Pyoderma

Pyoderma - a group of skin diseases, the main symptom of which is suppuration.

Etiology, pathogenesis. The causative agents are staphylococci and streptococci. An important role in pathogenesis is played by endogenous disorders (diabetes mellitus, blood diseases, abnormalities in vitamin metabolism, gastrointestinal disorders, obesity, liver disease, neuropathy, etc.), exogenous effects (micro-trauma, rubbing, cooling, overheating, skin contamination, defective Nutrition, etc.) and long-term treatment with corticosteroids and cytostatics. On the etiologic principle distinguish staphyloderma and streptoderma, which in turn are subdivided into superficial and deep.

Staphyloderma. There are the following varieties of staphylodermia: ostiofolliculitis, folliculitis, sycosis, epidemic pemphigus of newborns (superficial staphyloderma), furuncle, carbuncle and hydradenitis (deep staphyloderma).

Ostiophalliculitis - located in the mouth of the hair follicle, a small pustule with a dense cover, from the center of which stands hair; The periphery of the pustule is bordered by a narrow rim of hyperemia. With the spread of suppuration into the depth of the follicle, ostiophalliculitis is transformed into folliculitis, which differs clinically from the first by the presence of an infiltrate in the form of an inflammatory nodule located around the hair. Ostiophalliculitis and folliculitis can be single and multiple. They are localized in any area of ​​the skin, where there are long or well-developed fleece hair. When the involution is formed purulent crust, on the falling off of which is found a cyanotic-pink spot that disappears with time.

Staphylococcal sycosis is a multiple, cumulatively located on the bluish-red and infiltrated skin of the chin and upper lip, ostmofolliculitis and folliculitis, which are at different stages of evolution and are prone to a long, sometimes perennial, recurrent course.

Epidemic pemphigus of newborns is a highly contagious acute disease that affects newborns in the first 7-10 days of life. It is characterized by numerous bubbles of various sizes with a clear or cloudy content and thin flabby cover. The entire skin is affected, except for the palms and soles. Bubbles partly dry up with the formation of thin crusts or, continuing to increase in size, merge with each other and open, leading to the formation of erosive surfaces, sometimes engaging the entire skin (exfoliative dermatitis Rittera). It is possible to involve the mucous membranes in the process. Common phenomena, sometimes severe, can be associated with death.

Furuncle-purulent-necrotic inflammation of the hair follicle and surrounding tissues; Is clinically an acute-inflammatory node with a pustule on the apex. When necropsy is exposed necrotic stem, the rejection of which forms an ulcer that heals with a scar. Subjectively - pain. Furuncles can be single and multiple, their course-acute and chronic. Sometimes lymphadenitis and lymphangitis, fever, are attached. With localization on the face, especially in the nasolabial triangle, meningeal complications are possible.

Carbuncle - a dense deep inflorescence of crimson-red color with the phenomena of pronounced perifocal edema, resulting from necrotic purulent inflammation of the skin and subcutaneous fat. Through the holes formed thick pus, mixed with blood. By rejection of necrotic masses, a deep ulcer is formed, which heals with a coarse scar. Subjective - painful pain. The general condition, as a rule, is broken. Carbuncles occur in weakened and exhausted persons on the back of the head, back and waist. The carbuncles of the face are extremely dangerous.

Hydradenitis is a purulent inflammation of the apocrine sweat glands. In the skin (usually the axillary cavities) an acute-inflammatory knot is formed, at the dissection of which pus is released. Subsequently, the process undergoes scarring. There is soreness. Common violations are possible, especially with multiple hydradenites forming massive conglomerates. Hydradenitis is more common in full women with sweating.

Streptodermia. The main morphological element of streptodermia is fliktena - a cavity in the epidermis with a thin and flabby cover, filled with serous-purulent or purulent contents, located on smooth skin and not associated with the sebaceous-hair follicle. There are streptococcal impetigo, bullous impetigo and vulgar ecthim.

Streptococcal impetigo is a contagious disease that affects children and young women. It is characterized by a rash of fliesen, bordered by a rim of hyperemia. Often, the cover of a conflict is broken with the formation of superficial erosions of pink-red color separating abundant exudate. The exudate, like the contents of the conflict, quickly dries up with the formation of honey-yellow crusts, on the falling off of which pink spots appear, disappearing soon. With progression, the ficteni become multiple, can merge into vast foci, covered with massive crusts. There is a mild itching or slight burning sensation. The general condition is usually not disturbed. The process is localized on any part of the skin, more often on the face, in particular in the corners of the mouth in the form of a crack (zaeda); Sometimes the horseshoe covers the nail (okolonogtevoj impetigo). When joining staphylococcal infection, amber-yellow pustules are formed, quickly drying out into thick loose serous-purulent crusts, sometimes with a mixture of blood-vulgar impetigo arises, characterized by great contagiousness, lesions of large areas of the skin, folliculitis, furuncles and lymphadenitis, bullous impetigo is the heaviest Variant of streptococcal impetigo; Develops usually in adults on the feet, legs and hands. It differs by large strained blisters that have serous or serous-bloody exudate and a thick cover. The skin around them is inflamed. Lymphangites, lymphadenitis, general disorders, changes in hemograms can be attached.

Vulgar ecthima is the only deep form of streptoderma; Develops more often in adults on the lower legs, buttocks, hips and trunk. There is a large deep-lying flicten with purulent or purulent-hemorrhagic contents, dried in a thick crust, under which an ulcer is found. Healing by superficial, less often retracted scar. The number of ectimes varies from single to multiple. In weakened individuals, they acquire a prolonged course.

Treatment. In the case of multiple foci, a general wash is prohibited, in the case of single foci, the question is solved individually. Always avoid washing the foci themselves. Frequent change of clothes is necessary. Towels, combs and other household items should be individual. Nails trimmed and daily lubricated with iodine tincture. Hair around the foci shortly cut, and the skin wipe with salicylic or camphor alcohol. Ostiophalliculitis and folliculitis should be opened with a sterile needle and treated with aniline paints. On unopened furuncles and hydradenites apply "cakes" from pure ichthyol, at autopsy- hypertensive bandages, and after purification of ulcers - bandages with ointments containing antibiotics. When the furuncle is located on the face or neck - always inside sulfonamides or antibiotics. Carbuncles are subject to surgical opening with subsequent hypertonic and antiseptic bandages. The foci of impetigo are smeared with aniline paints, ointments with antibiotics (with bullous impetigo pre-open the blisters). In chronic and severe forms - therapy of concomitant diseases, antibiotics, sulfonamides, specific (staphylococcal polivaccine, autovaccine, anatoxin, antistaphylococcal plasma, antistaphylococcal gamma globulin, etc.) and nonspecific (autohemotherapy, pyrogen therapy, etc.) methods, physiotherapy, vitamins ; At a sycosis the repeated epilation is obligatory. Treatment in general phenomena it is desirable to conduct in the hospital.

Prophylaxis, prognosis. Hygienic general regime, full and regular meals, physical education and sports. Treatment of common diseases. Prevention and immediate processing of microtrauma. Compliance with personal hygiene. Isolation of children with streptococcal and vulgar impetigo, from collectives. Timely treatment of initial manifestations. The prognosis for curing in acute forms is usually favorable, with chronic, especially taking place against the background of severe general diseases, can be bad.