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BACTERIAL SKIN INFECTIONS
NORMAL FLORA OF SKIN
• Gm + COCCI STAPHYLOCOCCUS MICROCOCCUS
• Gm + RODS PROPIONIBACTIRIUM CORYNEBACTIRIUM
• Gm –VE RODS ACINETOBACTER
ROLE OF NORMAL FLORA
DEFENCE AGAINST BACTERIAL INFECTION
THROUGH BACTERIAL INTERFERENCE
PRODUCTION OF FREE FATTY ACIDS(FFA) FROM
SKIN LIPIDS
STAPHYLOCOCCUS AUREUS
ANTERIOR NARES 35 %
PERIANAL SKIN 20 %
AXILLARY SKIN 5-10 %
TOE WEBS 5-10 %
REDUCTION OF CARRIAGE
MUPIROCINE OINTMENT INTRANASALLY FOR 5 DAYS
ORAL RIFAMPICIN 600mg 7-10 DAYS
CLINDAMYCIN 150mg/day FOR 3 MONTHS
STAPHYLOCOCCUS DISEASES
ImpetigoEcthymaScalded skin syndromeFurunculosisFolliculitisCarbuncleSycosis
STREPTOCOCCUS DISEASES
ImpetigoEcthymaErysipelasCellulitisScarlet feverIntertrigo
IMPETIGO
CONTAGIOUS SUPERFICIAL INFECTION OF THE SKIN
ORGANISIMS: STAPHYLOCOCCUS AUREUS,
STREPTOCOCCUS
PEAK SEASON: LATE SUMMER
AGE: PRESCHOOL & YOUNG SCHOOL AGE
EXISTING SKIN DISEASE: SCABIES, PEDICULOSIS
CLINICAL FEATURES
VESICLE ON ERYTHEMATOUS BASE
RUPTURES - SERUM EXUDES
YELLOWISH BROWN CRUST
PERIPHERAL EXTENSION
HEALS WITHOUT SCARRING
TREATMENT
TOPICAL ANTIBIOTICS
NEOMYCIN
BACITRACIN
FUCIDIC ACID
MUPIROCIN
SYSTEMIC ANTIBIOTICS
IF WIDESPREAD OR SEVERE
ECTHYMA
PYOGENIC INFECTION OF THE SKIN CHERACTERISED BY FORMATION OFCRUST BENEATH WHICH ULCERATIONOCCURS
AETIOLOGY
STAPH. AUREUS, STREPTOCOCCUS
POOR HYGIENE
MALNUTRITION
OTHER PREDISPOSING FACTORS
CLINICAL FEATURES
BULLAE OR PUSTULE
HARD CRUST
PURULENT IRREGULAR ULCER
HEALS WITH SCARRING
BUTTOCKS, THIGHS AND LEGS
TREATMENT
SAME AS FOR IMPETIGO
INFECTIONS INVOLVING HAIR FOLLICLES
FOLLICULITIS
FURUNCLE
CARBUNCLE
FOLLICULITIS
INFLAMMATORY CONDITION OF THE HAIR FOLLICLE WITH CHANGES CONFINED TO OSTIUM
AETIOLOGY
BACTERIAL: STAPHYLOCOCCAL
FUNGAL: TRICHOPHYTON RUBRUM
CHEMICAL: TAR
DRUGS: STEROIDS
CLINICAL FEATURES
SMALL FOLLICULAR PAPULE OR PUSTULE
RARELY PAINFUL
HEALS WITHOUT SCAR
TREATMENT
REMOVE UNDERLYING CAUSE
TOPICAL ANTISEPTICS
TOPICAL ANTIBIOTICS
SYSTEMIC ANTIBIOTICS
FURUNCLE
ACUTE USUALLY NECROTIC AND DEEP SEATED INFECTION OF HAIR FOLLICLE
AETIOLOGY
STAPH. AUREUS
SEBORRHOEIC / ATOPIC INDIVIDUALS
DIABETICS
SCABIES
HIV
MALNUTRITION
CLINICAL FEATURES
SMALL FOLLICULAR NODULE
TENDER
LOCALIZED NECROSIS
HEALS WITH SCARRING
FEVER & MILD CONSTITUTIONAL SYMPTOMS
CAVERNOUS SINUS THROMBOSIS
TREATMENT
GENERAL MEASURES
SYSTEMIC ANTIBIOTICS
TOPICAL ANTIBIOTICS
ANALGESICS
CARBUNCLE
DEEP SEATED INFECTION OF A GROUP OF CONTIGUOUS HAIR FOLLICLES
AETIOLOGY
STAPH. AUREUS
MIDDLE AGED MEN
DIABETES, MALNUTRITION
CARDIAC FAILURE
DRUG ADDICTS
PROLONGED STEROIDS
ERYTHRODERMA
CLINICAL FEATURES
HARD RED PAINFUL NODULE
MULTIPLE DISCHARGING FOLLICULAR SINUSES
NECROSIS OF INTERVENING SKIN
DEEP ULCER WITH PURULENT FLOOR
BACK OF NECK, SHOULDERS, HIPS, THIGH
FEVER
SEPTICAEMIA
TREATMENT
SYSTEMIC ANTIBIOTICS
TOPICAL ANTIBIOTICS
ANTIPYRETICS/ ANALGESICS
SURGICAL INTERVENTION WHEN INDICATED
REMOVAL OF UNDERLYING CAUSE
CELLULITIS
ACUTE, SUBACUTE OR CHRONIC INFECTION OF LOOSE CONNECTIVE TISSUE PERTICULARLY SUBCUTIS
AETIOLOGY
STREPTOCOCCI
H. INFLUENZA
STAPH. AUREUS
PSEUDOMONAS
CLINICAL FEATURES
ERYTHEMA
SWELLING
HOT & TENDER
ILL-DEFINED MARGINS
CONSTITUTIONAL SYMPTOMS
COMPLICATIONS
FASCIITIS
MYOSITIS
GANGRENE
SUBCUTANEOUS ABSCESSES
SEPTICAEMIA
TREATMENT
APPROPRIATE ANTIBIOTICS
ANALGESICS
REST
TREATMENT OF COMPLICATIONS
ERYSIPELAS
EDGES WELL DEMARCATED, RAISED
BLISTERING COMMON
MORE SUPERFICIAL INVOLVEMENT
FACE COMMON SITE
RESPONSE TO TREATMENT RAPID
Common skin condition affecting the skin folds such as under the arms, in the groin and between the toes.
Erythrasma does not usually cause any symptoms.
It presents as a slowly enlarging patches of pink or brown dry skin.
Caused by Corynebacterium minutissimum.
Diagnosis confirmed by Wood’s lamp examintation which turns erythrasma to fluoresce a coral-pink colour.
Erythrasma can be treated with antiseptic and topical antibiotic such as: • fusidic acid cream • Clindamycin solution.•Erythromycin lotion.
VIRAL INFECTIONS OF SKIN
VIRAL WARTS
HUMAN PAPILLOMA VIRUS
DNA – VIRUS 50-55nm
77 DIFFERENT TYPES
CONT’D
INFECT SQUAMOUS EPITHELIA
CAUSE CELL PROLIFERATION -- PAPILLOMA
DYSPLASIA / NEOPLASIA
TYPES
Common warts
Plane warts
Filiform warts
Plantar warts
Acuminate warts
COMMON WARTS HPV - 2
FIRM PAPULES / PLAQUES
ROUGH HORNY SURFACE
SYMPTOMLESS
SITES - BACK OF HANDS, FINGERS,
ANYWHERE ON SKIN
65% DISAPPEAR IN 2 Yrs
PLANE WARTS
HPV 3, 10
SMOOTH, FLAT OR SLIGHTLY ELEVATED
1- 5 mm ROUND OR POLYGONAL
FACE AND BACK OF HANDS
FILIFORM WARTS
FINGER-LIKE PROJECTIONS
FACE, NECK AND SCALP
COMMONLY IN MALES
PLANTAR WARTS
HPV 1, 2, 4, 57
SMALL SHINING SAGO GRAIN LIKE PAPULE
USUALLY PAINFUL HYPERKERATOTIC
PRESSURE AREAS OF SOLE, PALMS
MOSAIC PATTERN
ACUMINATE WARTS
HPV- 6, 11, 16 ; VENERIALLY ACQUIRED
MUCO-CUTANEOUS JUNCTIONS AND INTERTRIGINOUS
AREAS
SOFT, PINK , MOIST SURFACE
PEDUNCULATED OR CAULIFLOWER LIKE
MACERATION - INFECTION, MALODOUR
DIAGNOSIS
HISTOLOGY
ELECTRON MICROSCOPY
IMMUNOHISTOCHEMISTRY (TYPE
SPECIFIC ANTIBODIES)
PCR
SPONTANEOUS RESOLUTION
GENERAL MEASURES
TREATMENT
AVOIDANCE OF SHARED TOWELS AND SHOES
AVOID BITING NAILS
ADEQUATE PLASTIC STRAPPING AT SWIMMING POOL
DESTRUCTIVE MODALITIES
Electrocautery
Cryotherapy
Salicylic acid
Podophyllin
Surgical methods
CO2 Laser
Other modalities
Cimetidine
Retinoids
Interferon
Imiquimod
Antiviral therapy (cidofovir)
Intralesional bleomycin
MOLLUSCUM CONTAGIOSUM
Caused by MCV-1, MCV-2
Mainly in children
Direct contact
Discrete shiny, pearly white, rounded papules
Umbilicated centers
TREATMENT
General measures
Topical Retinoids
Puncture with wooden probe dipped in tincture
iodine
Cryotherapy
Electrocautery
CO2 Laser
HERPES SIMPLEX
Herpes virus hominis
Type 1, 2
Persist in sensory nerve ganglia
Spread: Direct contact, droplets
CLINICAL FEATURES
Sub-clinical
Age 1-5 years
Incubation period 5 days
Fever, malaise, dribbling of saliva
Gums - swollen, inflamed
Primary infection
Cont’d
Vesicles, ulcers
Tongue, pharynx, palate, buccal mucosa
Regional lymph nodes – enlarged & tender
Recovery in 2 weeks
Cont’d
Herpes genitalis
Kerato-cunjunctivitis
Inoculation herpes simplex
Recurrent infection
50% type 1, 95% type 2
Smaller vesicles
Close grouping
No constitutional symptoms
Buccal mucosa not affected
TRIGGERING FACTORS
Minor trauma
Febrile illnesses
UV radiation
Dental surgery
Pre-menstrual period
Emotional stress
COMPLICATIONS
Cranial Nerve palsies e.g. Bell's palsy
Eczema herpeticum
Erythema multiforme
Encephalitis
TREATMENT
Mild, uncomplicated : no treatment or topical
antiseptic
Severe primary infection : antiviral therapy
(Acyclovir 200mg 5 times/day)
Recurrent : topical antiviral
CHICKEN POX
HERPES VIRUS VARICELLAE
DROPLET INFECTION
2 -10 YEARS
INCUBATION PERIOD : 14-17 DAYS
CLINICAL FEATURES
FEVER, MALAISE, RASH
MORBILIFORM ERYTHEMA
PAPULES, VESICLES
PUSTULES WITH RED AREOLA
DRY CRUST, PINK DEPRESSION
HEALS WITHOUT SCARRING
Sign (dewdrop on a rose petal)
Papules & vesicles
Polymorphic lesions
Chickenpox & bullous impetigo
Large pustules & umbilicated lesions
COMPLICATIONS
SECONDRY INFECTION
ENCEPHALITIS
HEPATITIS
PNEUMONIA
ARTHRITIS
SEPTICAEMIA
STEVENS - JOHNSON SYNDROME
TREATMENT
REST
ANALGESICS
SOOTHING ANTISEPTICS
DAILY BATHING
ANTIBIOTICS FOR SECONDARY BACTERIAL
INFECTION
ANTIVIRAL THERAPY
HERPES ZOSTER(SHINGLES)
HERPES VIRUS VARICELLAE
INCIDENCE INCREASES WITH AGE
PATIENTS ARE INFECTIOUS
CLINICAL FEATURES
FIRST MENIFESTATION – SEVERE PAIN
HEADACHE, MALAISE, LOCALISED
TENDERNESS
GROUPED RED PAPULES IN DERMATOMAL
PATTERN
VESICLES, PUSTULES
Cont’d
MUCOUS MEMBRANE INVOLVEMENT
LYMPHADENOPATHY
RECOVERY 2-4 WEEKS
OCCASIONALLY PAIN NOT FOLLOWED BY ERUPTION
Cont’d
THORACIC - 53%
CERVICAL - 20%
TRIGEMINAL - 15%
LUMBOSACRAL - 11%
Disseminated lesions
COMPLICATIONS
FACIAL PALSY
SENSORY LOSS
MENINGOENCEPHALITIS
POST HERPETIC NEURALGIA (PHN)
TREATMENT
BED REST
ANALGESICS
LOCAL ANTISEPTICS
TOPICAL ANTIBIOTICS
ANTIVIRAL THERAPY
TREATMENT OF PHN
