Pyoderma (pyodermiae; Greek. Pyon pus + derma skin; synonym: pustular skin diseases, pyoderma, piodermity, piozy) – a group of skin diseases caused by staphylococcus, streptococcus, rarely Pseudomonas aeruginosa, Escherichia coli and other microorganisms.
The most important role played by the presence of pyoderma atrium and reduction of the protective forces of organism. The source of pathogenic micro-organisms may be bacterial flora of the skin, upper respiratory tract, as well as the environment. The skin staphylococci are frequently in the mouths of hair follicles and sebaceous glands. In the upper respiratory tract, including oral, pathogenic staphylococci are found in almost half of healthy people. Pathogenic streptococci are identified mainly in the nose and mouth, about 10% of healthy people, the children in groups (kindergartens, nurseries, hospitals) – up to 70%. In the skin, staphylococcus and streptococcus penetrate into the ground microtraumas. Leading role in the occurrence of pyoderma belongs inhibition of cellular and humoral immunity. Development contributes to diabetes (increased sugar content in the skin creates a good breeding ground for pathogens).By the predisposing factors are also chilling and overheating of the organism, malnutrition, fatigue, chronic intoxication (eg, alcoholism), diseases of the gastrointestinal tract, liver, etc.
Depending on the pathogen isolated staphylococcal, streptococcal and mixed pyoderma. At the depth of skin lesions distinguish superficial and deep pyoderma. Adrift pyoderma may be acute and chronic. At the same patient may be a combination of superficial and deep pyoderma, while at some stages of the disease can be acute within, on the other – a chronic relapsing.Pyoderma may represent a secondary process, complicates other skin diseases, especially skin accompanied by itching.
The clinical picture of pyoderma varied, dependent on the nature of the pathogen, the individual characteristics of the organism, its reactivity (primarily on the immune system), the influence of predisposing environmental factors, severity and localization of the pathological process, as well as the duration of the disease.
When staphylococcal pyoderma process develops mainly in the field of hair follicles, in sebaceous and sweat glands. Emerging pustules have a conical or hemispherical shape, their walls thick, hard, center pustules often permeated with hair, exuding pus – a thick, yellow-green color. In children, such as epidemic pemphigus newborns may be superficial bubbles, not associated with hair follicles, sebaceous and sweat glands.
Streptococcal pyoderma occurs more frequently in women and children. Primary morphological element is fliktena – flaccid bladder with a thin lid and serous content, which is fast becoming sero-purulent, purulent later. Fliktena within the epidermis, it is characteristic of peripheral growth, and if its bottom is not necrotizing, as happens in the transformation of it into ecthyma, is formed in its place erosion quickly epiteliziruetsya; in the future remains a temporary hyperpigmentation.
When the surface forms bubbles located within the epidermis, and after authorization, they do not leave persistent trails. With deep pyoderma bubbles detected in the epidermis, dermis and often in the subcutaneous tissue, and after their healing scars and scar formation atrophy. With prolonged duration of deep pyoderma may occur pioallergidy – secondary allergic lesions in a variety of skin eruptions (eg, lichenoid, erythematous, eritematoskvamoznoy, eczematous rash).
By staphylococcal pyoderma, or stafilodermiyam include skin lesions: a vulgar sycosis, folliculitis, furuncle, hydradenitis, multiple abscesses newborn infants epidemic pemphigus, exfoliative dermatitis of Ritter.
Multiple abscesses of infants, or psevdofurunkulez Finger, develop in infants as a result of the defeat of the excretory ducts and glomeruli ekkrinnyh sweat glands. Disease promote the wrong care, overheating, excessive sweating, which leads to skin maceration, malnutrition, as well as enteritis, infectious diseases, etc. The skin of the trunk, usually the back, buttocks, thighs, there are numerous dense reddish-bluish nodes, which can expand to the size of a hazelnut. Nodes quickly softened in the center, opened, and were allocated semiliquid pus. The process ends with scarring. There are possible complications of impaired children in the form of a phlegmon, and even sepsis. Treatment for a pediatrician in the children’s hospital. Assign an antibiotic, tonic, producing surgical opening of abscesses.
Streptococcal pyoderma, or streptoderma are impetigo, strep Zayed, simply deprive persons with chronic diffuse streptoderma, erysipelas, ecthyma vulgar.
Simply deprive a person referred to as an atypical form of streptococcal impetigo. It is often noted in children, usually in spring or autumn. In the children’s groups from the disease can take an epidemic. It contributes to the emergence of non-compliance with the rules of hygienic skin care, inadequate drying of the skin after washing. The skin of the cheeks, chin, nose, trunk seldom sometimes slightly reddened, there are round or oval areas defurfuration white. In some cases, they merge, forming krupnofestonchatye foci. Often used to mark a number of new homes. Chance of light skin itch. Under the influence of the sun’s rays can pass the disease, skin in the affected areas tans weaker, resulting in secondary leukoderma. Treatment for a dermatology outpatients. Assign an ointment with antibiotics.
Chronic diffuse streptoderma, or streptococcal epidermitis, localized mainly in the skin of the extremities, women around the nipple and under the breasts. Characteristic one-sided defeat, the sharp boundary source, typical of streptococcal flikteny on its surface and near the fire, thick greenish-yellow rind and wet erosive surface formed after opening flikten with epidermal peeling aureole, a tendency to peripheral growth. The disease runs a long time. Often noted strong itching. Often, the result of irrational treatment of primary focus is eczematization with the transformation of microbial eczema. Treatment for a dermatologist. Assign antibiotics, topically disinfectants (aniline dyes, ointments with antibiotics).
For mixed forms include vulgar impetigo, chronic deep ulcer and vegetating pyoderma, chronic piokokkovuyu ulcer, shankriformnuyu pyoderma.
Chronic deep pyoderma ulcer is localized more on the lower extremities. It usually begins with flikteny surrounded by a hyperemic rim. Later fliktena opened and formed a rapidly growing ulcer on the edge of which is infiltrated with the roller width to 5 mm. Due to this ridge is an increase in the size of ulcers. At the same time can appear several ulcers. In their place are superficial scars.
Vegetating pyoderma is localized mainly in the large folds of skin on the scalp, the mucous membrane of the mouth. The process begins with the formation of pustules, not associated with follicles. After opening the pustules surface erosion vegetates. Sometimes opening up pustules develop granulation. The merger formed the major areas of rash lesions with scalloped outlines, their surface gets wet, in some cases the deposition of the crust. In resolving a rash on their site remains pigmentation.
Chronic piokokkovaya ulcer usually localized to the lower extremities. The process begins with a painful hyperemia, a small swelling, then there fliktena or abscess, which quickly ulcerate.The resulting painful ulcers surrounded by an inflammatory puffy rim, through which it increases, reaching in some cases the value of palms and more. Ulcers can be round or irregular, resulting in necrosis of the central part of it is rapidly widening. Later necrotic masses are removed, the bottom of the ulcer becomes clean, smooth, bluish-violet; liquid discharge, purulent.Crusts are not formed. Scarring ulcer lasts a long time. The process usually begins with the center. At the same time may be several ulcers.
Shankriformnaya pyoderma primarily characterized by the appearance of vulva, face, red border of the lips, oral mucosa, the language of the bubble, which is formed after opening the erosion or ulcer 2 cm in diameter round or oval shape with a seal at the base, giving it a resemblance to chancre (see Syphilis). Discharge small, often shrivel in the crust. It is usually found streptococci and staphylococci. Regional lymph nodes are enlarged. After resolving the bubble, which is usually single, may remain superficial scar.
Treatment of mixed forms of pyoderma conducts dermatologist or dermatological outpatient hospital, depending on the severity of clinical manifestations. It includes the use of antibacterial drugs, vitamins, specific and nonspecific immunotherapy, physiotherapeutic procedures, locally recommended disinfectants.
Prevention pyoderma: the content of the skin clean (regular cleaning and linen change), its protection from traumatic and maceration. Microtrauma should immediately handle disinfectants. Of paramount importance are measures aimed at improving the body’s resistance. To avoid contamination, which are particularly prone children, you must beware of their close contact with sick pyoderma. Should be systematically conduct inspections of personnel in institutions and remove from office persons, even with minimal manifestations of the disease.Prevention of pyoderma in a production environment consists of obschesanitarnyh, sanitary and technical measures, including self-defense, personal care worker and hygiene education.
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