Pyodermia.

A.Rodin

Pustular skin diseases (pyodermia) take the first place among all dermatoses and account 15% of all morbidity with loss of work capability.

Those diseases that usually occur as a result of exogenous intradermal introduction of pyogenic cocci refer to the group of pyoderma diseases. They can occur as firstly as well as secondly in complicated forms of other dermatoses. More often pruritis dermatoses are accompanied by mechanical injury and skin disintegrity.

Etiology.The causative agent of pyodermia is commonly Streptococci and Staphylococci, Escherichia coli, Proteus vulgaris, pneumococci and other microorganisms. Streptococci and Staphylococci are widely spread in nature, soil and air.

75% of healthy adults and 60% of infants have Staphylococci on the skin. 10% of them have Streptococci, however, there are no pyodermia manifestations as not all cocci are of pathogenic etiology; on the other hand, uninjured and functioning in norm skin is a perfect barrier for their penetration.

Therefore for pyodermia development it essential to have exogenous and endogenous factors changing the protective functions of the skin.

Exogenous factors:Destruction of water-lipid coverage under the influence of skin hygiene insufficiency (cement pollution, gas-oil materials, coal, etc.). Skin traumas (as well as microtraumas).

Supercooling causing the reduction of sweat glands, vasoconstriction, overheating Secretory malfunction: increased sweat secretion, seborrhea, that in its turn decreases its sterile properties.

Endogenous factors:1. Endocrine system pathology: diabetes , thyroid gland insufficiency, hypophysis and epinephros system insufficiency, and sex gland insufficiency.2. Vegetative neuroses accompanied by vascular tonicity malfunction as well as sweat gland malfunction.

3. Topical trophic disorders.4. Chronic intoxication (gastro-intestinal pathology, TBC, etc.), hypovitaminoses, hypotrophy, immunodeficiency.5. Hereditary inclination.

Classification.

Depending on the etiological findings the Staphylodermia, Streptodermia and mixed forms of infections are ascertained.

Staphylodermia

Staphylococci parasitize on the skin in the area of hair follicle orifice and fat ducts and apocrinic sweat gland. Moreover, a hair follicle is supplied with blood vessels and nerves, weaving a net around it that is why inflammation is easily appeared and has severe forms.

Children of neonatal period and up to 1 year old are excluded. Staphylodermia are manifested by means of elements, which are not connected with hair follicles and fat glands. But Staphylococci involve accrine sweat glands in children.

This is due to fact that apocrine glands dont function, hair follicles are not perfect and excretion ducts of accrine glands are short, straight and wide stipulating conditions for microflora penetration.

Vesiculopustulosis.It occurs on the 3-5 day after birth and is stipulated by follicle orifice involvement of the accrine glands. Pustules being of the size of needle head occur on the hair and folders. If the essential care is taken and an appropriate therapy is administered the dermatosis vanishes in 3-7 days.

Pseudofurunculosis. (multiple abscesses).Some children with vesiculopustulosis the course of disease is severe, infection is easily penetrates into depth of the skin involving orifice as well as the gland itself. Multiple intradermal nodes in the size of a pea to a nut, purple-red with blue shadows in colour appear on different areas of the skin.

Disintegrity of infiltrate is accompanied with skin node thinning than abscesses eruption takes place discharging yellow-green pus. Commonly, weak children suffer this disease (artificial feeding, delivery trauma etc.).

As a rule the general condition is destroyed (the temperature rises up to 39 C, anorexia, body weight loss, dyspepsia, intoxication). Hypochrome anemia, leukocitoses with left side shift, accelerated ESR are in the peripheral blood. There is a protein, leukocytes, erythrocytes, and cylinders in the urine.

Some children suffering pseudofurunculosis show septic condition with pyemic focuses such as a suppurative otitis, paraproctitis, flegmon, meningitis, pneumonia.

Epidemic pemphigus in infants (pyococcic pemphigoid). On the 3-15 th day after the birth slight blisters appear at the size of pea to nuts surrounded by lightly pink inflammatory crown. The rash is localized on the skin of the trunk near natural folders, on the extremities. Subfebrility is noticed.

After blisters eruption a moist erosian remains, however crust is not formed. In sever cases septic development can occur. Pyococcic pemphigoid is a catching disease that is why it is essential to isolate children.

Exfoliate Ritters dermatitis.It is one of the severe forms Staphylodermia in infants. During the exacerbation period of epidemic pemphigus, exfoliate Ritters dermatitis premature and weak children suffer this disease. Usually the onset starts in several days after the birth as a hyperemia and a maceration around the mouth.

Than slight skin hyperemia, epidermis exfoliation and blisters formation occur on different areas. The epidermis exfoliates with wide layers. A new-born looks as if it has a burn, clinical picture resembles a scald II, even a slightest touch causes epidermis exfoliation (Nikolsky symptom).

General condition is severe, temperature rises up to 41 C, many have toxico-septic condition, and afterwards sepsis develops. The lethal outcome is high.

Many scientists identify exfoliate Ritters dermatitis as a syndrom of Staphylococcic skin scald (up to 5 years old it is considered to a Staphylococcic variety of the toxic epidermonecrolisis Layel syndrome).

Ostiofolliculitis.The inflammatory process is localized in the hair follicle orifice as a pustule in the size of needle head conic in shape. The localization is frequently noticed on the skin of the face, neck.

The pustule exists only 2-3 days, dries up into a crust and afterwards there is a pigment spot remnants. Ostiofolliculitis can occur as a complicated pruritis form of dermatosis (scabies, pediculosis, eczema, atopic dermatitis).

Folliculitis.This form of the disease develops when the infection spreads into the depth of the hair follicules. The superficial and deep folliculitis are identified. In superficial form the inflammation appears on the papilla dermal layer level therefore the eruption doesnt leave any traces

. In deep form of folliculitis the process involve the whole follicle and necrotic masses is accompanied with small ulcer formation. The folliculitis usually painful thickened but without fluctuates in palpation. The course length takes about 5-7 days.

Furuncle.This disease involves not only the follicle itself but also surrounding tissues. It can develop from folliculitis however, the inflammation develops in the deep layers of the follicle having the size of a pea or a nut. The process is accompanied with intensifying painfulness, edema and hyperemia.

In 3-4 days the infiltrate becomes necrotic, thinned. The excreted pus has a green colour. The central part becomes rejected, and the inflammatory processes subside. The annular ulcer is filled by granulation to form a scar. The whole circle takes 10-12 days.

Carbuncle.It the most sever form of Staphylogenic piodermia. It presents any furuncles localized in one place. Sometimes the size can be of a fist. The localization is stipulated to the cloth wearing. In the center of the carbuncle one can notice some pustules, necrotic core.

After the rejection a huge scar forms. As a rule during period of exacerbation such symptoms as headache, general weakness, temperature increase and intoxication are observed.

Hydradenitis. Staphyllogenic purulent inflammation of apocrine sweat glands and as a result the localization is in the armpit, in the area of genitalia, perianus area. Clinical manifistation are in hyperemic abscesses (the size of a pea) and central fluctuation. The abscess extracts with a significant pus amount. There are no necrotic cores. The disease may prolong turning into a chronic-recurrent form.

Staphylodermia treatment.

Osteofolliculitis, superficial folliculitis can be treated topically pustule opening, painting the focuses with anilin paintings, prophylaxis around the area of focuses 2% salicylic, boric, camphor acid.

Deep foliculitis , furuncle, hydradenitis. Usually the application of topical forms is quite appropriate, but in case if the pustules are observed on the face antibiotics of a systemic action (polysynthetic penicillin, macrolides, tetracicline) are administed . After the eruption of the focus the use of hypertonic solution is of great importance, after the ulcer cleaning the use of ointments with antibiotics is also essential. Sometimes surgical intervention.

Carbuncle.Systemic antibiotic treatment, a wide X-like incision if the course it sever. Generally the treatment is the same to furuncle.

Streptodermia.

Impetigo or Streptodermia characterized by the surface involvement of the skin, folders. Follicles and sweat glands are not involved. Females and children suffer this disease commonly.

The 1-st morphologic element is phlychtena a thin blister of semi-spheric shape containing serous-turbid substance and located under the horny layer. Phlychtena occurs on the hyperemic spots. The development of each blister takes about 5-7 days. A thin cover erupts very quickly, the containing mass becomes dry very quickly.

After the rejection one can observe the erosion consequently epithelized with unstable erythema formation. There are no scar and atrophy changes. The place of localization is the arms, face, and trunk.

There are the following varieties of impetigo1. Blister impetigo. Mostly observed in females and children. The place of localization is wrists, planta pedis, and ankles but rarely. They appear singly, the size is variable from 1 sm up to an egg, and blisters are with serous-turbid contents. After the eruption the coverage form an erosive crust.

2. Cleft-like impetigo. This form is characterized with a quickly erupted form of phlyctena localized in the peripheries of the mouth, at the base of the nose wings, eye fissures. Due to the maceration clef-like fissures form, the crusts reject very quickly the disease is accompanied with painful cracks.

3. Intertrigo streptodermia. This form is usually developed in overweighed people, diabetic persons and pastosis children. The phlyctena occur on the surface of large folders, become fused, after the eruptions there are huge erosive moist surfaces of pink bright colour. This kind of dermatosis has the form of pruritis.

Chronic ulcer pyodermia.This disease is characterized with a quiet course, deep skin involvement, and usually a lower extremity. In pathogenesis microorganisms the main role play. The blood circulation and innervation also play an important part. Males suffer this disease often at the age of 40-50years old.

Usually the disease starts with deep pustule gradually proliferating and becoming fused. The periphery has the inflammatory infiltration, which become necrotic. Due to this fact the ulcer enlarges in diameter. There a lot of abscesses at the base of the ulcer. The possibility of periostitis and osteoperiostitis can occur.

The impetigo treatment.

In usual cases the skin is treated by means of alcohol solution, massive crusts are removed by lotions with oil. The focuses are painted with ointments with antibiotics.

Chronic pyoderma treatment

Due to the ecology, hypovitaminization, disease pyodermia turns into a chronic disease. The cause of this is immune deficiency. There is specific and non-specific immune therapy.

Specific immune therapy

Active immunization.1. Absorbed staphylococcic anatoxin 2. Native staphylococcic anatoxine3. Staphylococcic antiphagin

Passive immunization is performed when the patients organism is in no condition to produce its own protective properties. Staphylococcic hyperimmune plasmaAnti-staphylococci gamma- globulin.

Non specific therapy

Autohemotherapy; blood transfusionPyrotherapy (pyrogenal) Ultraviolet and laser radiation of the blood, ozonetherapyImmune modulators (T-activin, pentoxil, amixine, thymolin etc).

General therapy. Vitamines (B1, B6, B12, A, C, E), biogenic stimulants.In deep chronic cases antibiotics as well as corticosteroids are administered (20-40 mg of prednizolone) during 3-6 weeks.

In severe cases synthetic analog of vitamin A is essential aroma retinoid (Roaccutan).Physiotherapy. UV, microwave, ultersonnic and magnitotherapy. X-ray therapy in deep forms of pyodermia. Sanatoriums and resorts at period of remission (Radon, sulfic, sea, natrium chloride bathes).

Scabies.

is a parasitary disease, relating to dermatosoonoses (the penetration of a live parasite into a living organism). The causative agent is a scabby tick, the tick drills an entrance of 5-10 mm at length under the horny layer of epidermis and saves there its eggs. Contamination usually takes from 3-14 days to 1.5 months by means of hand-shaking, coitus, articles of the dress, toys, etc as well as cat.

Clinical characteristics Scabies tick drills entrances in the thin layers of the skin (interfinger spaces, wrists, genitalia., etc. in distinction from the adults the infants may have the involvements of face, palms, soles).

On the spots of intervention there are miliary papule, at the top of it there is a vesicle. The rash is doubled (the distance between them consists of 2-3 to 10 mm) the place of the parasite entrance and a place of egg-delivery. There is a gray line between them that denote a scabies transition.

Skin pruritis is a characteristic feature for scabies intensifying in the evening as during this period parasites drill the entrances.

Treatment.1) 20% benzil benzoatis during 4 days (children must be rubbed in 10% benzil benzoatis). 2) effective one-time use Spregal aerosol. Personal cloth articles must be disinfected.

The skin pruritis usually remains after the treatment for a period of 5-7 days as the algestic (painful) receptors of the epidermis were involved. That is why the use of antipruritis medicines with menthol, anaesthezine, etc.

PEDICULOSIS.

The causative agents are the louses, i.e. the parasites feeding with blood and living on the human body. The sources of contamination are the coitus, hat, articles of the dress, bed. There are head, pubis and underwear (clothes) parasites.

Head pediculosis.The parasites live on the hair. At the spots of bites the pruritis spots occur. As a result the second infection can appear. On examination of the hair one can notice the parasites themselves and the nits.

Pubic pediculosisThey in the hair part of pubis, low part of the abdomen, breast and beard as well as moustache is rare.

Underwear pediculosisThe parasites live in the underwear folders. The appeared vascular spot, papules elements are localized on the places of wear articles and skin contact (shoulders, upper part of the back, abdomen).

Treatment of the pediculosis