is more severe in erysipelas.
In erysipelas: blistering and hemorrhage.
Lymphadenopathy are frequent.
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• Edge of the lesion: well demarcated and raised in erysipelas and diffuse in cellulitis.
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CELLULITIS
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CELLULITIS
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COMPLICATIONS
• Recurrences may lead to lymphedema.
• Subcutaneous abscess.
• Septicemia.
• Nephritis.
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TREATMENT
• Systemic antibiotics, especially penicillin, e.g. benzyl
penicillin (600-1200 mg IV/6 hrs)
• Rest, analgesics.
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ERYSIPELAS
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SKIN DISEASES RELATED TO CORYNEFORM BACTERIA
ERYTHRASMA
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• It is mild, chronic, localized
superficial infection of skin by
Coryn. Minutissimum.
• Clinically: sharply-defined but
irregular brown, scaly patches
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• usually localized to groins,
axillae, toe clefts or may cover
extensive areas of trunk &
limbs. Obesity & DM may
coexist.
• Coral red fluorescence under
wood’s light.
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TREATMENT
• Topical treatment with azole antifungal agents for 2 weeks
or topical fucidin.
• Erythromycin orally.
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