Types of pyoderma: treatment, symptoms, photos, classification

August 12, 2017 15:31 | Pyoderma

Pyoderma is a dermatological pathology with the appearance of suppuration, various inflammatory and ulcerative dermatological changes that occur due to the introduction of pyogenic( pyogenic) organisms into the dermis.We will talk about it today.

Pyoderma is a medical name that unites dermatological pathologies, with a characteristic appearance of suppuration, inflammatory and ulcerative skin changes that occur due to the introduction of pyococci into the dermis of pyogenic( pyogenic) organisms. Piococci is a term that combines staphylococci and streptococci.

Pyoderma can be primary, that is, occur as a lesion of healthy skin, and secondary, when pyoderma becomes either one of the signs of an internal disease, or acts as its complication.

Can I get pyoderma?Many species have a high degree of contagiousness( infectiousness) in contact, transmitted from the diseased or carrier.Sometimes, when the concentration of bacteria in the air when sneezing, coughing a person with purulent foci in the nasophar

ynx, pyococci can enter the healthy body by airborne droplets.

What is pyoderma, the video will describe below:

Classification of pyoderma by species

The main pathogens of pyoderma, capable of causing pathological manifestations in the epidermis( staphylococcus), including golden, Epidermal, hemolytic, and streptococci( Streptococcus). There are 2 basic types of pyoderma in accordance with the identified pathogen:

  • staphyloderma, when the main aggressor is staphylococcus;
  • streptodermia, if pathology develops with the introduction of streptococcus.

In addition, it is often diagnosed as streptofrostoderma - a mixed lesion of the dermis of both coccus species.In addition to these, in combination with other pathogens, the disease is caused by anaerobic bacteria( vulgar proteus), enterobacteria( E. coli), and highly resistant to antibiotics Pseudomonas aeruginosa( Pseudomonas aeruginosa), which interact with other anaerobic microbes and fungiAnd among themselves.

With any pathogen, pyoderma can be acutely, even lightning-fast, wearing a sluggish character with periodic exacerbations.Its manifestations can be limited to a certain area of ​​development of abscesses, and if skin rashes occur all over the body or over a large area, the disease is considered diffuse( widespread).

Piedromy on the face of an adult( photo)

Staphylodermia

Pain manifestations are concentrated in the area of ​​hair bulbs( follicles), sebaceous and sweat ducts and glands.Inflammatory changes occur with the release of pus and the formation of areas with a destroyed tissue( necrosis), which is due to the action of enzymes and toxins produced by the microbe.

Surface

Surface types include:

  1. Ostiophalliculitis. Inflammation is concentrated in the upper segment of the follicle or sebaceous duct.
  2. Folliculitis. Suppuration occurs throughout the follicle with inflammation of adjacent tissue.
  3. The sycosis is vulgar. Pustular lesions on the skin( usually in men) in hair growth areas( mustache, beard, sometimes - on the pubic skin).
  4. Epidemic pemphigus( pemphigus, pyococcus pemphigoid). Spreading a multitude of abscesses all over the body( except for the palms and soles) in infants, usually in the first days after delivery.Very contagious.With a massive lesion, the death of a child is possible.Staphylococcal periportitis( vesiculopustulosis).
  5. . Inflammation in the zone of the mouths of the sweat ducts in infants with localization on the head, in wrinkles, on the skin of the trunk.
  6. Acne disease. Long-term current pathology caused by suppuration of the sebaceous glands ducts in young children and young people on the face, chest, shoulders.Passes to acne and keloid acne.

Deep forms

Deep forms of staphylodermia:

  1. Furuncle. Deep purulent and painful formation with inflammation of adjacent tissue on cheeks, nose, buttocks, back of neck, hips.
  2. Hydradenite. Severely leaking purulent process with necrosis, affecting the ducts and sweat glands in the zone of the armpits, anal passage, groin.
  3. Carbuncle. Deep extensive suppuration with tissue necrosis, affecting several hair bulbs.
  4. Multiple abscesses ( another term - Finger pseudofurunculosis) is a form of common staphylococcal dermis of newborn babies, in which a lot of purulent cavities are formed in the thickness of the skin on the back, buttocks, neck.

Streptodermia

Streptococcus damages mainly the upper epidermis, forming at the sites of inclined growth flictens( flat soft blisters) containing light yellow serous exudate, secreted by inflamed tissue.The streptokinase enzyme produced by Streptococcus disrupts the blood viscosity at the site of inflammation, destroys the DNA of the cells, stimulates the rapid expansion of the abnormal process.

Surface species:

  1. Dry streptodermia( lichen). Acute, infectious type of streptococcal lesion, more often diagnosed in childhood-adolescence.Pink scaly spots form in typical cases on the cheeks, around the mouth, behind the ears, on the skin of the folds of the hands and feet.
  2. Papulo-erosive. Diaper dermatitis or streptococcal diaper often develops on the buttocks, in the perineum, on the skin of the thighs only in infants, often suffering from digestive disorders, rickets, which are long in diapers.
  3. Simple( white), Bubble lichen of the face( erythematosquamous streptoderma).Acutely manifested in adolescence in the form of epidemics.
  4. Streptococcal impetigo, including such subtypes as bullous, slit, tourneyol( inflammation of tissues around the nail plates).
  5. Intertriginous streptoderma. Diagnosed in juvenile patients in the groin, underarms, buttocks, behind the ears( more often with obesity, excessive sweating).

Deep lesions:

  1. Ecthima vulgar. Refers to ulcerative streptoderma, which is characterized by long-term course and relapses.Most often occurs on the skin of the knees, buttocks.Complicated by the introduction of staphylococcal ulcers, inflammation of the lymph nodes.
  2. erysipelas. Inflammation of the dermis and lymphatic tissue with severe manifestations of general intoxication.More often diagnose after 45 - 50 years.
  3. Diffusive( diffuse) streptoderma. Pathology of chronic course with the formation of edema, inflamed, purulent and long-term ulcerative erosions.

The classification of pyoderma is described in detail in the video below:

Streptostafilodermia( mixed form)

Most typical for mixed cocci form:

  1. Shankriform ulcerative streptophila. Rarely occurring inflammation of the dermis with the formation of ulcers in the neck, lips, reproductive organs.
  2. Gangrenous. Severe, long-term progressive pathology with focal gangrene development and local tissue necrosis.Refers to emergency conditions, leads to disability.
  3. Ulcerative vegetative. Expressed in the long-term current and increasing process of tissue destruction with the formation of purulent, wet ulcers.
  4. Panaritium. The formation of purulent painful blisters around the nail on the swollen inflamed skin, accompanied by temperature.
  5. Acne fastens. Severely leaking and difficult to respond to treatment type of acne with a sharp onset, often diagnosed in young boys and boys.

Pyoderma in a child

Reasons for the occurrence of

Staphyloderma
Ostiophalliculitis Small pustules( pustules) with reddening at the base.Localize on the neck, face, legs, shoulders.After ripening, atrophy without leaving scars.
Folliculitis Foci of inflammation are larger, slightly painful, with a thick wall, pustules with dense greenish or whitish-yellow pus surrounded by reddened puffy skin.With a deep form of soreness increased, bubbles with pus reach 15 mm, the zone of hyperemia is increased.If a lot of pustules are formed, the process is accompanied by deterioration of the condition, blood indices.
Epidemic pemphigus of newborns Bubbles with a dull whitish exudate capture the entire surface of the skin in the first week of life.When merging blisters develop erosion.Massive spread of pemphigus can lead to the death of the baby.
Sycosis vulgar Shallow inflammation of hair bulbs in the area of ​​the lips, nose, chin, temples, pubis.Frequent fusion of abscesses, redness, itching.
Furuncle Very painful, cone-shaped crimson knot up to 50 mm in diameter, deeply embedded in the skin, filled with pus and a rod of dying tissues.When the abscess is opened up to 10 days, the syphilis exudes with pus and the necrotic stem expels.Heals up to 14 - 20 days with scarring.
Hydradenite Acute, painful, purulent nodule in the thickness of the cellulose up to 40 - 70 mm, formed from several ulcers in the zone of the sweat glands of the armpits.Characteristic: thick pus, cyanotic-purple color, strong puffiness.Maturation of the purulent conglomerate and the release of pus from the openings are accompanied by severe pain, fever, nausea.Lasts up to 10 - 15 days.Tightening of the wound after cleansing 10 - 12 days.
Carbuncle Formed during the confluence of 2 - 3 boils as a very large, almost black in color, a dense abscess in the thickness of the dermis.Characteristic: intense pulling pain, profuse suppuration, several central rods of dead tissue, fistula formation.After expulsion from the dermis of the rods, a deep ulcer appears, healing slowly with the formation of a coarse rumen.The course is severe with fever, chills, vomiting, high risk of sepsis.
Intertriginoid Flat bloopers( serous blisters) that burst, revealing red, wet wound areas that merge into foci surrounded by flaking skin fragments.Allocations dry up, forming brown crusts, under which the skin changes color.
Papular-erosive Small, combining blisters with a watery-bloody exudate.They burst, leaving inflamed sinking erosions.The disease quickly flows into a chronic form, with difficulty responding to therapy.
Erythemato-squamous( dry lichen) Rounded red-pink areas are formed, with small flakes similar to flour, scaly flakes.Sometimes there is itching.Can be combined with creviceal impetigo, intertriginous pyoderma.
Streptococcal impetigo Flat bubbles( fliken) 5 - 10 mm with watery( or purulent) exudate on the face( lips, gums, inside the cheeks).The dried discharge from fliken forms dry crusts of honey-yellow color.After their removal on the skin, long, not passing red spots are visible.
Ecthyma vulgaris Blister 10 - 20 mm with purulent, watery, sucronic contents.Dry brown-brown crusts, the tissue is inflamed, has a bluish-purple color.Under the crust formed a deep ulcer that heals for a long time and leaves a scar and a changed skin color along the edges.
Roger A sharp reddening for 5 - 8 hours transforming into a bright red swelling and dense inflammatory focus, passing on the cellulose.Skin hot, painful, stretched.Temperature rise up to 39 - 40 C.
Diffusive( diffused) streptodermia Large flicks or small blisters merge into large foci on the hyperemia edematous skin.Under the burst bubbles, ulceration with uneven contours opens.Abundant discharge, while drying out, form greenish-yellow crusts.The hearth grows rapidly, grabbing healthy skin.The course is long, it gives relapses.
Mixed staphylosterepiddermia
Shanriciform pyoderma Single, painless, rounded ulcer 10-20 mm, covered with a bloody crust.Around the dense edema.Outwardly similar to a syphilitic hard chancre.Sometimes several ulcers are formed.Lymph nodes swell.Heals after 30 - 60 days.
Chronic ulcerative vegetative Inflammation, swelling and congestion.Ulcers and soft flat plaques of cyanotic red color are covered with ulcers and are surrounded by a pink corolla.Foci from fused pustules, plaques and ulcers secrete serous-purulent fluid.After removal of loose crusts, epithelial growths in the form of papillae and thick pus are revealed.Soreness.Aggressive spread with the seizure of healthy areas.
Acne vulgaris
  • Bubble rashes with thick purulent contents on the back, neck, chest, shoulders, excluding the face;

  • rapid development of the ulcerative process;

  • temperature above 38C;

  • severe pain in muscles, bones, abdomen;Decrease in body weight, anemia,

  • ;

  • a worsening picture of blood with a high content of leukocytes, increased ESR.


The healing of foci occurs with the formation of scars.
Kind of pyoderma Basic symptomatology

The leading cause that causes pyoderma is the penetration of coccal microbes into the tissues of hair follicles, sweat and sebaceous glands with ducts, damage.However, the causes of secondary forms of pyoderma, including ulcerative, gangrenous species is still being studied, since in such cases the seeding agents pyogenic skin areas - again, that is, arises after the development of certain diseases.

highlight key factors provocateurs:

  • skin lesions( wounds, injections, abrasions, bites, scratches, burns);
  • Acute or long-term decline in general and local immunity;
  • skin pathologies, including allergic-dependent dermatitis, tick-borne lesions;
  • heredity;
  • shifts in the functioning of endocrine organs( "thyroid gland", hypothalamus, pituitary gland, adrenal glands, gonads), hormonal failures;
  • diabetes;
  • vascular diseases, varicose veins, thrombophlebitis, hematopoiesis disorders, gastrointestinal diseases;
  • focal infections with an inflammatory process in a particular organ or tissue, including the stomach, intestines, nasopharynx and ear area, reproductive organs;
  • drift of pyogenic flora during surgical manipulations;
  • hypersensitivity to allergens and reaction to piococci;
  • Neurological disorders and thermoregulation systems
  • Non-compliance with personal hygiene;
  • periodic skin trauma in certain areas;
  • increased humidity, absorption capacity, alkaline skin reaction;
  • intolerance to certain drugs;
  • frequent overcooling or overheating;
  • long-term experiences and strong physical fatigue;
  • depletion, any long-term disease;
  • obesity, a breakdown in the metabolism of fats and carbohydrates;
  • contamination of the epidermis with paints, kerosene, solvents, oils, varnish, coal dust, gasoline, cement.

Symptoms

General

Common symptoms characteristic of any type of pyoderma are similar and can be expressed in the following forms( of varying degrees of severity):

  • hyperemia( redness), swelling, pain;
  • formation of a purulent-serous focus;
  • skin pigmentation disorder, its structure;
  • itching, burning, tingling;
  • increase, tenderness of lymph nodes;
  • with massive rashes, deep suppuration - general deterioration associated with intoxication, fever, nausea, disability;
  • severe pyoderma, including carbuncle, hidradenitis, gangrenous form, give serious symptoms of intoxication with neurological component: vomiting, delirium, hallucinations.

It should be noted that all external and internal signs of pyoderma in infants, children, are more intense due to the undeveloped immune system, immaturity of the dermis, vessels, organs.The small body weight of a young patient is a factor that aggravates the poisoning( intoxication) of the child's body with poisons that are formed by the decomposition of necrotic( dead) in the places of suppuration.And the younger the child, the stronger this factor is expressed.

Specific features for various types pyoderma

Diagnostics

diagnosis is abnormal manifestations after analysis on the patient's skin and general signs of inflammation in the body.

To clarify the diagnosis and to distinguish pyoderma other dermatoses with similar symptoms, use instrumental and laboratory techniques, including:

  • study of fluid taken from the pustules, vesicles, ulcers, in the presence of a particular species of pyogenic organisms( culture);
  • microscopy of detachable and tissue fragments( examination under a microscope);
  • histological analysis for detecting oncological changes in tissues;
  • blood sampling for hemoglobin;
  • PCR-analysis of blood and exudate for the early detection of a particular type of pathogen;
  • test-RPR for syphilis.

In order to identify the existing diseases that are capable of provoking the development of pyoderma, they are examined by specialized doctors.

It is necessary: ​​

  • to make a caprogram, immunogram;
  • to conduct research on dysbiosis;
  • to make an analysis of blood biochemistry and highly specialized analyzes for hormonal status, development of the cancer process and other as directed by a narrow specialist;
  • make ultrasound of the abdominal cavity.

Treatment

The treatment regimen, the choice of specific physiotherapy procedures, medicines are related to the type of pyoderma, the severity of the process, the severity of the manifestations, age, internal diseases.The patient is maintained by a dermatologist, a surgeon with the addition of other specialists, if necessary.

Therapeutic way

Shown:

  • Ultraviolet irradiation for the purpose of increasing the local protective properties of the dermis, strictly in dosages that are not capable of causing flushing( redness);
  • dry heat, UHF( only by doctor's prescription, since it is allowed for all forms of pyoderma);
  • Vitaminotherapy with special emphasis on group B, vitamin A, C, E;
  • means for strengthening the immune system: tincture of eleutherococcus, aralia, pantocrin, mummy;
  • diet with restriction of salt, carbohydrates, preservatives, alcohol, spices;
  • method of blood transfusion( blood transfusion) in severe forms.

By medicamentous method

Selection of ointments, glucocorticosteroids, antibiotics is carried out only taking into account the type of pyogenic cocci, otherwise the drug will be useless.

is used for washing and applications for surface pyoderma: alcohol solutions, antimicrobial, antiseptic ointments, gels, aerosols, depressing growth and activity of piococci, simultaneously relieving pain and inflammation.

Among the most common:

  1. Ointment synthomycin, erythromycin, zelenka, Fukortsin, Chlorhexidine, Betadine, Levosin, Gentamicin, Levomecol, Stellanin, Gentaksan, Bactroban, Piolizin.
  2. Combined corticosteroid agents combining anti-inflammatory and antibacterial action: Gyioxysone, Triamcinolone, Fucicort, Belogent, Lorinden C, Triderm.

Also:

  • For extensive ulcers and wounds, hydrocolloid sealed dressings are used.
  • Before the application of external pharmaceutical means must uncover abscesses, clean them from dead tissues and pus( only in a medical institution), treat the wound areas.
  • For gangrenous pyoderma, surgical sanitation and alcohol are prohibited in order not to injure the wounds and cause their increase.They use "soft sanitation", applying moist compresses with salt, Burov's liquid, furacilin, a slightly pink solution of "manganese".

Antibacterial medicines

Before prescribing antibiotics or already using them, an antibioticogram is made to determine the degree of sensitivity of the detected pyococcus to different types of antibiotics.On the basis of the obtained result, the most effective antimicrobial preparation is selected.

Antibacterial drugs use:

  • with ineffectiveness of local remedies;
  • as an obligatory part of treatment in a widespread or deep painful process with obvious signs of poisoning, fever;
  • with rapidly progressive pyoderma complicated by concomitant pathologies;
  • Always with the therapy of boils, carbuncles, hydradenitis.

If pyoderma flows easily or with moderate severity, medications are taken orally.In severe forms, antibacterial drugs are injected into a vein or muscle with a course of at least 6 to 10 days.

  • Traditionally used drugs: Amoxicillin, Ampiox, Cephalexin, Cefazolin, Cefotaxime, Ceftriaxone, Doxycycline, Gentamicin, Tobramycin, Clarithromycin, Amicacin, Erythromycin.
  • In the therapy of pyelenic pyoderma, Cefuroxime, Thalidomide, Dapsone, Clofazimine are used.

Hormones

Assign with severe pyoderma, including gangrenous form.As a rule, in large doses( up to 80 mg per day) prescribe Prednisolone, a short course.

Immunotherapy

This method involves the connection to antibiotics of drugs that neutralize the action of pyococci, their poisons, enhance resistance to microbial agents.Recommended for long-term ongoing processes with relapse at least once in 12 weeks.Prior to the application of pharmaceuticals, the baseline parameters of the immune system are examined using an immunogram.

Apply: leukinferon, staphylococcal and streptococcal toxoid, dry bacteriophage vaccine, antistaphylococcal immunoglobulin.

Operation

Surgical intervention is necessary in case of severe pyoderma with an aggressive purulent inflammation process deepened into the dermis, and the formation of large volumes of pus and the necrotic tissue fragments that must be removed.

It is always used in carbuncle, hydradenitis, furuncle, accompanied by concurrent administration of antibiotics.The operation is conducted under local( or general) anesthesia.Step by step open the abscesses, remove pus and necrotic tissue, drain the wound, make bandages with NaCl solution( 10%), enzymes( Trypsin, Himopsin, Chymotrypsin).

Prevention of disease

Preventative measures against pyoderma of various types are simple and easy to perform.These include:

  • mandatory and early antimicrobial treatment of small wounds, abrasions on the skin;
  • maintaining the purity of the skin and taking measures against its excessive contamination during work, including homemade household plots;
  • treatment of any foci of inflammation and chronic infection, including nasopharynx and foci of caries;
  • early treatment to the doctor at the first signs of skin changes and timely diagnosis.

Complications

Without the treatment and in the deep process in the thickness of the subcutaneous tissues are possible:

  • inflammation of the lymph nodes and vessels;
  • penetration of infection into the organs and bone tissue;
  • development of multiple abscesses, purulent mediastinitis, phlegmon of the orbit;
  • of meningitis, thrombosis of cerebral vessels;
  • blood contamination with a very unfavorable outcome.

Forecast

Carrying out diagnostic tests with the appearance of the initial symptoms of pyoderma will allow you to quickly select the tactics of treatment and prevent complications or the transition of the disease into a prolonged form.

  • Accurate observance of the prescribed dosages of drugs, constant consultation and examination by specialists will help even in the most difficult processes.
  • The consequence of self-treatment or removal of ulcers is the deepening of the process, its spread to healthy skin, scars, severe complications.

Pyoderma treatment is described in the video below: