PRIMARY BACTERIAL INFECTIONS OF THE SKIN

DR. AKRETI SOBTI DEPT OF D E R M AT O L O G Y K . J . S O M A I YA H O S P I TA L

INTRODUCTION
Bacterial skin infections also known as Pyodermas

Mostly superficial
Easy to diagnose and treat Special investigations not required

Can be treated with topical antibiotics at most times

SKIN AS A BARRIER AGAINST INFECTIONS

Commensals Protective role against external organisms Mostly non-pathogenic Rarely pathogenic or opportunistic Depends on immune status of host pH of skin Dryness with exfoliation Use of harsh soaps and cleansers remove the normal flora and cause more harm

BACTERIAL INFECTIONS SKIN Hair

Superficial Deep

APPENDAGES Nails
Acute Paronychia Eccrine Periporitis

Sweat Glands

Sebaceous Glands
Acne

Sup. Folliculitis Furuncle Pseudo-folliculitis Carbuncle Tri-myco-axillaris Sycosis barbae Superficial Impetigo SSSS Pitt. Klysis Erythrasma Deep Ecthyma Erysipelas Cellulitis Nec. Fascitis

Apocrine

Hid. Supp.

IMPETIGO
Contagious, superficial bacterial infection

Commonly seen in Children

Most favoured sites : Face and extremities Peri-nasal involvement could be dangerous.

IMPETIGO 2 TYPES OF CLINICAL PRESENTATIONS: Bullous impetigo

Caused by Staph. aureus. Vesicle enlarge to form bullae

Caused by Streptococcus Vesicle rupture to expose red, moist base with crust formation as lesion expands radially. Honey coloured crusting is diagnostic

Nonbullous impetigo-

Bullous impetigo

Non-bullous impetigo

STAPHYLOCOCCAL SCALDED SKIN SYNDROME

Also called Ritters disease Staphylococcal epidermolytic toxin syndrome Follows an episode of sore throat Caused by lack of immunity to toxins and renal immaturity in children causing poor clearance of toxins Characterized by peeling of skin after blister formation similar to burns

STAPHYLOCOCCAL SCALDED SKIN SYNDROME

STAPHYLOCOCCUS SCALDED SKIN SYNDROME

TREATMENT:

Hospitalization
Intravenous antibiotic therapy Skin should be lubricated with bland lotions and washed infrequently

ECTHYMA
Characterized by formation of adherent crusts beneath which ulceration occurs Begins as small pustule on erythematous base which is soon surrounded by a hard crust. Crust can be removed with difficulty to reveal an irregular ulcer More common on the legs, thighs and buttocks Initiated by Group A Beta hemolytic Streptococci and contaminated with Staphylococci.

Ecthyma

CELLULITIS AND ERYSIPELAS

Both are deeper infections of skin

Cellulitis is applied to inflammation of subcutaneous tissue

Erysipelas is infection of dermis and lymphatics Similar bacteriology Streptococci and staphylococci

Erythema, heat, swelling and tenderness common in both

CELLULITIS AND ERYSIPELAS

In Erysipelas, edge of lesion is demarcated and raised.

In Cellulitis, diffuse blister formation with hemorrhage

Both can progress to dermal necrosis Lower extremities and face commonest

Complications subcutaneous abscess, septicaemia and nephritis(streptococcal)

Erysipelas

Cellulitis

FOLLICULITIS
Inflammation of hair follicle Can be :

Infective - bacterial/viral/fungal
Non infective - grease, oil or post waxing. Characterized by multiple superficial follicular pustules

Folliculitis

PSEUDOFOLLICULITIS
Not a bacterial infection Commonly seen in blacks Results from penetration of sharp tips of shaved hair into the skin Commonest site is the beard Characterized by papules and pustules on shaven skin May cause scarring, keloid formation and hyper pigmentation

PSEUDOFOLLICULITIS
More of a cosmetic problem Stop shaving for 4-6 wks

Maintain beard hair at 1mm length

Avoid plucking of hair Topical steroid - antibacterial combination

FURUNCLE
Acute, usually necrotic infection of a hair follicle with S. aureus Presents initially as a small, follicular inflammatory nodule pustular necrotic Single or multiple associated with tenderness Sites involved face and neck, arms and legs, buttocks and anogenital area

Furunculosis

CARBUNCLE
Deep bacterial infection involving group of furuncles Most favoured area is nape of neck

Marker for Diabetes mellitus

May require aggressive therapy

Carbuncle

ACUTE PARONYCHIA
Caused by staphylococci

Entry is gained through break in the skin or cuticle as a result of minor trauma
Characterized by acute inflammation with the formation of pus in the nail fold Treatment is with systemic antibiotics. Surgical drainage maybe required

PERIPORITIS
Secondary infection of miliaria( the eccrine sweat glands) with staph.aureus

Commonly seen in children

Summer exacerbation Characterized by multiple erythematous papules and nodules over the forehead face scalp and trunk Progress to form nontender fluctuant abcess D/D: furunculosis

ERYTHRASMA
Corynebacterial infection of the skin Characterized by well demarcated reddish-brown scaly patches on moist body areas such as the axillae or groins. Most commonly mistaken for Tinea cruris or intertrigo Differentiated by Woods lamp coral red flourescence

Erythrasma

PITTED KERATOLYSIS Caused by corynebacterium minutisimum, micrococcus sedantareus & dermatophilus congolensis Predisposing factors:
Excessive sweating Prolonged immersion of hands and feet in water Occlusive footwear

Characterized by cribriform pattern of fine punched out depressions on the palms and soles associated with foul smell

TREATMENT
Counseling

Oral antibiotics erythromycin, azithromycin

Topical antifungal and antibiotic creams Treatment of hyperhidrosis

TRICHOMYCOSIS AXILLARE
Misnomer Caused by corynebacterium tenuis axillary and pubic hair become beaded with concretions (yellow, red or black), made up of tightly packed bacteria This maybe associated with discoloration of sweat leading to staining of the undergarments and foul smell Topical antibiotics or shaving will clear the condition

TREATMENT
Topical antibiotics for localized infections Combination of Oral and Topical therapy for extensive infections. Topical modalities include Fusidic acid, Mupirocin, Sisomycin, Nadifloxacin, Framycitin-B Oral antibiotics preferred are Ampicillin, Cloxacillin, Amoxycillin, Cephalosporins or Azithromycin. Hospitalization, IV antibiotics and /or surgical intervention for deeper infections like Cellulitis and Erysipelas

SECONDARY BACTERIAL INFECTION

Bacterial infection on an underlying condition Scabies / Pediculosis Eczemas Vesiculo-bullous lesions Ulcers