Pyoderma – purulent inflammatory skin diseases caused by a variety of pathogens (staphylococci, streptococci, pneumococci, Escherichia coli, Vulgar proteus, Pseudomonas aeruginosa, etc.).
The skin is an open biological system, colonized by a significant number of opportunistic microorganisms ( Staphylococcus spp ., corynebacterium spp ., pityrosporum ovale and others), which under certain conditions are able to show their pathogenic properties, causing pustular lesions. These conditions are:
- reduced protective properties of the water-lipid mantle, alkaline reaction of the skin surface;
- increased moisture and absorption capacity of the skin;
- reduced immunity.
Vesiculopustosis ( periporitis )
The occurrence of vesiculopustosis is often preceded by prickly heat. Predisposing factors, in addition to the above, include overheating. The mouths of the ducts of the sweat glands are affected with the appearance of small (as big as millet grain) pustules located against the background of redness. Multiple rashes, located mainly on the body, in the folds, on the scalp. The general condition is not disturbed, and with proper care and timely treatment, the rash disappears on the 3rd-7th day.
This form of pyoderma develops on unchanged skin, but more often due to scratching on insect bites, scabies, atopic dermatitis, after a cold, purulent otitis, etc.
The pathogen is transmitted through toys, clothing, towels from persons suffering from diseases of the nasopharynx (angina, chronic rhinitis).
This pyoderma is characterized by the appearance, often on the face, of a flat, superficial abscess with a size of 0.5 to 1 cm in diameter, the contents of which dries out after a while in crusts, after their falling away, unstable pink spots remain. Scars do not happen. In addition to the skin of the face, blisters can appear on the mucous membrane of the nose, lips, cheeks, gums. With localization flikten on the scalp after their resolution may remain temporary pockets of baldness.
Slit-like impetigo ( zaeda, angular stomatitis)
A form of pyoderma, in which rapidly opening blisters appear in the corners of the mouth, at the bases of the wings of the nose, at the outer corners of the eyes, painful linear cracks are formed. The infection is transmitted from the patient to the healthy through toys, nipples, dishes, towels.
The disease often occurs chronically due to the constant traumatization during the meal, the presence of carious teeth, rhinitis, conjunctivitis, hypovitaminosis B2 and B6.
It is characterized by the appearance around of one or several nail plates of a multitude of bubbles with purulent contents, located against the background of redness. Pyoderma are usually preceded by mechanical damage to the periungual ridge ( biting burrs, etc.).
Characterized by swelling, tenderness in the focus. Increase in body temperature – up to 37.5-37.8 ° С.
It is more often observed in children with excessive sweating, overweight, diabetes.
The localization of the rash behind the auricles, on the skin of the adjoining surfaces of the inguinal, axillary folds, in the buttocks region is typical. The bubbles that appear here open up with the formation of weeping red wounds, which can merge with each other. Borders of foci are sharp, with a border of exfoliating epidermis. The exudate shrinks into yellowish-brown crusts, after the fall of which temporal pigmentation remains.
White lichen (dry lichen, erythematosus- squamous streptoderma )
Occurs more often in spring or autumn, the development of this type of pyoderma is promoted by insufficient drying of the skin after washing and chapping.
On the skin of the face, limbs appear rounded pale pink foci, up to 2-3 cm in diameter, on the surface of which mucoid peeling is expressed.
White shingles can be combined with Zayed, intertriginoznoy streptoderma.
The emerging flickenes are located on a slightly reddened background; after the bubble dries, greenish-yellow crusts form. After the crusts fall off, temporary pigmentation remains.
Diaper dermatitis ( Papulo- erosive streptoderma )
This pyoderma is characteristic only for infants and is more common in children with disorders of the digestive process (liquid stool with an alkaline reaction has an irritant effect), with rickets, using waterproof linen that prevents evaporation and creates favorable conditions for the reproduction of microorganisms.
The skin of the buttocks, the back and inner thighs, the crotch area, the scrotum is affected. Appear bluish-red, dense tubercles up to 0.6 cm in diameter, surrounded by an inflammatory corolla. Quickly opening blisters form on the surface of the tubercles, leaving wounds and crusts behind.
The most important in pyoderma is rational skin care, both in the lesion and outside it. It is necessary to limit washing, bathing. The skin around the lesion should be treated with disinfecting solutions (1-2% alcohol solution of salicylic acid, 0.1% aqueous solution of potassium permanganate, 1-2% alcohol solution of boric acid). With the defeat of the scalp in newborns, the use of alcohol solutions is not recommended due to the possible active suction through unclosed fountains.
It is also undesirable to use alcohol solutions in the localization of the pathological process in the folds because of the possible irritant effect of alcohol. The lesion itself is treated with antiseptic solutions (1% alcohol solution chlorophyllipt , fukortsin , 1% solution of methylene blue). Then, depending on the severity of the process, antibacterial pastes (2% erythromycin , lincomycin ), ointments ( hyoxysonic , erythromycin , lincomycin ) are applied . However, it is often difficult to determine the nature of the pathogen (bacterial, fungal, mixed).
On this basis, with pyoderma, the use of the Triderm complex drug due to its triple action: antibacterial, anti-inflammatory and antifungal is most justified . This tool can be used for infections of bacterial or fungal, and mixed / unexplained origin.
It is known that with pyoderma often a fungal component is added, which is an indication for prescribing local antifungal drugs, for example clotrimazole , which is a part of Triderm . At the same time, gentamicin, which is an antibacterial component of Triderm cream and is related to broad-spectrum antibiotics, is active against both gram-positive and gram-negative flora.
In addition, pyoderma quite often develops as a complication of atopic dermatitis, aggravating the course of this allergic dermatosis . In this case, the anti-inflammatory and antiallergic component, which is part of Triderma , is of particular importance.
Systemic therapy for pyoderma
Indications for antibiotic therapy are:
high prevalence of the process;
violation of the general condition (general weakness, fever);
The most effective and with the least number of adverse reactions are macrolide antibiotics , lincomycin , as well as cephalosporins I-II generation and other antibiotics that are resistant to b- lactamases and have a wide spectrum of action. Antibacterial drugs prescribed by mouth, in some cases – intramuscularly.Dosage regimen is individual, depending on the severity and extent of the process.
In addition to antibacterial therapy, with long-flowing pyoderma, specific immunotherapy agents are prescribed: staphylococcal toxoid, staphylococcal antiphagin , y-globulin. In the recovery period, a complex of vitamins A, C, group B, multivitamins is used.